First Aid Journal 1951-1953

Long waits In queues are not only , Anadin' Tablets relieve headach e and exasperating, but often detrimental to reduce fever. Two tablets may be taken health. Fully exposed to the rigours at the beginning of the cold or chill and of the weather one IS an easy prey repeated every three hou rs, if required. to colds and chills. These can often be dispelled at the onset by the timely

use of ' Anadin' Tablets.

SCENT

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PRINCIPAL CONTENTS

pointed out, economic conditions prevent the construction of these r.oads and other engineering projects hkely to reduce accidents. But there is no reason why some throughroads should not be set aside for fast traffic, and, at the same time, the areas around schools and thickly populated districts prohibited to motor traffic, or a speed limit of, say, 15 m.p.h., strictly enforced in those districts.

No doubt this would cause inconvenience and even confusion at first But how much longer are we to tolerate the slaughter on the roads ? Road drill, driving good manners, education and propaganda are excellent things, but something more will have to be attempted if we are ever to get at the root of the matter.

THE FESIIVAL OF BRITAIN

Editorial

ROAD COURTESY YEAR

Death on the road remains a terrible problem. Despite the strenuous efforts of Police, Local Authorities, National Safety organisations, and many other bodies, the toll is increasing.

There is a tendency to say that road safety propaganda and education has failed, because of these rising figures of killed and injured. But is that fair? Would not the position be much worse but for the effect of this work? Rather should we conclude that now is the time to increase our efforts.

In a recent statement, Ma;orGeneral B. K. Young, the DirectorGeneral of the Royal Society for the Prevention of Accidents, is frank about this point. He refers to the ill-informed criticism of road safety propaganda and education, and goes on : "The Society has never claimed that education and propaganda alone provide the panacea for reducing road accidents. We recognise the importance of engineering and enforcement. But we m\lst be

realists. Economic circumstances prevent us getting the roads we want, and the police are under strength; education is accordingly the main existing bulwark against the rising tide. Take away that prop and the rise in accidents will get completely out of hand."

We believe that this is very true. Now is the time to increase educational measures. It is useful and va luable work, and the new measures which the Society propose for 1951, details of which are given on another page, will be welcomed by everyone who is concerned with the accident problem. But at the same time, propaganda is not sufficient, and other and more sweeping measures will have to be introduced if the accident rate is to be reduced.

For example, there is a strong case made out for the relief of road accidents by the construction of special motorways which would allow fast and through traffic its own roads, directing it away from residential areas, schools, and other danger areaS, As Major-General Young has

This is the year of the Festival of Britain, when a special effort is being made to show the British way of life to our overseas visitors. In the organisation of the South Bank Exhibition and other shows the British Red Cross Society and the Order of St. John will have an important part to play, for they are to carry out the first aid duties. This big undertaking involves the services of hundreds of members of the two organisations, both full and part-time.

We may be sure that there will be numerous other occasions throughout the country when first-aiders will be on duty to render assistance In a way, they will be as noticeable to visitors, because of their distinctive uniforms, as our famous policemen who always seem to catch the foreigner's eye. We hope they will maintain the standards of efficiency and smartness for which they have always been noted, ' and in their actions help to demonstrate an important part of British life.

Another aspect of the Festival is that the local and national celebrations will afford excellent opportunities for competitions and demonstrations. It will be a specially good year for competitions, and in the revival of interest that will be shown there will be opportunities for recruiting new members.

Local plans for the Festival are now almost complete, and our information is that the ambulance organisations are in the vanguard of many schemes. We wish them every success in their efforts ,

Notes on the New St. John Textbook

AHEARTY welcome to the 40th edition of First A£d to the Injured)· warmest congratulations to all who have taken part in its production which must have taken many hours of hard and painstaking work.

The new book contains many changes both major and minor and it is obvious that everyone in the world of first aid-doctors and nurses as well as the first-aiders themselves-will have to settle down to careful study if they wish to bring themselves up to date in St. John methods.

The first point to notice is that the general plan of the book has been somewhat altered. Urgent conditions such as shock, asphyxia, wounds and bleeding are described in the earlier chapters while fractures and dislocations do not appear until later oh.

An important change of policy is announced on the first page, where the first-aider is warned that he will meet many variations of conditions to which he must adapt himself and apply intelligent appreciation. This new principle means that he will no longer be expected to keep entirely to "the word of the book " as he did in the past, but will be permitted-and indeed expectedto alter his methods to meet the needs of each patient, so long as he has good reason for so doing. This wide clause must be remembered by the first-aider throughout his work, since it may alter what might appear to be a hard and fast general rule. For example, under bleeding from internal organs, the first-aider is advised to remove the patlent to hospital at the earliest possible moment. But if a case of bleed,ing from the lungs occurred in a patient's own home, or anywhere else where there were suitable facilities for temporary the first-aider

by A. D. Belilios

M.B., B.SC. (Lond.), D.P. H. (Eng.)

would be entitled to postpone the removal until the patient had been seen by a doctor; indeed, it would be wise for him to do so, since the doctor might prefer to keep his patient at home or to postpone removal until preliminary treatment had been given.

Other important changes in the Textbook are best described under headings as follows :-

Bandaging

Generations of first-aiders will be sorry to say to the small arm sling which has been replaced by the "collar and cuff." This has been used for many years by the medical profession, and supports the fore-arm in a raised position. It is made from a clove-hitch which is passed round the wrist, the ends of the bandage being taken round the neck and tied in the hollow above the collarbone.

With the disappearance of the small arm sling, the shoulder bandage has been changed and is now completed with a large arm sling. Two further improvements will be welcomed in this chapter. In the first olace the student is advised when practising to place a "dummydressing " on the affected part. Secondly, if a bandage or knot is likely to be uncomfortable, a pad must be placed between it and the body.

Shock

This important subject has now been given the space that it deserves. Three varieties have been described, namely, nerve, hremorrhagic and toxic shock. The symptoms and signs of each variety are fully enumerated while extra information is given in an appendix which also contains some helpful diagrams. In spite of the careful division into the three varieties, however? this

distinction is not maintained in treatment where the same general rules apply to all types. It is interesting to notice that alcohol is no longer forbidden and is included in the paragraph on stimulating the patient.

Asphyxia

This subject has been given a chapter to itself and is no longer considered with the many other ofinsensibHity. The symptoms and SIgns have been fully described and divided into the two degrees of severity called early and later stages respectively. A formidable list of causes has been classified under three headings-those affecting the respiratory tract, the respiratory mechanism and the respiratory centre respectively, these technical terms having been described in the anatomy and physiology of respiration.

Wounds and Ha>morrhage

This chapter confirms and classifies the changes previously made in the Supplement, and the whole subject has been considerably simplified. The student is now required only to learn the names and courses of those arteries which can be stopped by the use of pressure points. There are only four, and it is gratifying to note that the brachial artery pressure point has been re-introduced.

The general rules for the treatment of wounds are divided into two sets, namely these accompanied by severe and slight bleeding; the former method of giving separate general rules for arterial, venous and capillary hremorrhage has been omitted. Bleeding from varicose veins has also been left out; this is rather a pity since although the treatment does not differ from other varieties of hremorrhage, the student should be familiar

FIRST AID & NURSING, JANUARY, 1951

with the condition and the alarming severity of the bleeding.

There is very little change in the chapter on hremorrhagc from special regions except in its arrangement. The treatment of nose-bleeding remains unaltered.

Fractures

Drastic changes have been made in this chapter. For the first time, the S.J.A.A. has referred to "closed" and " open" fractures as alterna.tives to the simple and compound varieties respecti vely. These terms, popular in medical circles, emphasize to the student the essential difference between the two main varieties of fractures since the word "closed" suggests an injury to which air cannot enter.

The symptoms and signs remain as before with the addition of the valuable sign called tenderness often mentioned in these columns. The importance of comparing the injured with the uninjured side has wisely been emphasized.

So far as treatment is concerned, considerable simplification has taken place. Splinting is only recommended for a few fractures and in special circumstances, e.g. when both thighs or legs have been broken, for a fractured knee-cap and when a patient with a fractured femur has to

MEDICAL NEWS

MEASLES

RECENTLY numerous cases of measles hav e been reported in many districts. This infectious ailment is caught by meeting someone who is already suffering from the disease, usually in a stage too early to be recognised. The complaint is spread by the breath and by the little droplets of secretion and saliva which come from the nose and mouth during sneezing, coughing, etc.

The first signs are those of a bad feverish cold accompanied by a cough. There is watering and redness of the eyes while sometimes nose-bleeding, vomiting and a sore throat occur. At first, however, it is very difficult to decide that the child is sickening for the complaint but examination of the red lining inside the cheeks may disclose a number of

be carried for a long distance over rough or uneven ground.

All fractures of the upper limb (except a Colles) and also the scapula are now to be treated by one of two methods. When the elbow can be bent without difficulty or increasing pain, the fore-arm is supported in an elevated position with a collar and cuff and the limb secured to the chest with two broad bandages. Padding is placed between the fore-arm and the chest, and further support is supplied by replacing the pacient's coat and buttoning it if possible. The collar and cuff is omitted in a Colles' fracture.

For the clavicle, the well-known three-handkerchief method has been adopted, while for a broken jaw the barrel bandage is now official.

Fractures of the thigh and leg are to be treated by bandaging the injured to the sound limb after placing adequate padding between them.

Other Injuries and Conditions

The chapter on unconsciousness has been lengthened and a longer list of causes has been given. These include minor epilepsy, diabetic coma and insulin ovc dc,sag;:: :1S well as others. The simple faint has been omitted since it is now considered a symptom of neurogenic shock.

bluish white spots (Koplik's spots).

The rash of measles begins on the fourth day of the illness when dark red spots appear at the roots of the hair) on the forehead and face. This rash spreads rapidly covering the body within three days during which time the child is seriously ill, refusing all food and lying listless in bed.

Quick recovery generally occurs, but there is always a danger of complications such as bronchopneumonia and ouns media (inflammation of the middle ear).

Book Review

A GUIDE TO MEDICINE

By DR. Ivo GEIKIE-COBB

George Harrap & Co., Ltd. 15 /-

IN his preface to this new book Dr. Geikie-Cobb explains that it is

Former students will be glad to learn that the subject of poisoning has been considerably shortened and simplified, while there are only a few changes in the chapter on miscellaneous injuries.

General Comment

As has been stated, the new edition contains many changes, too numerous to describe completely in this article. The student must be on his guard not to accept any part of the former edition as unchanged since alterations are to be found in unexpected places. Thus, although the treatment of broken ribs (uncomplicated) at first sight appears to be unchanged, there is now the valuable advice of instructing the patient to breathe out before the broad bandages round the chest are tied.

So far as the general style of the book is concerned, it is impossible to refrain from comment. There is no doubt that the new edition has been well edited. The wording is concise and accurate, but many may find it difficult to read unless they have had a previous introduction to a medical subject. Unfortunately, medical terms and expressions have been employed without a previous explanation of their meaning, and there is also a tendency to use words not usually in the vocabulary of the " average man."

neither a textbook nor an encyc1opredia of medicine. As its name indicates it is a guide for those who wish to know the meaning of medical words; it is selective and not inclusive, nevertheless, most of the terms in general use in medicine have been defined and the more important diseases and disorders described.

The work is designed for quick, handy reference, the arrangement is alphabetical in dictionary form, although there are special articles on the more important sub-divisions of Medicine. The form is rather like " Fowler's Modern English Usage," that is, a reference book arranged alphabetically, but with a number of concise articles covering the more important aspects.

This is obviously a most useful reference book; to first-aiders it can be warmly recommended for instruction and training.

TOPItJAL NOTES for First Aiders

and Nurses

Medical Advances in 1950

According to recent reports, no spectacular new drug was produced dming 1950, although much more was learned about some of the important drugs developed during the preceding years. Cortisone, or the substance that stimulates its production, known as A.C.T.H. eadreno-cortico- tropic- hormone), IS still practically unobtainable and will continue to be so until it can be completely synthesized. With the present method of production, forty head of oxen are required to furnish the daily dose for one patient with rheumatoid arthritis, and the world does not possess enough cattle to allow of the drug being used for all patients who might benefit from it. But with some of the best biochemical experts of many countries working on the problem there appears to be some hope that in the distant future more ade'quate supplies will be forthcoming. Even when the drug does become available it may have to be used, for a long time, for research work only, for although it has produced the most amazing improvements in patients crippled with arthritis, at the conclusion of their course of treatment many of them suffered severe relapses and also developed other distressing symptoms. As with other potent drugs, however, it is confidently expected that the unpleasant side-effects can be eliminated as the result of further research. Other advances in drug therapy associated with 1950 are concerned with improvements in the treatment of diseases of the blood and of the heart. The two most striking advances in surgery are stated to the operations performed on the heart and the insertion of plastic cups over the head of the femur in conditions of osteo-arthritis of the hip joint; which has had excellent results in this most painful and crippling disease.

Physiotherapy in the Home

An interesting dIScussion recently took place in Parliament regarding the extent to which domiciliary physiotherapy services were desirable for sufferers from advanced cardiac diseases, old age and advancing infirmity, for whom such treatment was prescribed but who could not go to hospitals or clinics. Many district nursing associations had been operating a mobile service of this kind, most of them under some form of contract with the Regional Boards, and these Boards had received instructions from the Ministry of Health which they interpreted as a direction to terminate these contracts.

Mr. Blenkinsop, ,Parliamentary Secretary to the Ministry of Health, pointed out that in the home was a very poor second best to that given in a hospital or clinic specially fitted out with all the apparatus required for physiotherapy, and that only the exceptional case needed treatment at home, and then on a temporary rather than on a permanent basis. Under contracts made with district nursing associations he felt that patients ffilght continue. to be treated at home when they had arrived at a stage when they could go to hospital for treatment, whereas if the domicilary treatment was arranged through the hospital itself it could be carried out only for so long as it was impossible for the patient to be taken to the hospital. He hoped that there would be no loss of treatment for those who must have it in their own homes. A point raised by his questioners was that many district nurses were also qualified physiotherapists and this country lacked sufficient numbers to carry out all the treatments that were prescribed for patients. Thus a heavier burden would be placed upon physiotherapists working in hospitals and clinics if they had also to visit patients in their own homes.

Smoke Abatement

Three million tons of smoke and grit and five million tons of sulphur gases pour out from the chimneys of houses and factories in this country every year, and we are all so accustomed to their effects that we cease to notice them. It is rather surprising, therefore, to learn that, as long ago as.: 1306, complaints about London's pall of smoke, which resulted from the change-over from wood to coal for fires in dwelling places, led to King Edward I appointing a Commission to stop it. He died in the following year and was succeeded by the shiftless Edward II, and the Commission was unsuccessful, as were many other efforts during succeeding centuries. Eventually, in 1929, a National Smoke Abatement Society was formed by a small group of people in Buxton. This Society has grown, and ,now has its headquarters at Chandos House, Buckingham Gate, London, S.W.l, with members in every part of the country. It publishes a quarterly magazine called " Smokeless Air." With the present public concern regarding fuel economy it is rather disconcerting to realise that millions of tons of coal are wasted annually in producing the smoke that spoils amenities and beauty in our towns, damages stonework, metals and fabrics, harms crops and plant life of all kinds, makes flying more difficult and costly, and injures health by its devitalising effects upon our lungs and by limiting the amount of sunlight that can reach the earth. Diverting labour to the task of cleaning up its filthy deposits, making good the damage it does and providing the extra artificial lighting that becomes necessary costs the nations scores of millions of pounds annually, which we all pay either in rates and taxes or in the price of goods that we buy.

The Story of " Lumena " No doubt many readers saw " Lumena," the " transparent woman," at the Food Fair at Olympia last autumn or at other exhibitions, and they may be interested in her history, which appears to reach as far back as 1911, when Dr. Georg Seiring, of Dresden, made anatomical health exhibits which were shown in all parts of the

FIRST AID & NURSING, JANUARY, 1951

world. In 1925, the first life-size transparent model of a human being -this time a man-was shown at the Hygiene Exhibition in Vienna. A good deal of wax was used in this model, which gave it undeniable drawbacks. Later experiments by Dr. Seiring and his colleagues, at the German Museum of Hygiene at Dresden, produced a semi-plastic material that was unaffected by heat or cold and was almost unbreakable the second world war interrupted thIS work. When Russian troops entered the Eastern Zone of Germany, Dr. Seiring and his team of sculptors, artists and technicians were invited to work in Moscow, but they. and went to Cologne to lllVeStlgate the possibility of transferring the museum and all its work to that city. Meanwhile, the Dresden offices and laboratories were ransacked, but many of Dr. Seiring's workers and their families escaped to C?logne, plans and equipment WIth them In what looked like innocent shopping parcels. A former Luftwaffe building in Cologne was reorganised as the Health Museum and it was here that was finally made. A young German woman was the model for a statue made by Max Paulus, a well-known German sculptor ; plaster casts were made from the statue and the transparent parts were modelled from the plaster casts. "Lumena" has been used in this counLry by many lecturers in order to describe the shape and position of the various parts of the human body and how ItS lllternal organs carry out their functions.

New Houses

A White Paper issued on 29th December states that the number of permanent houses completed In Britain during November was 17,453, compared with 17,603 in October. This brings the total of permanent houses completed during the first eleven months of 1950 to 182,221. Of the homes provided during November, 14,755 were completed by local authorities and 1,994 by private builders. The White Paper does not state how the remaining 704 came into being.

TO avoid pain something is often used to put the patient to sleepchloroform, ether or other newer drugs. A modern dentist" freezes" your jaw so that dental work may be painless. In fact one well-known very . successful and wealthy CanadIan-born dentist, called Parker, legally changed his first name to " PAINLESS," doubtless due to the value of doing painless dentIstry. He has many offices now and tens of thousands of patients. Some people fear anresthetics, but all the same they use sleeping tablets which may be more dangerous than any anresthetic in skilled hands. The most common anresthetic is breathed in and puts the brain to sleep. It can be very easily controlled by the person who has observed the various stages and recognizes the whole series of effects.

anresthetics are given by the medIcalyrofession by injection or by swallowlllg. Then again there are nerve-blocking systems, something after the style of what happens when your leg goes to sleep when you sit on the edge of 2 chair or hard seat. The most powerful example of this

BLOOD

BLOOD is needed in surgical cases, accidents, and also in certain cases of childbirth, anremia, and other illnesses. Blood is made up of plasma, red blood corpuscles, white blood corpuscles and platelets.

Plasma, which is the liquid part, constitutes 55 per cent. of whole blood. It is comprised of 92 per cent. water, 7 per cent. proteins, while the rest is mainly fats, mineral salts, carbohydrates, hormones, vitamins and enzymes.

The red corpuscles are produced in the red bone marrow, and are coloured with an iron compound called hremoglobin. They last for three months in the circutation, being continually replaced by new ones.

White corpuscles are active in body protection, such as against infection. Platelets start the process of blood coagulation.

Before a blood transfusion, the

is the sI?inal block or spinal anresthetic or anresthesia. It works well on the lo:w- er half of the body but is very tncky to apply.

There are some skin anresthetics An example is in the wad of deadene; the dentist sometimes puts on a gum to ease the entry of the needle.

Those in authority are usually very much bound by tradition and so tbe alleviation of pain by ether was P?stponed for fifty years after dIscovery. The pains had to continue until .1846 when the first public operatlOn took place. Even then there was no rush to use the new anresthetic The substance was available to kill pain but the organisation and mental attitude were absent. In our B. C. outlying camps, mines and are in just an eqUlvalent sItuatlOn in that although both anresthetics and blood plasma are available in the world yet they cannot be used freely in these outlying points because we just haven't reached that stage in our mental attitude and organisation. Given another decade or so then we'll be :w-ondering why we were so mentally mept .

SUPPLY

blood of patient and donor is matched to ensure that they are compatible. There are four main groups : 0, A, B, and AB. Group 0 is found in 46 per cent. of people; A in 40 per cent.; B in 10 per cent.; AB in 4 per cent. The Rh factor, a further subdivision, is Positive in 85 per cent. of people, and Negative in 15 per cent. The Blood Groups are characteristics inherited from one's parents.

It takes about 1,500 pints of blood daily to keep the hospitals of Canada supplied. All blood is obtained from healthy human beings. A person may donate not more than three times a year to the Red Cross NatlOnaI Blood Transfusion Service, which supplies the hospitals of British Columbia with all their requirements.

[ Thes e two ar t i cles a r e tak ell j r olJl " Fi rst Aid Attendant British ColumbiaOctober, 1950,

Preparation for Nursing Trainmg

By AGNES E. PAVEY, S.R.N., Diploma in Nursing (University of London)

(continued from the December, 1950, issue)

Eligibility fOl' Nursery Nurse Training

SEEING

that the qualifying examination for nursery nurses cannot be taken before the age of eighteen, and that two years' training is essential, it follows age for commencing training IS sIxteen or over. However, some nursenes accept girls from on the understanding that the t1:ne spent in the nursery before attammg the age of sixteen does not count as training. No girl under the age of sixteen may be employed for more than 44 hours a week, and this time includes the equivalent of one full working day spent in tion of general educatIon, eIther m the schoolroom associated with the nursery, or at a local school or 'polytechnic. Over sixteen, the maXImum hours of work and tuition are 48 per week.

Any girl who desires to ta.ke nursery nurse training must realIse that, although the work most interesting, it demands a kind and sympathetic understandmg of young children, intelligence and a good deal of both physical and mental effort. Good health is an essential qualification if she is to meet the demands made upon her and continue to be cheerful and happy in her work. She must, therefore, be medically examined by the nursery doctor before being accepted for training, and it is advisable that she should undergo a trial period of one. to three months before she enters mto any agreement with regard to the two-years' training.

Conditions During Training

All nurseries that are approved as training centres are inspected by an officer of the National Nursery Examination Board and they must conform to the conditions laid down by that Board, but the details of the training schemes under the various local authorities and voluntary societies differ somewhat.

All nursery students under the age of eighteen are required to undergo further education in general an.d vocational subjects throughout trammg. This may necessnate spending one day each week at a polytechnic The educational course IS arranged by consultation between the personnel of the nursery training centre aJ?-d that of the polytechnic. It may mclude English, arithmetic and el.ementary science only, or the emphasIs may be more upon literatl;lre, drama and music and dISCUSSIOn groups on various subjects. Where no suitable polytechnic or school is within easy travelling distance from the nursery training centre, the students. may spend six to eight weeks m a residential school each year, or they may enter the school for a complete term during the second year. Here, again, the residential training draws up the scheme and subffiltS It to the Board of Education for approval. are undergoing theIr course m Nursery Training Colleges, where the age for commencing training is 17 t or over, are not to undergo further general educatIOn, for the College usually requires that the student should have matriculated or have obtained the schools certificate.

Except in Nursery Training Colleges, the student usually receives free board, lodging, uniform and laundry, and pocket money of 15 fa week during the first year and £1 a week during the second year.

Three to four weeks' holiday is given annually, and this includes Bank holidays. A student is allowed to transfer once during her training, from one approved course to another, and to have one break, excluding holidays, of not more than three months in circumstances that are beyond her control.

The Syllabus to be Covered

The syllabus is very extensive. Every aspect of the development and

care of the healthy child is considered and so also is the care of and their equipment, of gardens, sand-pits and The student is taught, by SImple observation, precept and practical experience, what children are like through all the stages from babyhood to the age of five, and, in some residential homes, right up to the age of adolescence. Infant suitable menus for toddlers, cooking, the care of the milk-room, the larder and the storerooms receive adequate attention. The development of good hygienic habits and self-respect. in the child, the malting and mendmg of children's clothes, handwork and toy-making, and allowing the children to share in all tasks thn are within their capacity are all valuable experiences for the nursery student as well as for her small charges. She learns, by day to day observati?n, how children live, how they think and feel, how they grow in body and mind and become aware of the people and the world around them. The strength of children's feeliI?-gs and their difficulties in controlling them the underlying reasons for and other forms of " bad behaviour," of fears and nightmares, are explained to the nursery student, and she is shown how to help the children through these trying experiences so that they move, eventually, towards the good social behaviour that is shown by happy, wellintegrated pen,onalities. All this to do with the normal healthy chIld, but the student also learns the management of minor ailments of the ailing child, the common mfections of childhood and their means of spreading, the methods immunisation and the uses of publIc health and school medical services. In the field of child education and training, all the 0pportunities tha.t occur during the child's everyday lIfe are explored and are utilised as teaching material, and so also are all play The students are living and helpmg

FIRST AID & NURSING, JANUARY, with the children; but they are under the guidance of the trained superintendent of the nursery, and the tutors at the course centre, so that they are constantly helped by expert advice and explanation, and by discussions and ditions in the nursery Itself, With ItS playrooms, its and its wellpfanned days, all under the charge of a knowledgable. and understanding adult, help the physical, mental at;td character development of the gIrl who is undergoing training as well as of the children themselves, and, in addition to the acquisition of general knowledge by the continuance of education, it must engender efficiency and poise. The value of nursery nurse training as a background for home life IS self-evident, for it enables a girl to become a much more successful housewife and mother than she could possibly be without such training.

Future Openings for the Nursery Nurse Mter receiving her qualification the Nursery Nurse has a wide field from which to choose the kind of work she prefers, for there will always be much interesting and varied work available, both in the public and the private sphere. She may like to continue in a day. or residential nursery, where salanes, in addition to residential emoluments, usually start at £120 to £130 a year and increase according to experience and qualifications. If wishes .to do adminis [rative work m nursenes she will be required to take further training before being appointed to a senior post. Alternatively, she may take further training in Child Care or as a Nursery School Teacher.

If she feels that she would rather have the care of individual children she may become a "nannie". in a private family, and her certlfi.cate and experience will be speCIally valued.

As a preliminary to nursing training, either for the Gene!al Register or for the Regis.ter of SICK Children's Nurses, she will find that her training and experience with normal healthy children will be an inestimable help to her.

Whatever her subsequent sphere of activity she should never cease to value the ordered, disciplined routine of her training centre during two of the most formative years of her life.

News Reports

1951 Road Courtesy Year

The Royal Society for 1 the Prevention of Accidents has launched a new drive for road safety in 1951, with the object of reducing the mounting toll of killed and injured on on the roads. The Society's seventeen Accident Prevention Federations, to which are linked the thousands of Road Safety Committees of Great Britain, have pledged their full support of the campaign.

Since the Ministry of Transport decided not to sponsor a National Safety Week in 1951, requests from all over the country have been received for the Society to do so. It will accordingly make the highlight of the ye ar's persistent campaigning a National Road Courtesy Week from 2nd June to 9th June.

Throughout the year the Road Safety Committees will again have the support of their powerful allies the teachers and police. The symbol of the campaign is the familiar red safety triangle encompassed by a double circle containing the slogan of the year: "Courtesy on the Road saves lives."

The Society's new DirectorGeneral (Major-General B. K. Young), said recently that. because road accidents had risen m 1950 there was an increasing tendency to say that Road education had faIled. The cntlcs are ill-informed," he declared.

" There is no widespread spirit of defeatism among the mass of road safety workers. We believe that our efforts are worth while ; that we are rendering an important social se:vice and that it is having an appreCIable effect. Road safety propaganda must not be reduced, it must be redoubled.

"The 1951 theme of Road Courtesy is based quite simply on the Golden Rule Do unto others as you would have them do unto you.' We seek to make every man, and woman in this country aware of the fact that nine out of every ten accidents are avoidable because, under existing road conditions, they are primarily due to the road-users' own fault and disregard of the

Highway Code Co-operation on the roads leads to safety. A good example leads others to follow. It is just old fashioned courtesy and , Courtesy is infectious.'

"The Society has never claimed that education and propaganda alone provide the panacea for reducing road accidents. We recognise the importance of engineering and enforcement. But we must be realists. Economic circumstances prevent us getting the roads we want, and the Police are under strength, Education is accordingly the main existing bulwark against the rising tide. Take away that prop and the rise in accidents will get completely out of hand."

The Society's aims during the campaign are :-

(a) To persuade all road users to exercise care, consideration and courtesy on the roads at all times.

(b) To induce all road users to acknowledge acts of courtesy by others.

(c) To work for law enforcement and engineering improvements.

(d) To encourage the widespread adoption of the mo bile patrol (or Courtesy Cop) scheme.

In order that the safety movement shall speak with a united voice, Society has prepared an outline programm e for the year's campaign. It is divided into four quarters, as follows :-

January to March, 1951-the present focus on " Children's Safety" to be continued. April to June, drivers and motor cyclists. July to September, 1951-pedal cyclis ts Octob er to December, 1951pedestrians and passengers.

The Society encourages practical schemes for raising the standard of courtesy of all road users. It its permanent exhibition and tramlllg centre at RoSPA House, Hyde Park Corner.

BRITISH RED CROSS SOCIEIT Festival of Britain

The British Red Cross Society, in conjunction with the Order of St. John is to carry out first aid duties in all sections of the Festival of Britain Exhibition. This includes duty on the South Bank site, the Funfair in Battersea Park, a South Kensington Museum, and in the ship H.M.S. Campania. This big undertaking involves the services of hundreds of members of the two organisations, both full and part-time.

The News Chronicle has offered part of its premises not far from the South Bank site to be a Pavilion of Youth; its aim-to depict the part Youth plays in the British way of life. Here the Youth of Britain will be "at home" to the world. The Standing Conference of National Voluntary Youth Organisations, of which the British Red Cross Society is a member society, is responsible for the arrangements in the Pavilion. There is to be an information room, stocked with literature about the various S.C.N.V.Y. organisations represented and each is to give a small exhibition of its own work. In addition there will be a small theatre where organisations may put on " Shows " of various kinds. On the roof there will be a tea garden where out-door demonstrations will take place

Korea

The United Nations Organisation has appealed to the League of Red Cross Societies for eight teams to carry out relief work in Korea-each team to consist of a doctor, a sanitary engineer, and a welfare officer. On receipt of a cable to this effect from the League, the British Red Cross Society immediately agreed to provide one of these teams which is now being assembled.

The St. John and British Red Cross Society's Hospital Library Department has extended its service to British Servicemen wounded in Korea. The Department has already sent out over 2,000 books and Penguins as well as magazines of every type to a Service Hospital in Kure, Japan, where a Welfare Officer who is already there will maintain a Hospital Library Service. Two automatic page-turners will be flown out to Singapore very shortly for the use of Service patients who are unable

to use their hands, and it is also intended to provide small travelling libraries which will be put on to each of the planes evacuating British wounded from Singapore. These will contain approximately fifty books, Penguins and magazines of all types and to suit all tastes, including crossword puzzles and quizes. The books will be contained in specially constructed cases made to measurements which will enable them to be fitted between the stretchers in the planes.

ST. JOHN AMBULANCE BRIGADE

No. 85 (Ealing) Ambulance Division

A gathering of over 300 people witnessed the Finals of the Fifth Ealing Open First Aid Competition, organised by the Ealing Ambulance Division, and held at the Ealing County Grammar School, Ealing Green, on Saturday, 2nd December.

Brigadier A. Sachs, Director of Pathology, War Office, accompanied by his wife who is a Serving Sister of the Order, presented the trophies. In his remarks, Brigadier Sachs paid tribute to the very high standard of first aid shown by all competitors, and also complimented the organising committee, particularly Sgt. Derek R. Fenton (Competition Secretary) on the hard work they had done over the preceding seven months, and ill preparing an extreme!y efficient and well-organised competition.

Ambulance Officer G. L. Smith, Officer in Charge of the Ealing Ambulance Division, who introduced Brigadier Sachs, thanked all present for their support. He also expressed appreciation to the judges, stewards, timekeepers, patients and many others who had contributed in making this year's competition the most successful held in Ealing. The total entry was 36 teams and 81 individuals, representing 25 Divisions and Association Classes drawn from all parts of London, Home Counties, and one entry from Cambridge. Grateful thanks were also due to Mr. J. Gow (Pinewood Studios) for his untiring efforts in staging so realistically all the team tests.

Lt.-Col. E. J. Selby (County Surgeon, Western Area) thanked Brigadier Sachs for attending, and also thanked the members of the public who were able to see Brigade and Association members at work.

FIRST AID & NURSING, JANUARY, 1951

Councillor F. Tann, on behalf of the public, expressed deep admiration of the St. John Ambulance Brigade, and the work they are doing. "Whenever, wherever the services of the Brigade are required," he said, " they always answer the calL" The results were as follows :-

EALING CHALLENGE CUP (Brigade Teamsfrom Borough of Baling only).

Judge: Major H. Stewart (County Surgeon, District H.Q. Staff). Marks

l. Hanwell Division 142

2. Ealing Division . , . 130

3. Greenford Division 113

BARCLAy-SMITH CUP (Advanced Teams, Women). Judge: Dr. G. M. Shaw-Smith (County Surgeon, Northern Area).

l. Acton Division , 153

2. Southgate Cadet Division 133

3. Ealing Division .,. 132

4. Clapham Common Division 118

WILLOUGHBY - GARNER CUP (Advanced Teams, Men). Judge: Lt.-Col. E. J. Selby (County Surgeon, Western Area).

1. F. Division, Metropolitan Police (Hammersmith) .. , 177

2. B.O A.C. Security (Brentford) 169

3. No. 146 (L.M.R. Camden) Division, S.J.A.B. 168

4. London Transport Executive (Chiswick) 146i

5. British Transport Commission Police (Cambridge) 119

N. J. CALDWELL CUP (Beginners Teams, Men). Finals held 14th October, 1950. Judge: Dr. C. A. Osborn (Divisional Surgeon, Greenford).

1. Molesey Ambulance Division 71

2. F. Division, Metropolitan Police, Greenford Division, S.J.A.B. 56

4. Ealing Division 45

5. L.M.R. Camden Division 42

6. Hanwell Division 40 FLORENCE CUP (Beginners Teams, Women). Finals held 28th October, 1950. Judge: Dr. C. A. Osborn (Divisional Surgeon, Greenford).

l. Clapham Common DivislOn

2. Twickenham Division

3. Willesden Division

4. Southgate Cadet Division

5. Ealing Division and Richmond Division

FIRST AID & NURSING, JANUARY, 1951

HILL CUP (Individual, Beginners, Women). Judge: Dr. Clara M. Warren (Divisional Surgeon, Richmond).

1. C. J. Thomas (Post Office, Savings Bank Division) 30

2. E. M. Clark (Kensington) 23t

3. D. Wregg (Clapham Common) 21

4. O. W. Pearson (Willesden) 20

5. G. Bailey (Southgate) and 1. B. Roger (Twickenham) 19

BARNARD CUP (Individual, Advanced, Women). Judge: Major G. E. R Payne (County Surgeon, Western Area).

l. M. Thomas (Clapham Common) 53!

2. G. E. Phillips (Acton) ... 51

3. A. E. Beeson (Acton) 45

4. E. M. Thomas (Acton)... 44

5. B. Bowkett (Southgate) 41

6. J. Hodge (Southgate) 38

WRANGHAM CUP (Individual, Beginners, Men). Judge: Dr. Michael Rowan (Divisional Surgeon, Kensington).

l. T. Pocock (Greenford) 56

2. C. Bugden (RO.A.C.) 51

3. E. Stegner CHanwell) 48

'

4. H. Ilott (L.M.R. Camden) 46

5. L. E. McSweeney (Willesden) 43

6. D. J. Brooks (Hanwell) 37

7. R. McEntee (Greenford) 35

BROOKS CUP (Individual, Advanced, Men). Judge: Lt.-Col. E. J. Selby (County Surgeon, Western Area).

l. G. Kirkham (L.M.R. Camden) 76

2. R. Greig (F. Division, Metropolitan Police) 74 t

3. J. Barnes (L. T.E.) 73

4. E. Bugden (RO.A.C.) 66t

5. V. Wrighton (F. Division, Metropolitan Police) 61

6. A. W. H. Darke (Southall) 56t

7. G. Astle (RO.A.C.) 49

8. J. Worthy (Post Office) .,. 48

9. W. Jennings (Ealing) . . . 46

Guildford

C?fficer C. E. Chaplin. The mspect!ou of books and records was carried out by Asst. Commissioner J. P. Flavin.

After the Inspection a presentation of two Long Service Medals was on behalf of the County ComrrussIOner by Asst. Commissioner J. P. Flavin to Divisional Supt. A. J. Stockwell and Pte. N. Appleby, the parade being dismissed by the Inspecting Officer.

Before the Inspecting Officers VIsIted the garage to inspect the ambulances.

POLICE

Palmer Trophy

The "Palmer" Trophy first aid competiti.on was held recently in York, WIth the following result:

1, North Riding (Headquarters and Road Traffic Division), 270 (maximum 400); 2, (dead heat), British Transport (D arlington Division) and Durham County "B," 265t; 4, Durham County "A," 260' 5 British Transport (Newcastle sion), 259t; 6, Tynemouth, 259 ; 7, Sunderlal1:d, 256t; 8, Newcastle, 255; 9, Gnmsby, 252; 10, South 244t 11, (dead heat), Hull and East Riding, 240; 13, Middlesbrough, 231; 14, North Riding (Northallerton Division), 228t; 15, York City, 215t; 16, Northumberland County, 215.

BRIIISH RAILWAYS

London Midlan.d Region

Saltley Motive Power and Traffic Ambulance Class held a social evening at the Fox & Goose Hotel recently with Mr. Seal, Yard Master, Saltley, presiding. The Concert programme arranged by Norman Seabridge, was much enjoyed by the large gathering.

9

successful classes, but teams from the Saltley Class have always held a high place in Railway and Bngade Competitions.

He numerous awards for mentonous first aid rendered and holds Railway Long Service Gold and Bars, and Brigade Long and Bars for over 40 years serVIce. He is an Officer :Srother of the Order of St. John, and It was of his modesty tha.t he paId a generous tribute to the aSSIstance he had received during his years of Class Secretary, and congratulated his successor, Mr. Tyson, on excellent arrangements made for his presentation, and wished him and the Class every success in the future.

Western Region presentation of meritorious first aId awards granted for the years 1948, 1949 and the early part of 1950 was held in the Boardroom, ton? wher: Mr. K. W. C. Grand, ChIef RegIOnal Officer, presided, and made the presentation s. Mr. W. P. Allen, C.B.E. (Member of the Railway Executive), Mr. H. Adams Clarke (Chief Officer for Staff and Establishment, Railway Executive) were present, and the Western Region were represented by Mr. H. G. Bowles (Assistant Chief Regional Officer), Mr. G. Matthews, C.V.O., C.B.E. (Operating Superintendent), Mr. C. Furber (Commercial Superintendent), Dr. C. T. Newnham (Regional Medical Officer), Mr. Y/. N. Pellow (Mo tive Power Supermtendent), Mr. S. G. Ward (Assistant Regio,nal Staff Officer), Mr. A. Lane (Chief of Police, SouthWestern Area), and Mr. P. Anstey (Regional Ambulance Secretary).

87 82 79 78 50

The Annual Inspection of the Ambulance Divisions of the Borough of Guildford Corps took place at the Ambulance Headquarters, Woodbridge Road, on Tuesday, 12th December, 1950.

The Inspection was carried out by Asst. Commissioner Capt. P. Ellis who was accompanied by County

Opportunity was taken by Mr. Garfield, District Operating Manager, of presenting to Mr. J. J. Bolton, a wallet of Treasury notes and a pair of cut glass vases to Mrs. Bolton, to mark their association over the past 22 years with the Ambulance Movement at Saltley.

" Joe," as he is affectionately called by his railway colleagues, was responsible for the organisation of the Class, and his enthusiasm for the work of the Order of St. John was such that he stimulated not only

Mr. Grand stated that Western Region staff had gained twelve Class 1. awards (clock and certificate) and eIghteen Class 2 awards (certificate) and it was with great pleasure he made the presentations, because they were really for something that had been done, something that was quite exceptional which had to be done in the ordinary run of events.

In the course of his speech Mr. Allen said the first aid movement was an it was not a duty, It a It was people giving theIr serVIce freely and voluntarily in order to assist their fellow men in time of need.

Queries and Answers to Correspondents

The Textbook to 'which reference may be made in this column is the 40th (1950) Edition of the S.J.A.A Manual of First Aid to the Injured.

C01'respondents are requested to write on one side of the paper only.

Fractures of Both CJavicles

E. W. (Edgware).-With reference to th e new method of tr eatment for fractures of the collar bon es (on pages 133- 135 of Revis ed Textbook), we are instructed to pass narrow bandages with th eir centres in front of the shoulders to tie off at the back, and then to pass a third bandage through the two rings and tie off over a flat pad betw een th e shoulders, thus bracing the shoulders backwards.

Owing to the difficulty a first-aider may have in diagnosing th e ex act point of the fracture (such as close to the shoulder) may I respectfully ask if there would be any dange r to t he fracture from pressure applied by the shoulder rings pressing on the injured part? As an alternative, I would like to suggest that a nar row bandage be tied around both upper thirds of the humerus with a long end and a short end. The long ends are then to be tied to each other across th e flat pad as before, thus removing any danger of pressure from the fractures. We thank you in anticipation, and eagerly await your reply.

Thank you for suggestion, but trial proves that the method advocated in the Revised Textbook gives the best result Personally, I fail to see how the method suggested by you improves in any way the method of the Textbook.-N. Corbet Fletcher.

Examination Howler

D. H. (Edgware).-In a recent examination the doctor asked one candidate what were the possible dangers to men working in gas-works. Much amusement was caused to examiner and members of the class when the candidate r eplied-" The pressing dange r is gastritis ! "

Good! Next please! !-N.C.F.

Fractures of Both Thighs and Legs

E. W. (Edgware).-With reference to the treatment of fractur es of both thighs and legs, we are told to apply a well-padded splint from crutch to feet. May r ask if this instruction applies to male patients only or to all cases irrespective of sex ? I hope that I am not premature with my questions on the instructions of the Revised Textbook.

This instruction applies to patients of both sexes. Do not ·,vorry about questions on the Revised Textbook which all of us must study closely.-N.C.F.

Classification of Fractures

J. M. (Montreal, Canada).-On page 62 of the Textbook, fractures are classified in two ways-(A) according to the condition of the tissues and (B) according to the injury to the bone itself.

1 can see why compound and complicated fractures are in Class A, but would you not think that comminuted fractures should be in Class A instead of simple fractures because there must be quite a lot more damage to surrounding tissue than with simplefractures? Indeed, you would think that simple fractures would go along with impacted and greenstick fractures in Class B. While you have always given satisfactory replies to other queries, 1 would like your kind and expert advice on this one.

The need for a clearer definition of fractures has long been felt and presumably this is the opinion of the Revision Committee. In the Revised Textbook the division into Groups A and B no longer appears, and fractures are now classified as (i) simple or closed (the latter being those fractures in which there is no wound leading down to the fracture); (ii) compound or open (the latter being those fractures in which there is a wound leading down to the fracture); and (iii) complicated with which there is some injury associated with the important internal structure of the bone. The Textbook then points out that there are other varieties of fractures which cannot normally be diagnosed by first-aiders such as comminuted, impacted, greenstick and depressed.N.C.F.

Venous Circulation

S P (Wingate). - Would you please tell me if there are any valves in the jugular v eins, and if the blood goes straight through to the lungs to be purified. I always thought that ther e were valves. A fellow student, howe ver, said that if the jugular veins were cut we should get bleeding from both sides of the wound. Yet in bleeding from a wound of a vein we are told that the blood flows in a continuous stream from the side of wound further from th e heart. I thank you for your kindness in answ ering my queries and assure you tha.t it will always be appreciated by me. In the veins of the limbs valves are necessary because the venous blood has to travel in an upward direction and there is always the possibility of backward flow. This possibility does not exist when the blood is flowing from the head because blood is flowing downwards towards the heart. Hence the need for valves does not arise. The jugular veins join with other veins to form the superior vena cava:, and this vessel carries the blood to the right side of the heart. It is from the heart that the blood reaches the lungs for purification as is shown in the coloured diagram on page 101 of the Revised Textbook.N.C.F.

Pressure Points

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Bailliere*J s

ELEMENTARY ANATOMY & PHYSIOLOGY

By D. M.B., D.P.H., Lecturer in First Aid to the L.C.C.; Examiner,

-

S. P. (Wingate).-In .your "Catechism of First Aid" there is a question which asks how many pressure points there are in the upper limb. Being asked this question, I, as the insi'ructor, replied-sub clavia, axillary, brachial, radial and palmar. A member of the class kept saying that I was wrong in omitting brachial flexion, which I do not regard as a pressure point. So please tell me whether I was right or wrong.

According to present-day teaching bQth of you are incorrect because if you refer to the Supplement to the Textbook you will find that there are only three pressure points in the whole body-namely Carolid, Sub clavia and Femoral. In the Revised Textbook one additional pressure point is given which consists of digited pressure on the upper end of the brachial artery in the armpit.N.C.F.

Trichlorethylene

R. W. (Enfield).-I have just read the query raised by T. O. (Northfleet) regarding Trichlorethylene in the October/ November issue of FIRST AID and I feel that I may be able to help your correspondent. I am the manager of a company using large quantities of this solvent; and

I have proved that the best treatment for Trichlorethylene in the eyes is that which is suggested by Imperial Chemical Industries Limited, namely ;-

The eye should be irrigated continuously for twenty minutes, preferably with the following lotion;

2 per cent. saline (sodium chloride), 2 per cent. boric acid, in sterile water. The lotion to be filtered.

After irrigation, the eye should be treated with a drop of cod-liver oil.

If the eyeball is painful or red and inflamed, a pad and bandage should be applied and medical advice sought.

It is also interesting and useful to know that Trichlorethylene swallowed should be treated as an irritant poison and an emet£c given.

Your interesting and instructive letter is much appreciated.-N.C.F.

Letter to the Editor

A TRIBUTE TO "N.e.F."

DEAR SIR,

Kindly find enclosed P.O. valued 5 /- for my annual subscription for FIRST AID AND NURSING for 1951.

I am very sorry to hear that our very valued and kind friend Dr. N. Corbet Fletcher, O.B.E. has decided to retire as Surgeon-in-Chief of the St. John Ambulance Brigade. It will not seem the same reading, as we have for a good many years, his answers to our problems to find that the answers have ceased. It is hoped that the probability is correct that we are not altogether losing his valuable services. We shall never forget him. I have been a member of the St. John Ambulance Brigade for 48 years and am still taking an active part in its work, and I look each month for the Query Column, and the answers which he gives, and so certain am I of the correctness of his replies that I take the Journal to my Division and read out to those present the queries and Dr. Fletcher's replies.

J. c. CHESTERMAN, Div. Supt. CR.) O.St.J., M.S.M. Oxford, 27th December, 1950.

Although Dr. Fletcher has relinquished the post of Surgeonin-Chief of the St. John Ambulance Brigade, he will continue to answer readers' queries in this Journal in the capacity of of Hon. Medical Adviser.-EDITOR.

HOUSEHOLD PHYSICIAN

Describes in simple language, with helpful colou red plates and diagrams

The COMPLAINTS OF MEN, WOMEN AND CHILDREN

Their Cause, Treatment and Cure

A few of the Subjects treated:

How to Keep Well, First Aid

What to Do in Emergencies

Influenza, Colds, etc.

Measles, Mumps, Corns and Warts

Physical Culture, Self Defence

Treatment for all Skin Diseases

FIRST AID:-

General Rules

Examination

Fractures

Dislocations

Sprains

Wounds

H:£morrhage

Types of Bandages

Splints

Shock

Artificial Respi ration

lifting

Transporting, etc., etc.

The Lungs. Pleurisy

Hygiene, Anatomy. Pharmacy

Fevers, Bladder, Kidneys

Pregnancy, Childbirth

Home Remedies, Diet

PrinCiples of Nursing

Eye. Ear. Nose Throat, Liver

Chest. the Heart Stomach, Duodenum

Teeth. the Muscles

Child Welfare

Homceopathy, Arthritis

Neurasthenia

Rheumatism, Poisoning

Patent Medicines

PRESCRIPTIONS

375 proved remedies

MOTHER AND CHILD teach ing pictu res

BEAUTY TREATMENT

how to bring out your best points

SELF DEFENCE

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HOME STUDY alone can now qualify you to enter this profession. A unique system of correspondence lessons has been perfected that makes study simple, fascinating, always interesting. May we send you our free booklet, called U PHYSIOTHERAPY AS A PROFESSION"

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ELEMENTARY ANATOMY & PHYSIOLOGY

By D. Bel!lios, M.B., D.P.H., Lecturer in First Aid to the L.C.C.; Examiner, General Nursmg D. K. Mulvany, N.i.B., F.R.<;.S., Lecturer and Examiner in First Aid to the L.C.C.; Exam!ner, General Nursmg Katharine F. Armstrong, S.R.N., S.C.M., formerly Exammer to the General Nursmg Counctl. Pp. viii + 186 with 116 illustrations.

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Address 'C ' a - INVALID FUR ITURE ,PATENT

"PORTLAND" AMBULANCE GEAR

The Gear Iliustrated(A.B.C.D.) carries two stretchers on one side of Ambula'1ce, leaving other side clear for sitting patients

The UP AND DOWN action is quick and easy for loading or unloading.

A. Shows the two stre tchers in position.

B. Shows the top stretcher lowered r eady for loading.

C. Illustrates the same Gear WIth the top stretcher frame hinged down for use when only stretcher case is carried.

D Shows the saIU " position as in' C" only with cushio'ls and back rest fitted for convalescent cases.

Where Ambulances are reqUired to carry four beds two Gears ore fitted, one on EITHER SIDE. and the same advant:tges apply as described above.

Hot OXO - so quickly and easily prepared, is an excellent sti m u lant incases of accident or shock.

Warming and sustaining, it gives the patient a feeling of 'well-being,' and is invaluable in convalesce n:e.

PRINCIPAL CONTENTS

are. temporary and that the present penod of austerity publishing will be short.

We can assure our readers that every effort will be made to see that they lose as little reading matter as possible by the new arrangement. Our articles and monthly features will be continued as before, and it may even be possible to increase the size of the issue, although this will depend on the paper po sition. Readers who subscribe annually will have their subscriptions adjusted to the new rate.

We repeat that this step is taken with reluctance, but we believe that readers will appreciate our difficulties, and will prefer their Journal at a normal price once in two month s rather than to have a smaller Journal at a much-increased price once a month. The new arrangement comes into force right away, and the next issue will be dated March i April. Publication date 18th April. We trust that readers will suffer little inconvenience from this adjustment in publishing, and we hope that we may soon re vert to normal publication.

Bland yet potent iodine

Although highly active, ' Iodex' is entirely bland even on open wounds. I t penetrates to the deeper tissues and does not harden, crack or stain the skin· Chilblains, bruises, painful muscles, and swollen joints quickly yield to its soothing and resolvent properties.

, Iodex dressings are ideal for minor cuts and abrasions. Since they do not adhere to broken surfaces, they can be renewed without causing fresh bleeding and with the minimum of discomfort to the patjent.

Editorial

PRICE & PUBLICATION CHANGES

COMMENCING with this issue

FIRST Am AND NURSING will in future be published once in two months instead of monthly. The Publishers have reluctantly taken this step after full consideration of all the factors involved, as being the only effective means of combating the steep rise in production costs, and the shortage of paper.

copy in future (Annual Subscription, 3s.), but this will represent but a small slice of the extra costs we are having to meet. There is also the problem of paper shortage, which has recently become In the face of these difficulties it is considered that the interests of readers and advertisers alike will best be served by publishing less frequently.

MEDICAL NEWS

INFLUENZA

DURIN G the past t wo months a serious epidemic of influen za has affected most of England and has also occurred in other countries. It is stated to have originated in Sweden, in the North of Spain and in Northern Ireland.

Bandages, if employe d , should light and loose, NOT tight or air-excluding.

Iodine Ointment

Since the end of the war there have been several increases in printing charges, while the price of paper has also steadily gone up. These additions were first met by increasing the price of the Journal to 4d. and by raising the advertising charges. But prices continue to rise, and these heavy costs, coupled with the present acute shortage of paper, add new burdens to our production difficulties.

To pass on the increased cost to the reader would mean raising the price of the Journal to an impossible figure. As it is, we shall have to charge Sd. a

The alternative was to cease publication, and this we feel would be taking an unnecessarily pessimistic view, for we are confident that the position will improve in the future. When this happens, and we hope it will be soon, we shall resume monthly publication.

The Journal enjoys a wide circulation and an ever-widening one. Our readership has never been so large in peace time, and it is ironic that these problems should have to be faced at a time when the Journal is so popular. But we sincerely hope that the difficulties we are meeting

Influenza is caused by a virus-a minute variety of germ which can only be seen with an ultramicroscope, if at all. The ailment is very infectious and is spread by the breath of those who are developing the complaint.

The onset is sudden and consists of headache, pains in the arms and legs, shivering, sweating and cough. The temperature rises rapidly to 103 or 104. Less commonly, influenza is of the gastro-intestinal type and accompanied by diarrhrea and vomiting.

Complications are very variable and include bronchitis, pneumonia, otitis media (abscess in the middle ear) and inflammation of the sinuses. Sometimes there is septicremia with rapid heart failure and early death.

FIRST AID & NURSING, FEBRUARY, 1951

o AGNOSIS

By A. D. BELILIOS, B.S. (Lond.), D.P.H. (Eng.)

MANY members of the S.J.A.B. are now carefully studying their new textbook and may therefore appreciate a few articles on first aid to help them in their work. This month, the important subject of diagnosis has been chosen since it comes in the first lecture of the course of training.

Diagnosis consists of finding out what injuries a patient has sustained in an accident or, if he has been taken suddenly ill, the disease with which he is afflicted. Diagnosis is one of the most difficult subjects in the whole realm of medical science and it is most important that every first-aider should appreciate this fact. Difficulties chiefly arise when a doctor is endeavouring to diagnose an obscure ailment. So many laymen expect him to do so immediately ; if he is unable to give a positive diagnosis at his first interview with the patient, some members of the public lose faith.

It must be clearly understood that in many cases of illness, it is quite impossible to make a diagnosis in the early stages of the complaint and often, observation, special tests and X-ray examinations have to be undertaken before a final conclusion can be reached. In the interval, of course, the doctor will apply the general principles of treatment and, like the first-aider, treat his patient for the most serious ailment from which he could be suffering.

The diagnosis of injuries is not so difficult as that of illnesses. In any case, the first-aider possesses a definite advantage over the doctor, since he is only expected to appreciate the most serious injuries that the patient may have sustained and to treat them if present until medical assistance is obtained. Thus, if the first-aider attends a patient with an injured ankle which on examination he thinks may be a sprain or might

be a fracture there is no need for him to make a positive diagnosis; the reqQirements of first aid will be satisfied if he treats the patient for a fracture although later on the injury may turn out to be a sprain. Nevertheless, a first-aid diagnosis should always be as accurate as possible so long as it does not take up unnecessary time. It is interesting to note that more experienced first-aiders become extremely efficient and accurate in the course of time.

To make a diagnusis tbe first-aider must consider tbe history, the symptoms and the sign s .

The history is the story of the accident, the events that led up to it and exactly how it took place. It is obtained from the patient, if he is conscious, by invitmg him to tell his story in his own way, asking him questions only when his meaning is not clear.

As an example, a patient described recently how when running he caught his foot in a rabbit bole and twisted his leg, wrenching his knee. Whereupon he felt a " click" on the inner side of the joint which was accompanied by intense pain. He found he was un able to straighten his knee which remained slightly bent. This history at once supplied an important clue as to the nature of the injury which was a displaced cartilage in the knee joint.

Many first-aiders neglect the history failing to appreciate its great value in diagnosis. It is often possible for a doctor to dIagnose an illness solely by listening to the patient's story or that given by his relati yes and friends. As an example the case of a woman may be quoted whose husband 'phoned up the doctor and described how she had woken up one morning with severe pain in the front of her chest which was accompanied by shock and vomiting; the pain

moved upwards to the left shoulder and down the arm. Advanced firstaiders who have studied elementary medicine, will recognise this history as being typical of a case of coronary thrombosis, a variety of heart attack, which the doctor diagnosed without seeing the patient.

Sometimes it is desirable to obtain a little history of the patient's previous health. This applies particularly when dealing with unconsciousness. The relatives or friends may know, for example, that the patient suffers from epilepsy, or that he is attending the hospital for diabetes in which latter case diabetic coma or insulin overdoseage would be possible causes of the unconsciousness. In the case of apoplexy, relatives or friends of the patient may be in the position to state that the patient has been under his doctor sufferingfromhigh blood-pressure. In all cases of unconsciousness it is essential that the first-aider should enquire whether there is any possibility of a head injury.

Symptoms are unpleasant feelings that the patient experiences and call his attention to the fact that there is something wrong. They must be regarded as the most valuable warnings of nature, never to be neglected either after an accident or in illness.

Symptoms can be divided into two groups (a) those which suggest that the body as a whole is affected, (b) those which direct attention to a particular. part. Thus, feeling cold or shivering, faintness, nausea and thirst are usually symptoms of a general bodily disturbance while pain, loss of use of a limb, numbness, etc., guide the first-aider to the affected part. After a bad accident, the patient may complain of both sets of symptoms.

Signs are unusual appearances which the first-aider notices about

his patient. These too can be divided into two groups, e.g. pallor, a quickened pulse and a lowered temperature, all of which disease of the body as a whole, whIle swelling, deformity and tenderness refer to a particular region. Signs are discovered by. making an examination of the patIent. The extent of this depends on the nature of the case. If the patient is conscious, he can guide the first-aider by his symptoms to tbe seat of injury and this part should be examined first. It may be clear from the history and the general condition of the patient that there no to examine further, but m a senous accident, particularly one accompanied by it is essential to exarrune the remamder of the patient's body since there may be other injuries which are causing the patient less pain and for this reason are escaping his notice.

When making a complete examination, the patient should be exposed as little as possible; it may be necessary to remove or displace a certain amount of clothing and also the blankets which are being used to cover the patient for the treatment of shock. Each part should be recovered as quickly as possible. An important principk of examination is to compare the injured with the uninjured side. Signs such as deformity and swelling, if slight, can only be detected if this is done.

In all cases the first-aider should make an examination for the signs of shock noticing the rate of the pulse, temperature of the patient's body, his colour and the character of his breathing. Moreover this examination should be repeated periodically in all except minor cases until the patient has come under professional case since it is well known that in certain instances the onset of shock

TEST YOUR KNOWLEDGE

QUESTIONS

Do muscles of the internal organs come under the control of the will ?

What is the first thing to do when dealing with cases of hremorrhage ?

Would you discontinue artificial respiration if breathing did not commence in ten minutes?

In cases of hremorrhage, would you elevate a limb ?

Is the object for the treatment of wounds, to stop bleeding and to prevent contamination ?

When bleeding (associated with foreign body present in wound) is not controlled by pads and bandages, what would you do ?

Would a person suffering from a fracture of a thigh-bone be able to raise the limb from the ground?

What should be done when bleeding has stopped, apart from dressing the injury ?

Is the arresting of hremorrhage more important than dealing with any other injury?

How frequently should a tight constricting bandage (which is controlling bleeding) be released?

How many kinds of nerves have you in each part of the body?

Describe a rupture of a muscle or tendon.

may be delayed. When the patient is unconscious, a complete examination is necessary. I t is usual to begin with the head, examining carefully for signs of injury, noticing the pupils with their comparative size, and the ears, nose and mouth. The odour of the breath may be of importance. In diabecic coma it smells of acetone (musty apples). During an examination, whether of a conscious or unconscious patient, the patient should be handled as little as possible. The signs of many of the conditions described in first aid can be divided into two groups: ( a) those which can be seen; ( b) those which can be felt. If there are suffi cient signs to enable an injury to be diagnosed by sight alone there is obviously no point in seeking those that can be felt. H andling a patient unnecessarily only increases his discomfort and aggravates shock.

How many times a minute do you induce breathing when applying artificial respiration ?

Give the treatment for a ruptured muscle of the leg.

H ow many bones have you in your forearm ?

Name the joints most frequently dislocated?

How many fingers should be used when taking the pulse?

In dealing with fractures, in what cases are you instructed to raise and support the limb ?

When arresting the subclavian artery, which bone do you press against ?

Would you always cut clothing to expose injured part quickly ?

What must you be to Dote the causes and signs of injury ?

How is concussion caused ?

What must you be to secure the confidence of the patient or bystander ?

Compression is a condition due to ?

What must you be to give real comfort and encouragement to the suffering ? .

In promoting warmth in cases of injury to the head, where would you position hot water bottles ?

What should you be if at first your efforts for the patient are not successful ? . .

What caution should be given to a patient suifenng from head injury after return to consciousness ?

What must you be in order to handle a patient without causing unnecessary pain ?

When are you instructed to keep a patient quiet in a darkened room ?

(Answers on page 12)

ATOMIC WEAPONS

We commence this month reproducing an important article which appeared in the" International Health Bulletin of the League of Red Cross Societies," dealing with the effects of atomic weapons and the role of the Red Cross.

We are doing this because we feel that this is a subject of first importance which affects everyone in this country, and especially those concerned with the treatment of casualties.

The atom bomb is a terrible wea-pon and we all hope we shall never have to face it, but a recital of its horrors will get us nowhere. Only a clear knowledge of what such a weapon can do, and what can be done to combat it, can give the confidence to handle any emergency with courage.

The matter is well summed up in the foreword to the article :-

" There is nothing very extraordinary in regard to the effect of this new and highly powerful weapon. Almost all the victims succumbed, in the same way as during ordinary bombings, to blast and heat, amplified, however, to an inconceivable degree. The only new element is radioactivity ; the mass release of rays similar to X-rays. No mystery therefore exists ; there is nothing against which the modern world is entirely unequipped. Neither resignation nor a simple philosophical shrug of the shoulders is to be recommended in face of such a real danger. At least, it can be inspected clearly and objectively and every means of protection investigated, as well as the remedying of after-effects and the bringing back to life and health all who can survive."

EVER since the first atomic bombs fell on Hiroshima and Nagasaki, the Red Cross has concerned itself with the fate of those exposed to such weapons in the future.

A film taken on the spot shortly after the explosion shows surviving members of the Japanese Red Cross attending to the victims only a few hours after [he bomb burst.

The Red Cross first of all attempted to have the atomic bomb outlawed. Unfortunately, however, neither the Red Cross Societies nor their governments have succeeded in preventing nations from looking on the atomic bomb as a military weapon.

If a world war were to break out now, it would doubtless commence with the dropping of atomic bombs on one or several cities. This threat is undeniable. The attack would be extremely sudden since mode-rn aircraft travel almost as fast as sound, and former civil defence methods would be all the more inadequate in that there would be no time to apply them.

The most harmful attitude to our mind is that adopted by the indifferent who remain silent and hope that nothing will happen. Without abandoning the hope of avoiding war, it is our duty to try to find a form of defence equal to the danger threatening us.

The legend which holds that man is defenceless against the atomic bomb does not fit in with the facts.

While it is true that this weapon, born of the knowledge of nuclear energy, is the most powerful destructi ve force ever possessed by mankind and one against which there are few effective means of defence, definite possibilities of protection remain, even if the power of the bomb increases still further. The risks must be known if protective measures are to be found, and it is defeatism and fear which are the greatest dangers.

A recent Netherlands Red Cross booklet very aptly states, "We, in the Red Cross, are still less liable to defeatism as we have a positive task. We can do something; we even have a great deal to do, beginning now." Indeed, each Red Cross Society has a specific task to carry out, even if it is only that of awakening its government to certain realities and urging it to adapt its country's civil defence. Once more the Red Cross can playa" pioneer role" vis-a-vis the authorities, placing its full force at their disposal.

First of all, let us examine the effects of the atomic bomb then the measures which can reduce the extent of the damage and, finally, the role of the Red Cross in this connection.

The Effects of the Atomic Bomb

In exploding, an atomic bomb releases energy in several forms of which the principal are: blast, thermal radiation (heat), light radiation and ionising radiations.

FIRST AID & NURSING, FEBRUARY, 1951

a long period. Finally, if the bomb explodes in water, the blast effects operate only on a reduced surface, heat effects are non-existent, but the residual radioactivi.ty is much greater. As the most effective form of stra tegic destruction is when the bomb is exploded in the air, this would probably be the method most used. First of all, let us study the effects of blast and heat which are comparable to the effects of normal modern bombs, the difference mainly being one of force. The effects peculiar to the atomic bomb, e.g. nuclear radiations, will be considered afterwards.

Blast and Heat

Blast is the most destructive, demolishing buildings, producing injuries and causing the greatest number of victims.

Thermal radiations are the direct cause of serious burns (flashburns) and also start fires which cause ordinary burns.

Light radiations are capable of causing conjunctivitis but are not a danger.

Ionising radiations (gamma rays, neutrons, alpha and beta particles) cause radiation sickness.

In addition, radioactive dust (fission products) falling back on the ground, or the influence of neutrons, can make the ground surface radioactive for some time. This is known as residual radioactivity and can, in certain cases, be dangerous.

Three of these effects cause death, namely: blast, heat and radioactivity.

The relative danger attached to these three main causes of death varies according to the place the bomb explodes. If the bomb explodes in the air, high above the ground as at Hiroshima and Nagasaki, the blast and heat effects are extensive; there is, however, no residual radioactivity, as the fission products are dispersed in the atmosphere. If the bomb explodes in the ground, as in the Mexican desert test, the effects of blast and heat are still powerful, but over a reduced area, while the ground will be dangerously radioactive, perhaps for

can have five types of direct effect :-

(1) death by mutilation;

(2) instantaneous death, without external injury ;

(3) death after 24 hours ;

(4) pulmona ry lesi.ons on persons appeanng unharmed;

(5) no lesion ).

The danger of radioactivity lS twofold :-

1. At the very moment of the explosion, the radiations released, particularly the gamma rays, penetrate the tissues and enter into the system, thus causing radiation sickness.

The photographs of Hiroshima after the explosion show vast areas completely wiped out, except for buildings here and there which are scarcely affected. These are buildings constructed to house public services and designed to be earthquakeresistant. They are made of reinforced concrete of special composition (Californian type) and stood up to the blast, even at a distance of no more than 200 yards from the epicentre. Only the inner walls, the doors and windows were blown to splinters. It is true that nearly all the inhabitants succumbed, as we shall see later on, but it is important to note that a certain type of building can resist an atomic explosion. Apart from these buildings, which were rare, dwellings were destroyed by blast, followed almost immediately by fires, due in part to the extreme heat produced by the explosion of the bomb.

We have said that there were three causes of death. The first two, blast and heat, are the most important. During the months following the first atomic attack particular attention was paid to the victims of radioactivity as this was something new and hitherto unknown to the general public, though not to scientists and doctors. Radioactivity caused, at the most, 10 to 15 per cent. of the deaths. At least, 80 per cent. of the victims succumbed to the direct or indirect effects of blast and heat, were burnt or killed on the spot, monally injured by the wreckage or buried under the rubble with no-one to rescue them.

Judging from the experience of the last two wars and experiments carried out by scientists on animals, blast

The victims of (3) and (4) will appear to the rescue-teams to be suffering from shock and will have to be treated accordingly. Persons in the open-air near the point of explosion have no means of protection against blast. Pulmonary injuries may perhaps be avoided by wearing a thick belt of sponge rubber round the thorax.

Burns of one kind and another occurred as far out as 14,000 ft.. at Nagasaki and 12,000 ft. at Hiroshima.

Forty to fifty pe r cent. of the total number killed were affected by burns. Three-quarters of the victims cared for in hospitals around Hiroshima and Nagasaki were victims of burns. Of these, 53 per cent. were dead by the end 0 1- the first week and 75 per cent. at the end of the second week.

Burns from ordmary fires have no special characteris ti cs, but flash burns produced by the t h ermal radiation at the time of the explosion are rather different. They do not penetrate very deeply (1 to 3 mm.) but are extensive and it is this which makes them so serious. They are serious within a radius of 2 miles from the point of explosion.

The magnitude of the problem shows the necessity of being ready to treat a great many burns at onceperhaps tens of thousands. There is no need to distinguish flash-burns from ordinary burns caused by fire, as their special peculiarity will be their number and varied intensity. There is nothing special in their treatment, which should be the same as that applied to victims of burns following incendiary raids in the last war. Naturally, each country has its own methods.

The effects of radiation are very serious, but the persons most exposed to them, i.e. the persons nearest the epicentre are likely to be killed by blast or heat and each of these causes is sufficient in itself. It is difficult and of no practical value to know whether they succumbed to blast, heat or radiation.

2. Mter the explosion: in bombed cities, there exist, in certain cases, fission products which continue to emit radiations, and neutrons may have made the soil and other objects which they have entered, radioactive. This is known as residual radioactivity. It is much less powerful than instantaneous irradiation but can, nevertheless, in the long run provoke dangerous lesions.

The syndrome produced b y irradiation and called " atomic bomb sickness" is similar to the illness caused by to X-rays

The syndrome was to be 0 bserved, together with its precocious or retarded symptoms, among all the Hiroshima survivors within a radius of between approximately 2,100 and 9,000 ft. The most serious cases were those of persons who were quite near the epicentre but protected from blast and heat. There is the case of a building situated at approximately 200 yards from the epicentre and containing 23 persons. The building stood up to the explosion and the inhabitants had only slight injuries from glass splinters, but 21 of them fell ill and died within two weeks. Distances smaller 01' greater than those mentioned are of little interest. At less than 2,100 ft. injuries and burns are so serious that radiation need not be considered. At more than 9,000 ft. the dose is generally too small to have serious consequences.

The doses of radiation can be measured in roentgens, although strictly speaking this unit is only applicable to X-rays and gamma rays. t o b e co n tin u ed )

AGNES E. PAVEY

Readers will learn with regret that Miss A. E. Pavey, S.R.N., our regular contributor, is seriously ill in hospital as we go to press, hence her usual article is omitted from our pages. We are sure all will join us in 'wishing her a speedy recovery.

News Rep rts

BRITISH ELECTRICITY

The British Electricity Ambulance Bulletin, journal of the British Electricity Ambulance Centre, gives the following account of a splendid piece of first aid work.

Mr. F. Elvey was working near the top of a 370 ft. chimney. The pin of a pulley block slipped out The wire rope came loose and caught him round the ankle. He fell, inside the chimney, on to some scaffolding 17 ft. below.

The contractors, Peter Lind Co. Ltd., had in their employment a first aid man, Mr. J. M.ahoney. He ran 300 yards to the chimney, climbed up, hand over hand, and found Mr. Elvey with a compound fracture of the ankle. He fixed a tourniquet to arrest bleeding, applied covering dressings and a splint.

Making a rope cradle, Mr. Mahoney supervised the gentle lowering of the patient to the ground, an operation in which Mr. Elvey, in spite of his injury was able to give considerable help. One loop of rope was under his armpits and the other round his knees.

The ambulance driver had been warned, and he was waiting at the foot of the chimney. Mr. Mahoney told him that the tourniquet had been applied for as long as was safe, and it was removed. More comfortable, safer splints were applied. Only 35 minutes after the accident the ambulance left for hospital.

HOSPITAL LIBRARY DEPARTMENT

It is now just over six months since the Hospital Library Department of the Order of St. John and the British Red Cross Society started a contributory scheme whereby civilian hospitals and sanitoria, by contributing 5 /- per occupied bed per annum (or approximately 1d. per week per patient) can avail themselves of a hospital library service provided jointly by the Order and the Society.

So popular has this service become that 790 civilian hospitals and sanitoria throughout the country are making use of it, and over 95,600 patients are benefiting. The Order and the Society also supply the reading needs of homebound patients, particularly T .B. cases, and service hospitals at home and overseas and Ministry of Pensions hospitals receive a free service.

Requests from Hospital Management Committees to extend this service to other civilian hospitals are constantly being received.

NATIONAL HOSPITAL SERVICE RESERVE

The Ministry of Health announces that recruitment to the National Hospital Service Reserve passed the 10,000 mark at the end of 19'50. During December 1,433 new members brought the Reserve total to 10,433-9,427 auxiliary members and 1,006 trained nurses. One in every 10 members of the Reserve is a man.

FIRST AID & NURSING, FEBRUARY, 1951

FIRST AID & NURSING, FEBRUARY, 1951

Wales enrolled 342 members during December (total 2,245). In England, the South-West Metropolitan Hospital Region retained its November lead with 222 new recruits (total 1,320); and Bristol came second with 125 December recruits (total 765).

THE ST. JOHN AMBULANCE BRIGADE

Addiscombe

A founder mcmbel of the Addiscombe Division, District Officer E. J. Prew, has announced his resignation as Officer-inCharge. He has beell an ardent first aid worker since 1909 when he obtained his certificate, and in 1947 he was awarded the B.E.M. for exceptional services in the interests of the British Red Cross Society and St. John joint

In 1921 he was app c inted District Officer, and became Officer-in-Charge of the Addiscombe Division in 1932.

Welwyn Gal'den City

Another successful year was reported by the Hon. Secretary, Mr. L. Blake, at the Annual Meeting of the Division recently.

Mr. Blake said that over 500 public duties were completed by the Division during the year. A high standard of interest was maintained in the weekly drills, and it was anticipated that thete would be several more recruits after c; course of first aid lectures which was to be held shortly.

Divisional-Superintendent E. A. Rusch said it had been a ::,atisfactory year, but more recruits were needed if all the calls made upon the Division were-to be met. Wandsworth and Southfields

Once again the 98th Division were able to give a grand Christmas tea to blind children from North House and Linden Lodge schools for the blind, homeless children from Earlsfield House, and members' children. Altogether 132 children sat down to tea and among the distinguished visitors to wish them a happy time were the Mayor and Mayoress of Wandsworth, Councillor and Mrs. R. W. K. Edgley, District Officer and Mrs. C. W. H. Hipkins and District Officer and Mrs. F. Stratton.

After tea the children were entertained with musical items, community singing, and Punch and Judy. Later, Father Christmas arrived and each child received a toy and a bag of fruit.

The Social Committee of the Division thank everyone whose help made the evening possible and such a grand success.

LONDON TRANSPORT AMBULANCE CENTRE

The presentation of first aid awards was held at the Paddington Hall, Bayswater, W.2, on Thursday, 7th December, and was accompanied by a variety concert. The presentation was made by Mrs. Norman, who was introduced by Mr. John Cliff, Deputy Chairman, London Transport Executive. Mr. Cliff spoke of the increased interest and great advance that had been

made in first aid training and activities within London Transport during the last two years and particularly mentioned the women's teams, who had distinguished themselves and brought glory to the Centre by winning the British Railways and London Transport (Railways) National First Aid Competition, and other trophies during the present year. Some 300 out of about 500 awards gained recently were presented to members, followed by special awards, and long service medals to the undermentioned :Certificate for the Furtherance of First Aid to " Mr. W. Shepheard, Punch Works, Stockwell.

Team Plaques were awarded to " Baker Street women's team.

Acton Works team.

Chiswick Works teams. Long Service lvIedals were awarded to 15 YEARS-

D. Young

F. C. Morgan

B. Rodd

D. Simpkin

H. Kenner

J. Mooring

20 YEARS BARS-

B. Rodd

30 YEARS BAR-

H. Pitcher

F. Lovesey

H. Pingram

H. Sinclair

F. Collier

H. Pleasants

R. Thurlow

A first-class concert under the direction of Mr. E. H. Knee, Depot Inspector, Riverside Garage, was thoroughly enjoyed by an audience of some 600.

In passing a vote of thanks to Mr. Cliff and to Mrs. Norman for kindly deputising for Mrs. Cliff at short notice, Dr. L. G. Norman, Chief Medical Officer, and a VicePresident of the Centre, spoke of the keen interest taken in the Centre by the Deputy Chairman, who always followed the various activities very closely, and whose presence on this occasion was a great encouragement. He also spoke of the assistance given to the movement by the London Transport Medical Officers at lectures, competitions and re-examinations, and concluded by urging all successful candidates to keep their knowledge up to date by regularly attending practice classes and lectures.

Mr. Alex. J. Webb, C.St.J., General Superintendent (Staff and Training) Railways, Chairman of the Centre, presided at the function and was supported by the Vice-Chairman of the Centre, Mr. T. T. Shephard, Rolling Stock Engineer (Road Services).

BRITISH RAILWAYS

Medtorious Fit'st Aid Awards

On 17th November, at Liverpool Street Station, Mr. C. K. Bird, Chief Regional OfEcer, Eastern Region, supported by Mr. W. P. Allen, member of the Railway Executive, presented Meritorious First Aid Awards consisting of clocks and framed certificates to Mr. William Woodhall, Assistant Yard Master, Temple Mills, and Mr. H. Clark, Goods Guard, Worksop.

The case of Mr. H. Clark was a most unusual one. He was in charge of a transfer of wagons from the Up to the Down marshalling yards at Worksop, 20th October, when he had the misfortune to be knocked down. He was caught by a bridge girder and fell with his right foot under

moving wagons and we,dged between the girder and the raIl while 17 wagons passed him.

The injuries suffered were crushed nght foot (boot stripped o!f by .the wag 0 l:1 s), severe wow1ds to the nght thIgh and shin lacerations on the face and scalp ; severely bruised eye and profound shock.

Despite these terrible injuries, Goods Guard Clark hopped over the down main and shunt roads, clear of further danger and sat down with his back to the bridge. By reason of the profuse hremorrhage from the foot and the fact that he is an ambulance man of 17 years' standing, he flexed his right leg tightly to his chest with folded coat behind the knee, and called for help. Although the shock was profound the patient retained consciousness throughout. The crushed foot had to be amputated and seven stitches were inserted in the thigh.

There is no doubt that Goods Guard Clark's knowledge of ambulance work, at a serious moment, saved his own life.

In the second case, a shunter accidentally slipped near a moving wagon and his right hand was cut off. He then fell with the injured arm through the spokes of the wagon wheel, and the arm torn off to within 2 in. of the shoulder )omt.

The only person about at the time (3.40 a.m.) with any knowledge of first aid was Assistant Yard Master W . Woodhall, and he was sent for. He controlled hremorrhage by means of pressure on the sublcavian artery and with the free hand padded and dressed the. " " of the arm with a firm pad paracularly 10 the armpit. It was not an easy job, especially single-handed An ambulance was called, and within ten minutes of the accident the casualty was on the way to Whipps Cross Hospital.

A feature of the treatment was the comfort Mr. Woodhall was able to give to the injured man, in an anti-shock way, and it should be added that three surgeons who happened to be on duty at this early hour of the morning were able to operate immediately and no secondary shock had developed.

BRITISH RED CROSS SOCIETY

The team provided by the Society for work in Korea left for New York on 13th January. From New York the United Nations Organisation will be responsible for their conveyance to Korea, and on arrival at Tokyo the team will report to the representative of the Public Health and Welfare Section. From then on they will operate under the direction of the unified command.

Leader of the British team is Mr. Peter Driscoll, who served with the B.R.C.S. since 1940 in Normandy, Belgium and Germany. After the war he served with the British Red Cross Civilian Relief Commission in Germany, until seconded to the League of Red Cross Societies in 1949 as Assistant Field Superintendent in the refugee relief operation in the Middle East.

The Medical Officer) Lt.-Col. M. C. L. Smith, M.C., served in the India Medical Services before the war, and was on active service in the Middle East during the war. He gave valuable assistance in the relief of

distress which followed the famine and floods of 1946 in West Punjab, and has worked among refugees in Burma.

The third member of the team is Mr. H. Miller, who performed war service in the Hygiene and Sanitary Sections of the R.A.M.C. in France, Belgium, Holland and Germany.

Countess Mountbatten of Burma, C.l., G.B.E., D.C.V.O., Superintendent in Chief of the St. John Ambulance Brigade, and Chairman of the St. -; ohn Ambulance and Red Cross Service · Hospitals Welfare

9

Committee, left London Airport recently on a tOur of West and East Africa. She is to see the work of the St. John Ambulance Associati?D: ,and Brigade, and to explore the posslbility of extending the work of St. John Ambulance Association in territories not already covered.

Countess Mountbatten will visit the Gold Coast, Sierra Leone, Gambia, Nigeria, Kenya, Uganda, Tanganyika, Zanzibar and Aden. Military hospitals in Kano, Kabuna, Mackinnon Road, Nairobi and Aden will also be visited.

TOPlfJAL NOTES FOR FIRST AlDERS & NURSES

Investigating the Common Cold Colds are all too common at this time of year ; and just as common is the complaint that " someone ought to invent a cur e ." It is a real problem, but work is being done on it, and the Common Cold Research Unit (which is run by the Medical Research Council and the Ministry of Health) has been investigating cold cures for over fou: years.

One of its latest experiments was that of introducing colds to a party of students living in on a small Scottish island. Fxplaining why this was done the Council say that a direct hit by a sneeze from a coldsufferer can doubtless convey infection. But knowledge as to relative importance of other routes is vital if spread is to be checked. The route, for example, might be via tiny airborne particles, by dust or by manual contact.

Studies on these lines were not apparently feasible under the conditions under whIch experiments are conducted by the Unit with volunteers at because cross-infection seldom occurs between a subject with a cold and a normal healthy person. It was with the aim of concentrating on these aspects as well as testing the theory that small groups of people living in isolation for some time are prone to get colds shortly after their return to "civilisation," that the experiment of taking a party of twelve persons to live for three months on an island was undertaken.

The party, mamly from Aberdeen Uni versity, landed on the island early in July last year with camp equipment, stores and all necessities, so

that any personal contact between them and the mainland should not be necessary for about three months. Even letters were banned. A small radio transmitter and receiver kept them in daily communication with the mainland.

Unexpectedly, when near the end of the time people with colds were brought on to the island, they failed to infect the isolated volunteers. It is suspected that this is because the cold -virus used to infect them had been modified by artificial person-toperson transfer at Salis bury, so that, though it would still cause colds, it would no longer " jump " from one person to another. A crofter with a natural cold was then brought on to the island, and his cold did " jump " to three of the isolated people.

The experiment has been fully described in The Lancet. Commenting on the experiment, Dr. C. H. Andrews, head of the Research Unit, says that it has given new ideas for studying the transfer of natural colds. "Another thing we are trying to find out, " he said, "is why school children play such an important role in the spread of the common cold. A survey of the incidence and distribution of colds in a rural community, focussed attention on the school as the source of infection. Antihistamines, so much boosted a year ago in America as cold-cures, were found quite ineffective in preventing or modifying colds at Harvard, even when given 2 or 3 days before infection. Others have obtained similar results. The pricking of the antihistamine bubble has been so poorly publicised in America that the public there is still wasting hundreds of thousands of

dollars in buying drugs which are useless against colds.

"We are now entering the 5th year of our experiments at Salisbury but we are running short of volunteers. Volunteers aged 18-40 are still urgently needed. Here is the chance of ten days' holiday with free travel warrant and pocket money! Apply, Medical Officer, Harvard Hospital, Salis bury. "

Awards for Blood Donors

Blood donors who have given repeated gifts of their blood are to be recognised by the award of a brooch or lapel badge. The Ministry of Health announces that awards are to be presented to "long service" donors in the National Blood TransfUSIon Service, the Scottish National Blood Transfusion Association and the Greater London Red Cross Blood Transfusion Service. To qualify a volunteer must have given at least ten donations of blood since September, 1939. Women donors will receive a brooch and men a lapel badge.

The design of the award, which has been personally approved by His Majesty The King, shows two interlocking hearts surmounted by the Crown and resting on a scarlet background. There will be three classes of award-silver-gilt for at least 50 donations, silver for 25 donations and bronze for 10 donations.

There are now nearly 400,000 donors in the National Blood Transfusion Service, and it is estimated that about 200 donors will be entitled to the silver-gilt award, 5,000 to the silver and 70,000 to the bronze.

Her Royal Highness The Princess Royal, who has herself given blood to the Service, has graciously consented to present the silver-gilt awards at a ceremony in London on 3rd April, 1951, at the Royal College of Surgeons.

Health Exhibits at the Festival

There will be a number of medical exhibits at the Festival of Britain Exhibition at the South Bank, which opens in May. The Health Pavilion will have as its theme the health of the individual and that of the community.

Its introductory section describes the body and its functions; there is a section devoted to the maintenance of health; and environmental public health is emphasised

in exhibits relating to clean water supply and sanitation, pure air, etc. Mass immunization, biological standardization, a.ild vital statistics will also be illustrated.

Other parts of the exhibition will demonstrate Britain's contribution to therapeutics, neurology, cardiology, and surge ry There will be the story of nursing, telling of the British tradition, started by Florence Nightingale, of treating the patient as a person whose comfort must be considered.

Infantile Diarrhrea

The International Health Bulletin of the Red Cross quotes an interesting and simple treatment found effective against infantile diarrhcea.

It is carrot soup prepared in the following fashion: 500 gm. of carrots (preferably fresh) are washed and well scraped. They are then finely chopped and cooked with 150 gm. of water for 15 minutes in a pressure cooker. The entire pulp is passed through a fine strainer and diluted with hot w9ter up to one litre, 3 gr. of common salt being added. The soup is fresh ly made every day.

After being received in hospital, the children sufft; ':ng from diarrhcea are given this bl..re rage in as large amounts as possible, 12 hours' treatment usually sufficing to produce a marked change in their condition. The anti-diarrhcea effect of carrots is probably due largely to their pectin content, as is the case with apples, bananas, tomatoe s. Hardly any side effects accompany the administration of the substance, though cedema, which rapidly sub:.. ides, may develop from profuse administration of the soup to under-wc: ght children.

" Since 1944," states the doctor, " I have used car.rot soup in about 450 cases of diarrhcea, particularly in infants. It is extremely reliable ... I have found (it) to be far superior to all substances hitherto employed. It can be given even to premature babies."

Metallic Poisoning

In an address recently to the Royal Sanitary Institute, Dr. A. J. B. Griffin, who is Medical Officer of Health for Worcester, said that to-day it is food poisoning from bacterial a.ction which so much engages attenHon, but we should not be unmindful of the possibility of metallic poisoning.

FIRST AID & NURSING, FEBRUARY, 1951

Because of public health safeguards, lead poisoning in industry was a rarity, "Phossy" jaw is a thing of the past, as is mercurial poisonin g. The more modern industrial poisons-bisulphide of carbon, trinitrotoluene and tetrachlorethane-are taken care of by the factory inspector and the works doctor. But in the public health field, said Dr. Griffin, occasional cases still occurred of metallic poisoning from food and water. Susceptible people still developed symptoms from lead-bearing water, and the present indifferent quality of food handlers gave little sense of security where food poisoning, either bacterial or chemical, was concerned.

Metal poisoning from canned foods is of little importance owing to the great care now taken by the reputable canners to avoid metallic contamination. Zinc poisoning from galvanized receptacles has occurred, and many will know of antimony poisoning from the action of acid fruit juices upon containers lined with cheap enamel. The Ministry of Health Report 78 of 1935 destroyed the then existent canard of aluminium poisoning. Copper poisoning has resulted when soft drinks were served from a copper-lined tank.

Dr. Griffin mentioned a case of copper poisoning which occurred after a bus driver and his conductor had taken an early-morning cup of coffee at a canteen. Within five minutes of returning to their bus the driver vomited violently. The conductor felt sick and nauseated, but did not vomit. Later he was relieved of his post and was away from work for several days. The driver continued on duty.

Following inquiries, it was learned that other men had been taken ill after taking coffee at the canteen early in the morning. Only six men were affected, because the buffet staff suspected the hot water geyser and used it no more for beverages. Investigation showed that the first morning drawings from the geyser were heavily contaminated with copper, possibly detached from the metallic surface by vibration. In the case of the driver it acted with emetic effect, and he quickly recovered; the conductor's stomach was more retentive of the irritant.

Hundreds of these refreshmentbuffet geysers are in use, and Dr.

FIRST AID & NURSING, FEBRUARY, 1951

Griffin points out that inefficient and very infrequent servicing might produce copper contamination of the water by deposit loosened by vibration.

Health Records

Two official announcements from the Ministry of Health speak of new health records. The provision al stillbirth rate and infant mortality rate (babies dying under one year of age) were the lowest ever recorded, and figures for the first half of 1950 show a big drop in the deaths from T.B. while new cases are fewer. The stillbirth rate was 22.6 per thousand total births, as against the previous lowest annual rate of 22.7 in 1949. The infant mortality rate fell to 29.8 per thousand live births, the first time the rate has been below 30.

In July, 1950, Hospital Boards were asked to make a special drive to bring beds into use for tuberculosis patients. In the six months up to the end of last year 761 new beds were provided and 386 re-opened, a total of 1,147. Since the National Health

Efficient FIRST AID

can save much pain and many man hours

Service began in July, 1948, up to June, 1950, 1,506 new beds were opened and 897 re-opened, a total of 2,403. Altoget her, 3,550 extra beds are in use, and there is the promise of more to come.

Nursing staff is also increasing. The year ending 30th September, 1950, saw 705 extra whole-time nurses and 153 part-time nurses recruited to the staffs of sanatoria and tuberculosis hospitals.

Deaths have decreased sharply. Provisional figures for the first six months of 1950 show a drop of 17.7 in the numbers cl) mpared with the same period in 1949. This is much larger than for many years past, and compares with a d ro p of 5.6 per cent. in the same periods of 1948 and 1949. Taking respiratory tuberculosis alone, the number of deaths fell by 1,671 (compared with 247) or 17.4 cent. (compared with 2.5 per cent.) Much of the fall may be attributed to the increasing use of new methods of treatment such as streptomycin and para-aminosalictlic acid, but increased services have also played a part.

Book Review

AIDS TO PRACTICAL HYGIENE FOR NURSES

By YVONNE M. D. COOPER, B.Sc. and HELENA V. DAVIES, B.Sc.

Lecturers in Pre-Nursing Science, Bournemouth Municip3l College

Balliere, Tindall & Cox. 5 / -

THE authors note that although some excellent books on the theory of hygiene are to be found, the need for some suggestions for practical exercises to accompany them seems to have been felt by students and teachers in schools and colleges known to the authors. This book, therefore, describes the experiments in practical hygiene carried out in the pre-nursing classes at the Bournemouth Municipal College during the past ten years. It covers the hygiene syllabus for Part I of the Preliminary State Examination in Nursing, and includes further experiments on works subsequent to this examination.

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Queries and Answers to (jorrespondents

The Textbook to which reference may be made in this column is the 40th (1950) Edition of the S-J.A. A Manual of First Aid to the Injured.

Correspondents are requested to write on one side of the paper only.

Dislocation of Joint

P. B. (Cardiff).-Recently I had to treat a man w,h? had dislocated his right shoulder. He was complazmng of numbness in the joint and of pins-and-needles below the joint. I shall be grateful if you"" will be kind e1'!0ugh explain how these szgns and symptoms arzse wzrh dislocation of shoulder joint.

The head of the displaced bone presses on nerves and bloodvessels in its neighbourhood with the result that, consequent on irritation of the nerves and interference with the local circulation, there may be numbness at tbe seat of injury and tingling (or pins-and -needles) sensations below the joint.-N. Corbet Fletcher.

Examination Howler

M. R. (Cannon Street).-In a recent examination on the Revised Textbook I asked one candidate to defin e a poison and was much amused at his answer which was" A poison is any substance which taken in insufficien t quantity is incapable of destroying life ! "

Good! Next please! !-N.C.F.

Treatment of Injured Hand

N. P. (Gospel Oak).-Recently some pals of mine had to treat a young fellow who knocked his hand and low er end of forearm against a wall with result that a swelling appeared in the metacarpal region. They supported th e injury with a triangular bandage and sent patient t o hospital. I suggested afterwards that they should hav e applied a cold compress with the object of reducing pain and swelling, but another colleague maintained that the hand and wrist should have been immersed in water as hot as patient could bear. Your comments will be much appreciated.

Beyond all doubt I prefer the treatment given by your pals. If, however, the swelling was a local bruise and medical aid was not immediately available then the

1. No.

continuous application of cold would have been correct treatment because in such a case cold gives relief for the fi_st 24 hours after the accident. Immersion of the part in water as hot as patient could stand would certainly be wrong because of the risk of scalding the injury.-N.C.F.

Pin in Tongue During Insensibility

T. M. (Cromer).-During a recent discussion one of our members suggested that we should pass a pin through the tongue of an insensible patient to prevent it falling backwards and choking him. Neither the Textbook nor any St. John lecturer has ever made such a suggestion which caused controversy among us, the majority being of th e opinion that the use of a pin in such circumstances is unn ecessary and far too drastic. We await your ruling on this problem with interest and thank you for your reply.

If you keep an unconscious patient's head well turned to one side (as the Textbook tells you) you will guard against any possibility of his tongue falling backwards and choking him. By so doing you will obviate any need to adopt such a drastic procedure as piercing the tongue with a pin. P ersonally, I have never found any need to hold on to patient's tongue even when doing Silvester's Method of artificial respiration, much less to stick a pin through i t ! !

Concussion or Shock

S. T. (Dublin).-Pl ease tell me if a knock-out blow on the chin of a bo x er caus es concussion or shock. Also please tell me what is the essential difference indicated by thes e t w o differ ent tetms. Finally, pleas e accept my best t hanks for your kind replies to my queries.

A knock- out blow on the chin results in a violent shake -up of the b r ain and causes what is termed concussion of the brain whereas shock is a condition of prostration of the body arising from sudden exhaustion of the vjtal activifies, as the Revised Textbook tells us. The essential difference between concussion and shock , however, is that in the former condition there is either a history or local evidence of some violence to the head which has caused a shake-up ofthe brain.-N.C.F.

Test Your Knowledge-Turn to page 5 before

2. Place patient in suitable position . Sit or lie down.

3. No.

4. Yes, if not fractured.

5. Yes.

6. Apply firm bandage round limb a few inches above wound.

7.

No. Keep the patient warm. Give plenty of fluids, especially warm tea if available.

Yes. Every twenty minutes.

12.

Two. When, during severe exertion the muscle or tendon is actually torn-it is ruptured.

Twelve.

Place the patient in the most comfortable position. Afford support to the injured part. Apply a hot compress.

15. Two.

16. Shoulders, elbow, thumb, fingers and lower jaw. 17. Three.

18. Knee cap and crushed foot.

19. The first rib. 20. No.

21. Observant.

22. By a blow or fall on the head, or by a fall on the feet or lower part of the spine.

23. Tactful.

24. Pressure on the brain by blood clot or piece of bone

25.

26.

27.

28.

in fracture of skull. Sympathetic. To sides of the abdomen and lower limbs. Persevering. Not to resume physical or mental activity without consent of a doctor.

29. Dextrous.

30. In cases of " injuries to the head."

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One cannot inherit specialised knowledge, nor buy it, nor lightly acqUire it. It reqUires interest, intelligence, and time. Readers of ,< First Aid" have the necessary interest to embark, if they will, on a study that will lead them surely and directly to graduation in an assured profeSSion. PHYSIOTHERAPY offers everything. Independence, Security, Freedom, It is the profession with the increasing status, the now recognised method of treating diseases and deformities by physical methods, massage, manipulation, and medical electriCity. It is a most remunerative profession; several of our students earn over £2,000 a year.

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design, product "l and equipment of an ambulance l.J or the more ambitious form of mobile medical unit demands a wealth of specialised knowledge in many fields. Mechanics, coachbuilding, electrical engineering, all play their part in the production of these highly technical appliances, and constant research with prototypes forms the background of these developments. A study of worldwide operating conditions is also necessa ry, especially in producing for overseas markets.

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Calls fo ·r Recruits

Speaking to the Press after his recent visit to Bermuda and the West Indies, Lieut.-General Sir Otto Lund, K.C.B., D.S. O., Commissioner-in-Chief of the St. John Ambulance Brigade, emphasised the need for more recruits. "We have fou nd that the demands on our services are on the increase rather than otherwis e," he declared. The constant gro wth of commitments had necessitated a great ' effort to get more ad uIt recruits.

Enormous Scope " I am quite sure," he went on, "the public wants to realise that there is enormous scope still for vo luntary work in first aid to ensure that the people who meet with accidents are got to the hospitals and m to the doctors' hands with the mi nimum of damage being done to t hem.

"At any public event you will fi nd that where our members are d oing duty, the Ambulance men are able to move the individual who has

met with an accident, and take him to a first aid post where he is looked after by the nursing members before being efficiently put in an ambulance and taken to a hospital. You will appreciate that the combined team does consist of both men and women trained to work together in this way.'"

Encouraging Young People

Sir Otto talked about his plans for increasing the number of ambulance and nursing workers, for encouraging young volunteers, and for replacing some of the elderly men and women in the units. He went on: "With regard to the efficiency of the St. John Ambulance Brigade, I think I should stress the necessity of support both here in England and especially overseas where the facilities are not so great, of the co-operation of the medical profession, not only the official doctors of the Government but also

those in pnvate practice. We insist in St. John that not only i s an examination taken to obtain the certificate required for memb er ship in the first place, but also each year a re-examination has to take place conducted by a doctor to ensure that those people who set out to help the public are indeed qualified to do so . "

Brigade Overseas

Speaking of his tour of Bermuda and the West Indies, Sir Otto said the Brigade was strong and active, but there was scope for expansion.

" In Trinidad and British Guiana," he added, "we have for a number of years had a teaching organisation. But it was not until our visit this year that we decided to form uniformed Ambulance Brigade units in both places. It was with great pleasure therefore that we formed the first Ambulance units to be followed, I have no doubt in due course, by Nursing Divisions."

MEDICO-BIOLOGICAL LABORATORIES LTD., C ARGREEN RD.,

NOTES ON

SHOCK now occupies one of the most important chapters in the new St. John book. It is a subject which everyone will have to study carefully since it is liable to occur in so many emergencies. This month, therefore, it is proposed to devote an article specially to this subject in order to assist the first-aider in his study.

Shock is defined as a state of prostration ansmg from sudden exhaustion of vital activities. « Prostration " means extreme physical weakness and it should be noted that this affects the body as a whole rather than one or more particular systems.

The "vital activities" which become suddenly exhausted include, of course, the heart and circulation. Defective circulation of blood can affect every other system in the body and it will be noticed that the various symptoms and signs described under each type of shock could be classified according to the systems affected.

So far as the factors in the production of shock are concerned, injury is placed first. Emotion, the second factor given, emphasises the importance of the mind and its influence on the functions ofthe body. Medical research has shown that many physical ailments can be traced to nervous causes. Thus asthma, gastric and duodenal ulcer, high blood pressure and many other diseases are in many instances partly nervous in origin. Moreover, it has always been well known that many faints occur from purely nervous causes, e.g. the receipt of bad news, the sight of blood, etc.

The third factor given-medical emergencies-requires a little explanation. It is the term applied by the medical profession to an illness of sudden onset and of a serious character. Thus in acute appendicitis, the organ may become so swollen and distended that it ultimately « bursts" or perforates, as it is called technically, in a manner very similar to a boil. Perforation of a gastric or duodenal ulcer supplies

by A. D. Belilio::;, M.B., B.S. (Lond.), D.P.H. (Eng.)

another example, while severe shock generally occurs at the onset of the heart attack known as coronary thrombosis.

It will be noted that patients debilitated as a result of disease react more seriously to shock. The medical term « d\!bility " is applied to a state of lowered vitality of the body such as occurs when a patient is suffering from a severe or chronic disease, e.g. cancer. The general resistance is below normal and it is not surprising, therefore, that shock, in a case of this kind, would have more serious consequences than in a normal individual. It is important, however, only to use the term '( debility" in its true medical sense since it is often employed to explain minor ailments, e.g. being "run-down" through over-work, worry or other cause.

Three types of shock are described in the book: (1) Nerve, (2) Haemorrhage, and (3) Toxic.

Nerve shock is of immediate onset and varies considerably in its degree of severity. It includes fainting and may be caused solely by emotion.

Appendix (ii) explains that Nerve shock is a reflex action. This medical term is applied to any action of the body which takes place automatically without the use of consciousness or will. Reflex action has a purpose, namely to provide immediate defence of the human body against harm and in this respect reflex action can be described as first aid applied by the body to itself.

An example of a reflex action will make this point clear. If a foreign body attempts to enter the eye, the lids immediately blink and frequently succeed in protecting the organ. The blinking takes place within a fraction of a second-far more quickly than could occur if the process were conscious and willed. Other examples of reflex action include withdrawing the hand from a painful article touched accidently and coughing if a piece of food attempts to enter the air-passages.

The Appendix explains how the

FIRST AID & NURSING, MARCH/APRIL 1961 and faintness. In haemorrhagic shock, however, the patient may be apprehensive and restless, or talkative and abnormally cheerful.

symptoms and signs of Nerve shock serve their purpose of protecting the body but a further point is wisely stressed, namely that the first-aide r must always be suspicious that one of the other varieties of shock-both more serious-may be present in addition.

So far as the symptoms and signs of the three varieties of shock ar e concerned, the student will assis t himself if he remembers that in each case he will usually be able to discover abnormalities in the colour, condition of the skin, pulse, breathing, condition of the pupils and state of consciousness; moreover many of the characteristics apply to all three varieties. Some reader s will wonder why the Revision Committee did not describe the symptoms and signs as a whole, mentioning later the chief differences in the thre e groups. The probable explanation is that it is desired that the student sha ll obtain a complete picture in his min d of each type but to facilitate stud y classification may be helpful.

The colour in all varieties is pale and in addition there may b e cyanosis or blueness. This cyanosi s affects particularly the lips and finge r nails but may extend to other parts of the body. It is extreme in toxi c shock when the patient's colour ma y become grey and even leaden.

The skin in all varieties is cold an d clammy; sometimes beads of col d sweat appear on the forehead.

The pulse is quick and feeble and may become imperceptible at the wrist. Occasionally, in the earlie r stages of nerve shock, it is slow.

The breathing is generally shallow and quicker than normal. In nerve shock it may be irregular, while air hunger may occur if the condition of the patient becomes serious.

The pupils are usually dilated although occasionally they ar e normal. In toxic shock, the eyes hav e a glassy or vacant stare.

Unconsciousness may occur in any variety and, if not insensible, the patient often complains of giddines s

General Weakness resulting from loss of muscle tone, is mentioned under Nerve and Toxic shock. All muscles are normally in a state of slight contraction known as muscle tone. They are ready to go into full contraction at a moment's notice when stimulated by the nerves which supply them. This muscle tone can be compared with the tension of a piece of elastic which is kept slightly on the stretch. Loss of muscle tone therefore means that the muscles become "slack" and no longer react quickly and efficiently.

The treatment of shock is described under thiee headings: (1) preventive action, (2) action in established cases, and (3) subsequent action. There is no object in discussing I or 3 in this article but it may be helpful to notice that the various measures to be undertaken in established cases can be classified into three groups (a) general principles of first aid, (?) spe.cial principles for shock, (c) sHmulatlOn.

General Principles include stopping bleeding, laying the patient on his back, turning his head to one loosening tight clothing, exammmg and treating injuries, and arranging for removal to shelter.

Special Principles include the patient in the anti-shock pOSItIOn, ensuring warmth, re-assurance and the prevention of excitement and worry. The latter could really be considered a general principle of first aid but it is well to emphasise it in shock since nervous apprehension is often an important symptom.

Stimulation of the patient can be undertaken by many methods, e.g. drinks, sal-volatile, smelling salts, inhalation of ammonia, warmth to the pit of the stomach and heart, sprinkling the face with hot and ,water alternately and by rigorous fncHon of the limbs.

The first-aider should be careful that he does not over-stimulate the patient. In many cases, the administration of fluids, little and often, will suffice and will not interfere with one of the most important measures necessary for the treatment of shock, namely absolute rest.

FOOD hygiene is a most important thing. Every year thousands of people are seriously ill with food poisoning and there are many deaths. The tragic thing is that most of these cases are due to neglect and carelessness on the part of the food handler. Fortunately, the matter is being energetically tackled, and the St. John Ambulance Association are co-'operating with local authorities in a particularly worthwhile scheme.

Because of the success of what is now known as the « Southport Experiment," the Association has decided to launch a national campaign for the institution of lectures on food hygiene for all who handle food. Those who take the course, and pass an examination, will be presented with a certificate, which, it is hoped, will in the course of time be as valuable and as well-known as the certificate in first aid.

The Southport scheme started three years ago with a trial course, sponsored by the Health Department in co-operation with the St. John Ambulance Association. It was at once successful, and some 200 people have attended or are attending courses, while there is a waiting list of 300. Now a nation-wide scheme is being launched.

Major A. C. White Knox, principal medical officer of the Association, has pointed out that one day the Government might introduce legislation making it a statutory requirement for all food handlers to hold a recognised qualification, and it is hoped that the certificate of the St. John Ambulance Association in hygiene and food handling might be prescribed at the recognised qualification. With the right co-operation this movement will do much to stamp out the evils of dirty food.

yours

DEAR SIR,

It was with much concern that I read your article on Physiotherapy in the January issue of FIRST AID AND NURSING, in which it is stated that Physiotherapy in the home is frowned upon, and has been ordered to cease by the Minis try of Health.

One wonders if the Health Service as at present conducted, is run for the benefit of the suffering public or just another means of providing « safe " jobs for more officials: . .

As a PhysiotherapIst m pnvate practice, I can assure the Ministry that there are literally thousands of sufferers who could, and would be, alleviated of their ailments if we were recognised under the National Service, and allowed to treat patlents in their own homes.

The statement that there are too few Physiotherapists is not altogether correct the fact is that there are so few work in hospitals and clinics because, like myself, the tious person resents the practlce of. being paid so much per. irrespective of the condltlon to be treated with the result that, as many are got through in the day

*as possible, to the detriment of the patient's recovery. Again, if the patient does not respond to the treatment prescribed by the doctor in charge of the case, the treatment must not be altered by the operator without the consent of the doctor. Also, the Physiotherapist is never allowed to make his own diagnosis It has been my experience that the majority of clients who come to me are dissatisfied with clinical treatment, owing to (a) the manner to whIch they are subjected, (b) the waiting, (c) yery or no improvement m theIr condltlon. Further, treatments carried out in the home would stop the Ambulance Service being used as a Taxi Service, which is what has happened ever since the present Scheme came into operation. .'

Give the private PhYSIOtherapIst recognition, and allow home treatments and I am certain that all and kindred complaints would show a great decrease in the statistics of future reports.

BARNET, 30th January, 1951.

F. W. JACKSON, M.S.F.

British Railways - Southern Region

FIRST AID FINALS

The 1951 Ambulance Finals Competitions for Men, Police and Women took place. at the Borough. P?lytechnic, London, on March 30th, and as in past years the pick of the RegIOn s Ambulance men and women's teams strove for first aid honours in the presence of a large throng of spectators. Horsham No. I won the men's. cO?Ipetition ;, Liverpool Street headed the Police teams; and Dorking No.2 was the wmmng women s team. The tests were well staged, which added to the realism.

AFTER acknowledging with Women thanks the welcome he had Dorking No.2

received, Mr. C. P. Hopkins, Chief Eastleigh Loco Accounts Regional Officer, expressed sincere Dorking Beginners admiration for all he had seen that Southampton d Brighton ay, which marked the end of a London Area of voluntary work unstintingly gIven.

The result of the competitions was announced by Mr. J. Lithgow as follows :Men

Horsham No.1

Exmouth Junction No.1

Mrs. C. P. Hopkins, wife of the Chief Regional Officer, presented the trophies and prizes to the successful teams.

Col. N. McK. Jesper, Chief of Police, London Area, proposed a vote of thanks to the judges, and in reply Dr. F. H. Edwards said that it had been his pleasure to judge the Men's Team Test, the standard of their work was indeed high. He the winners and paid tnbute to those responsible for the organisation of the Competition.

Mr. F. A. Trott, in proposing a general vote of thanks, paid tribute to stewards, patients and competitors, emphasising that the object

of competition work must not be forgotten, which was the basis for stimulating members to greater effort in training, with a view to making them most proficient. It little mattered whether one won a cup or prize so long as the competition had become useful in further training and that it stimulated to greater effort in order that they might better serv.;: those they lived, worked and played with.

Brighton's Record in Police Competitions

WITH their recent win in the finals of the Police National First Aid Competition, Brighton Borough have carried off the Pim Trophy for the third time, a feat unequalled by any other Force. Previous wins were in 1938 and 1948. They only just did it, however, for the runners-up, Metropolitan L Division, were but three points behind. Third place was taken by Birmingham City No.1. , The Home Secretary, Mr. Chuter Ede, presented the trophies, and in his address recalled that the connection between the St. John Ambulance Association and the Police dated back to 1878 when the Metropolitan Police first inaugurated first aid classes. In 1927 the Order of St. John proposed competitions among Police forces, and this scheme was given the strongest Home Office support.

Sir Ernest Bur0.on, ReceiverGeneral of the Order of St. John, expressed appreciation of the value of Police first aid training. He thought there was a wide field open for collaboration between the voluntary bodies and those taken over by the State.

Results were (maximum 400) :-

1. Brighton Borough 287

2. Metro. L Div. 284

3. Birmingham City No.1... 267

4. City of London 2241

5. Lancashire County "A" 221 t

6. Devon Constabulary 221{

7. Mid-Wales Constabulary

8. Sunderland Borough ... 210

9. Yorkshire W.R. "A" 202

10.

Morphia Supplies for Trains Urged

DR. D. D. PAYNE, Medical Officer of Health for Harrogate, who was a passenger on the train which met with an accident at Batley Bridge, near Doncaster, on March 16th, has written to The Times urging that supplies of morphia should be carried on trains under the supervision of the guard.

Describing the scene at the wreck he says that while supplies of first aid dressings, coffee and brandy were soon available, there was an urgent need for morphia for the more seriously injured and trapped persons.

"Morphia, by relieving pain, reduces shock and is a life-saving treatment," he says. "In this accident an unavoidable time elapsed before supplies of morphia were available for injection. In most longdistance trains it is likely that there will be a doctor among the passengers, but unlikely that he will have with him supplies of morphia.

" It would seem desirable in the interest of the public that an emergency supply of morphia in a form ready for injection should be kept in a locked container, under the guard's supervision. There would seem no reason why this should not be made legally possible, as similar arrangements exist in mountain rescue work, and were available during the war for civil defence."

Sister Hutchings Cup

The 1951 First Aid Competition for the Sister Hutchings Cup, London Transport Ambulance Centre, was won by Chiswick "A" team, led by Mr. J. Baynes, with a tot al of 191 marks. Other teams to gain prizes were: second, Baker Street (Women), leader, Miss E. Bristor, 172 marks; third, Chiswick (Women), leader, Mrs. R. Cole, 165 marks; fourth, Baker Street " A," leader, Mr. S. Weekes, 164 marks; fifth, Chis wick " B," Mr. R. Stride, 151 marks; total possible marks were 250. Other team's taking part were Lots Road, Ruislip, Reigate (Women), Camberwell " A," " B " and "C," Sutton, Charlton and Dunton Green.

TOPICAL NOTES

FIRST AlDERS & FOB NURSES

First Aid Services for the Festival of Britain

In conjunction with the St. John Ambulance Brigade the British Red Cross Society is staffing first aid posts in all sections of the Exhibition, the South Bank Site, the Festival Gardens, the Science Museum, the Land Travel Exhibition and the Festival Ship, H.M.S. Campania. At the South Bank Site and the Festival Gardens alone, over thirty officers and men will be on duty every day. They will come from all over Britain, and it is estimated that by the close of the Exhibition they will have completed over 43,000 hours of voluntary duty between them. First aid duties in connection with the Travelling Exhibitions will be carried out by the County Branches in the immediate locality of the various halting places

Many Branches are taking part in local Festival activities. For example, a Derbyshire Division is organising a Pageant entitled " Through the Ages," a Worcester Branch is producing a play depicting the growth of the Red Cross, and detachments in Merioneth are taking part in an Exhibition by the Urban District Council. At Headquarters, in Grosvenor Crescent, London, S.W .I, an Exhibition showing the national and international development of the Red Cross will be open from Monday to Friday (excluding Bank Holidays) from 12 noon till 5 p.m. It will be open from May 9th till September 30th.

Motor Section of the National Hospital Service Reserve

The Ministry of Health announces that a special section of the National Hospital Reserve is to be formed for the war-time operation of the mobile first aid units attached to hospitals. Car drivers and motor cyclists who hold current licences are asked to volunteer. They will be recruited as nursing auxiliaries and will be given the usual training in first aid and home nursing, and will obtain hospital experience. They will thus

be available for general nursing duties in hospital as well as standing by for driving duties with the mobile units. The new section of the Reserve will be known as '( Nursing Auxiliaries (M) Section," and its members will be described as "Nursing Auxiliaries (M)." Both the St. John Ambulance Brigade and the British Red Cross Society are appealing to their own members who have the necessary driving qualifications to join the new section, whilst non-members who wish to volunteer may do so through the local headquarters of either of the two organisations.

Wearing of Red Cross Insignia in Korea

Several national Red Cross Societies provided teams of welfare workers for Korea, but after they left their own an unexpected hitch occurred over the question of the wearing of R ed Cross insignia by these welfare Unified Command, Tokyo, did not agree that the insignia should be worn, and the matter was discussed at Lake Success and at Washington. Pending the results of these discussions several teams, including that of the British Re d Cross, were instructed to wait in Tokyo. However, an agreement was reached between the League of Red Cross Societies and Unified Command, and on March 1st the British Red Cross Society'S 'Welfare Team left Tokyo for Korea wearing United States Army uniform with British Red Cross insignia. The team is now established in Korea, it is carrying out the work for which it was organised and equipped.

Radio Publicity for the Red Cross

After the one o'clock News on Wednesday, April 25th, there will be a broadcast on the work of the British Red Cross Society and an appeaJ for flag sellers. This is an important work that needs many volunteers, and which makes it possible for the Society to extend its activities ; for the amount collected by flag sellers and house to house

The Winning Womens' Team. Dorking No. 2

Royal Ulster Constabulary 158t (Lancashire County take fifth place because of their higher aggregate of marks in the individual tests.)

collectors in 1950 was over £100,000.

On Sunday, April 29th, at 9.35 p.m. an hour's feature broadcast on the origin and development of Red Cross work and of its present-day activities is being arranged. Book the date and make a point of listening, for the broadcast promises to be most entertaining as well as instructive.

A Settlement for Partially Paralysed Ex-Service Men

By providing the sum of £ 130,000 from money remaining in the Duke of Gloucester's Red Cross and St. John Fund at the conclusion of the second world war, it has been possible to establish the Settlement known as (( Kyt es," near Watford, Hertfordshire. It consists of a central building which contains, among other departments , recreation rooms and other social facilities, and al so quarters for a trained nur se. Around this central building is grouped 22 bungalows, all specially constructed to meet the needs of the physically handicapped. They have no stairs and the doorways are especially wide to allow for the pas sage of wheel chairs and similar equipment. The men live with their wives and families in the bungalows. They are encouraged to go out, to work at suitable occupations and to live as normal a life as possible ; and their di sabilities are not emphasised more than is absolutely necessary.

The Settlement was honoured by a visit from Her Majesty the Queen on F ebruary 28th last

Two New Publications

The British Red Cross Society has just published a Junior Nursing Manual, written by Miss Elizabeth Gravelius, with a foreword by Dame Emily Blair, Matron-in-Chief. It is profusely and attractively illustrated and is excellently produced. It deals with all aspects of home nursing and the preparation and care of the sickroom. There is a most interesting chapter on children's convalescence, with many suggestions for amusing occupations to while away the tedious hours until ordinary activities can again be resumed. I t is very moderately priced at 2s. 6d.

The second publication is the Junior First Aid Manual translated

Medical News

SOME members of the public still think that if they take a larger dose of medicine than that prescribed by the doctor they will get well more quickly. Unfortunately, the result is often quite the reverse and the death of a child from this cause has recently been reported. Another danger results from the careless storage of medicines. Two children succeeded in reaching bottles of a nicely flavoured linctus and helped themselves; both died. In one case it was estimated that the

into Afrikaans for the use of the South Africa Red Cros s Society. The English edition has, of course, been available for our own juniors for some time, and it has proved invaluable in schools, youth organisations, clubs, factories and offices.

Barnett Hill Courses for June, 1951

175. Commandants' Course.Friday, June 1st to Monday, June 5th. This is open also to Assistant Commandants and all Detachment Officers. The programme will cover the organisation and running of a detachment, and the wider aspects of Red Cross work.

176. Speakers' Course.- Tuesday, June 5th to Friday, June 8th. Open to all officers. The programme covers Public Speaking, Committee Procedure, etc.

177. Members' Cours e.-Friday, June 15th to Monday, June 18th. This course will cover a wide field of Red Cross work.

178. Casualties Union Course.Friday, June 22nd to Monday, June 25th. Open to all officers and members. It is intended primarily for thos e acting as leaders for Casualty Union Study Circles. There will be demonstrations of the staging of accidents, acting and make-up.

179. Picture Library Course.Friday, June 29th to Sunday, July 1st. This course is intended for Picture Library County Organisers,

Unusual Cases of Posioning

child had drunk seven or eight times the normal adult dose.

Two other unusual cases of poisoning have been reported in the past few months and emphasize the danger of mixing domestic cleansers. In one instance, a lady sprinkled her lavatory bowl with "Harpic " and followed it with half a bottle of " Brobat."

A cloud of yellow fumes containing chlorine arose and nearly overcame her before she could get into the open air. The second case was very similar and resulted from mixing (( Harpic" with (( Domestos."

Hospital Representative s and others interested in the British Red Cross Society's Picture Library Scheme.

An early application for all these courses is advisable, as the bookings are always rather heavy.

Factory accidents were fewer in 1949, according to the annual report of the Chief Inspector of Factories, recently published. Employers and worker s, it is stated, are giving more attention to the treatment of minor accidents, and the provision and use of first aid facilities.

The number of accidents notified in 1949 was 192,982, of which 772 were fatal. The ye ar before there had been 201,086 accidents, including 861 which were fatal. The report gives particular credit to foremen and chargehands for the reductions in accidents.

Accidents to young workers continued to fall. In the five years 1944--49, accidents to boys dropped from more than 24,000 to 9,100, and accidents to girls fell from nearly 8,500 to 3,500.

Lack of supervision and instruction was still the real cause of most of the accidents to young workers in 1949, though inexperience, curiosity, lack of self-discipline, and " skylarking" were other contributory causes

There are also examples of accidents where machinery guards are suitable for adults but do not exclude the slender fingers of boys and

We continue from the last issue publication of an important article dealing with the effects of atomic weapons and the role of the Red Cross which appeared in the "International Health Bulletin of the League of Red Cross Societies."

FIRST AID IN ATOMIC WARFARE

THE effects of radiations on living {Jersons depends on the total dose recei ved and also on the rate of absorption. They vary according to whether the dose is acute (all received in a short time) or chronic. Six hundred roentgens are lethal if they are absorbed in a single day but would have no appreciable effect, if received during 30 years. If the dose absorbed each day is very small, it is possible for the affected tissue to build up a r esistance. A dose of 0.3 roentgen per week is harmless over a period of several months.

The effects of radiation sickness, which are decreasingly acute according to the dose, are described as follows in Th e Effects of Atomic Weapons :-

(a) Lethal Dose-about 600 roentgens or more. Fatal within 2 weeks of the explosion, all treatment useless ;

(b) Semi-lethal Dose - about 400 roentgens, mortal in 50 per cent. of the cases, death occurring between 2 and 12 weeks after the explosion;

(c) Moderate Dose-from 100 to 300 roentgens. Generally non-lethal.

Treatment of Radiation Sickness

Before examining what can be done to save as many people as possible in the event of an atomic raid, we shall consider how radiation sickness can be treated. Since 1945, t here have been ceaseless experiments on the Japanese victims and on animals in the laboratory.

Little can be done in the way of t reating radiation sickness when the acute dose is 600 roentgens or more, but if the dose is smaller, e.g. 400 ro entgens, many lives can be saved with proper treatment. Immediate

hospitalisation, so as to ensure complete rest and avoidance of chills and fatigue, is the essential first step.

Whole blood transfusions should be given until the bone marrow has had time to regenerate and produce blood cells.

Adequate nourishment should be applied through intravenous feeding to supply the necessary sugars, proteins, vitamins, etc.

To help the system deprived of white blood cells to fight infection, antibiotics should be used: penicillin, streptomycin and aureomycin. The latter would also have a certain effect against hremorrhages. The whole subject of radiation sickness is being given extensive study and important advances in its treatment may be expected.

It must not be forgotten that victims of radiation sickness may also suffer from burns and injuries. This will complicate the task of the doctors. The injuries to be treated are burns, shock and lacerations. Radiation sickness is less urgent.

Decontamination

There are three means of minimising the dangers associated with radioactive contamination: first, to dispose completely of the material by deep burial in the ground or in the sea; second, to keep it at a distance for a sufficient time to permit the radioactivity to decay to a reasonably safe level (in sea water, the sodium salt will be the chief radioactive substance and will remain radioactive for about three days); and third, to attempt to remove the contaminant, that is, to decontaminate the material.

In the event of serious radioactive contamination, the most important steps would appear to be the removal or of loose material which

might form dust that would be inhaled or ingested with food. For paved streets, the best procedure would be flushing with the aid of detergents (soap, alkali or soda) or vacuum sweeping. Concrete, stone and brick buildings would have to be sandbla sted with a fir e hose and re-roofed, as the roofs woul d have received the greatest amount of radioacti ve material. Soil tends t o concentrate radioactive material. Th e only solution would be to cover it with fresh soil or simply to turn it over. It is alway s wise to wate r it first to minimise the du st danger. Cloth, clothing, blankets and upholstered furniture should be burnt but care should be taken in doing this as the smoke would be radioactive. If the contamination is not too serious, laundering may be effective in removing and diluti n g radioactive dust .

Properly covered food s, such as preserves, would not be contaminated, and there is no means of decontaminating unprotected food.

In general, there should b e little danger from contaminated wat er, except for a short period immediately following the explosion

Organizing Civil Defence

The Civil Defence Services wi ll become of great importance : the public must be instructed , shelters must be built, volunteer s recruited, schools established fo r officers and courses for staff, while possible objectives and local resources must be investigated It is that one in every ten person s IS required for Civil Defence

It would therefore be advisable to take imm ediate action so that the nation may be ready to make most of its available resources III ensuring relief for all the disaste:-s which might result from atomlC warfare ,

The basis . of all such measures should naturally be the national civil defence organisation, grouping together all the competent services of the public authorities and the voluntary organisations. This body would be entrusted with the establishing of the national organisation plan comprising :-

(1) the most effective mobilisation and employment of the nation's medical and health resources;

(2) co-ordination between the authorities and communltles on measures aiming at ensuring relief;

(3) the co-ordination and distribution of medical, health, civilian and military services on a national scale, to meet every emergency situation;

(4) the preparation of a plan for the decentralisation and evacuation of every important centre ;

(5) the study of a system of feeding, storing and improving means of transport and communications in the zones most exposed to bombing.

In this vast Civil Defence programme, we shall distinguish between urgent measures and longmeasures and, finally, we shall mdicate the procedure to be followed on the day the bombing takes place. ,

Long-term Measures

It is widely agreed that there are certain general measures which would reduce the risk of a high death-rate following an atomic attack. These measures are difficult to apply and would radically alter present ways of living, but they would be the most effective. We refer to decentralisation, new building procedures, etc. Nevertheless certain of these measures, such strengthening of certain buildmgs, scientific research and the reorganisation of health services could be started at once.

Planning of New Construction.-

New should be applied in the constructIOn of new buildings and new towns; provision should be made for wide streets, avenues and and firebreaks should be WIder than usual; underground

factories and premises should be constructed to shelter essential industries, power stations and vital supplies.

In buildings under cons truction, is possible. to incorporate inexpenSIve protectIve measures; in any case, every new building should ha ve its shelter.

Decentralisation. - Large-scale decongestion of major towns and vulnerable centres should be provided for. These principles must be borne in mind when new industries, military bases or schools and hospitals are !he idea is to disperse VItal mdustnes and supplies and preserve the population. Scientific Research should primarily be undertaken by military research centres and laboratories. The of detection, disinfection, protectIOn and therapy in air attack demand the co-operation of a wide range of specialists.

Reorganisation of Health Services.-

In future wars, civilians will probably be more exposed to danger than even front line combatants. The majority of medical and nursing staff mus.t be held at the disposal of CiVIlIans and doctors mobilised on the spot. A single health service on a national scale, under the Ministry of Defence, should be organised.

Immediate Measures

The measures mentioned above are valuable, but some of them are difficult to apply for the time being. Those described below are urgent and can be carried out at once.

The Instruction of the General Public.- This most important. They must be. alIve to the possibility of an atoffilc war, realise that protection is possible and know what they should do in the event of atomic attack. The main principle to be stressed is that they should rush to the shelters at the first sound of the alert.

Claustrophobia and the fear of being buried alive should be combated. They not only prevent people from going down to the shelters but even prevent rescueworkers from going to the assistance of in wreckage. In an atomIC war, Immediate shelter is a sine qua non of survival.

Another useful instruction to the public is to try to eliminate inflammable material from their houses

particularly dark black-out curtainssomething else will have to be used

Certain people are panic-striken at the thought of the atomic bomb while others remain indifferent and that the danger is exaggerated leads to a psychological to keep the genera l p.ubhc m a state of apprehension nsks creating conditions favourable to panic; to tell them not to overworry may encourage them to be apa.thetic and inactive. The psycho,Preparation of the population IS of VItal Importance. The truth is that while no-one is safe, many can be saved. There are means of protection and they must be known. It is better to lay emphasis on the necessary action than on the horror of the effects. Every citizen must know how to protect himself and how to go to the rescue of his neighbours. Every citizen must be ready not to take flight, but to serve and 'to obey the authorities.

The Warning.-An efficient alert system is obviously essential for the Civil Defence Services. The public must be trained to heed the warning and take shelter.

She!ters.- The organisation, constructIOn and upkeep of shelters in the town is one of the main functions of Civil Defence. Underground tunnel shelters of reinforced concrete offer the maximum security, judging They afford protectIon agamst all forms of atomic destruction, even near the point where the bomb explodes. Against however, only a layer of lIght metal or some iron oxide mixed with the concrete would be effective.

The experiences of the last war demonstrate that shelter is the most effective means of protection against bombs. The shelters which were used. then could also stand up to atomIC attack and the best thing to do is simply to adapt them to the new conditions.

Provisional corrugated iron earthcovered shelters (English Anderson type) or even wooden shelters can be effective, provided of course that they are covered with earth or sandbags to a total thickness of at least 2 feet. Instead of doors, baffles used, as they offer protectIOn agamst the immediate dangers: flash-burn and direct radiation

FIRST AID & NURSING, MARCH/ APRIL 1951

(gamma rays), since thermal and nuclear radiations travel in straight lines. There should always be two means of exit. Each large communal shelter should also contain surgical kits and large quantities of dressings, plasma, penicillin, concentrated liver extracts, vitamins for injections, heart tonics and opiates. One thing should not be forgotten: in shelters, neither electricity, water, nor the town gas supply can be counted on, as they may all be cut off following atomic attack. Reserves of water and independent sources of light and heat should therefore be provided.

Personnel.- To reduce the loss in human lives, it is estimated that one out of every ten persons must take part in Civil Defence in one way or another; but each individual must know how to help his neighbour and play the part of the good Samaritan.

Owing to the magnitude of the task to be carried out following an atomic attack, no-one can really count on anybody but himself. Nevertheless, certain preparations should be made in advance by the competent services. Everybody must be capable of serving in the relief teams required for giving the alert, rescue work, first aid and evacuation. Each team will have its own strictly defined task as it will be necessary to give first aid, transport the wounded-those suffering from radiation sickness and those who have been buried in wreckageto evacuate and group the survivors, to mark off the contaminated areas, to see that the commands of the Civil Defence authorities are carried out and that order is kept in the shelters, to fight fire.s and floods, deal with the dead, re-establish communications, help · in feeding, transport, clearing the principal thoroughfares, etc., etc.

The effectiveness of a relief team depends on its knowledge, experience and speed. First aid workers should, first of all, be well trained.

Anybody can, more or less, deal with the physical problems of relief, but the psychic and emotional element often plays a large part. Thus, claustrophobia, the fear of being shut in and confined in a narrow space, may impede all action, prevent a buried person from trying to find a way out through a small tunnel, or a first aid worker from entering. To conquer this reaction,

realistic training on the English model should be given. This fear can only be conquered by exercise and experience .. What the body can pass through wnhout damage is only known when it has passed through !

The whole population must have learnt the art of rescue work first aid and the treatment of the and this is one of the tasks of the Red Cross.

Training and Instruction of Medical Staff and Auxiliaries -In Hiroshima as in Nagasaki, the losses in medical staff were impressive: only 30 of the 298 doctors in Hiroshima survived. Out of the 2,400 members of the nursing profession, scarcely 600 were capable of working after the explosion. Thus, 75 per cent. of the medical staff were out of action. Only one of the hospitals in Hiroshima was still available for the reception of patients. Also, the municipal, medical and military authorities were wiped out. In such conditions, medical treatment could only be given at a very slow pace. It must therefore be anticipated that some victims will have to wait for hOl!rs and even days, before being seen by a doctor or even by a nurse. Consequently, the functions of auxiliary staff must be extended and they must be given more responsibility, though only for the emergency period, for necessity is imperious. Auxiliary staff should therefore be entrusted as much as possible with all tasks which are not of an exclusively medical nature.

The medical and auxiliary staff should be acquainted, to varying degrees, with the treatment of burns. Instruction should also include the treatment of shock, resuscitation, an::esthesia and blood transfusion. This example should be followed in every country and an atomic refresher course for doctors given in medical associations, hospitals and medical schools. Similar instructions should be given to dentists and pharmacists so that they may take an active part in first aid.

These courses should be organised forthwith to enable doctors to cooperate in the instruction of the general public.

Nurses will be the link between the doctors and the personnel of the relief teams and will often have to replace the former and make decisions. They should be registered

in the same way as doctors and their position in the of Civil Defence clearly defined. Nurses should receive special instruction in to the injuries caused by the atomIC bomb and their treatment.

D:.lfing and attacks, they WIll have speCIal dutIes to perform in the shelters where people may have to remain for some time. They may be entrusted with first aid, looking after children, sick persons and old and the isolation of persons suffenng, or s.uspected to be suffering, from contagIOUS diseases, confinements, accidents, acute illnesses and health problems.

Medical Auxiliaries.-In this term we include nurses) aids, people who have taken courses in first aid and the care of the sick and wounded, or are q,:alified to do something m the medIcal sphere and, indeed, any ready and willing worker who could learn to give transfusions of blood plasma, dress wounds and inject analgesics or stimulants if required.

J. W. Creyghton writes on this subject: "I consider that rescue workers must be taught not only how to make transfusions, but also how to make sub-cutaneous, intramuscular and intra-veinous injections of preparations with a base of morphine salts and of various stimulants. "

In our opinion rescue workers soould certainly be allowed a large measure of independance during the first 24 hours following the explosion in order to relieve the doctors and nurses of tasks which are not essentially medical, but we consider there to be a certain amount of risk in entrusting them with those which are specifically medical.

Apart from the possible ill-effects of unskilled treatment, there is the danger of auxiliary staff subsequently misusing its training in this respect, in peacetime. Hence both temerity and prudence are demanded.

The mysterious powers of residual radioactivity have been greatly exaggerated. We have seen that, after the explosion, fragments of the atomic bomb (fission products) will be dispersed by blast or wind. These particles, these sub-microscopic bombs, continue to emit dangerous radiations though if the explosion should take place more than 1,500

(continued on page 12)

Training

FOR NURSING l-'RAINING (III) as a Hospital Cadet

by Agnes E. PAVEY, S.R.N., Diploma ill Nursing (University of London)

Cadet Nurses

THE idea of establishing a Cadet Nurse Corps originated in America during the second world war. Its aim was to increase the number of nurses in America as rapidly as possible, and the United States Cadet Nurse Corps was created by a Bill that passed through Congress in 1942. The response exceeded all expectations, for 65,000 girls joined during the first year. Girls as young as seventeen enrolled for a two and a half years' accelerated course of nursing training. It was stated to be "the largest project of nursing training ever planned"; but it was maintained for only five years-from 1942 to 1947-and during that period nearly 180,000 students were enrolled in the Corps.

Nursing Cadets in Britain

In this country the nursing Cadet fills a very different role. Her course is intended to fill in the time between leaving school and commencing nursing training. Although attached to a hospital she is not employed in nursing and she does not come into contact with very sick or injured persons, now that her duties are properly organised.

Owing to the somewhat indiscriminate employment of young girls in some hospitals, and their contact with serious illness, severe accidents and death at an age when they were e?lotionally immature, representations were made to the Ministry of Health. Detailed regulations controlling their employment were then issued, definitely stating which types of work were suitable and which unsuitable or undesirable. When, however, an interim period of wageearning has to be undertaken between leaving school and commencing nurse it is obviously an advantage

If the employment can be associated with the hospital service in such a

manner that interest is maintained and some knowledge of a student nurse's life and conditions can be acquired. The suitability of the girl for nursing training can be assessed and she is more likely to settle down than the girl to whom hospital life is completely strange.

Age and

Conditions of Employment

Although the Ministry of Health allows girls from 15 years onwards to be employed as hospital Cadets, many hospitals arrange their own courses and do no t accept girls under 16. All Cadets under the age of 18 are required to undergo further basic education for one full school-day each week, and although this is usually shorter than the hours of duty in the hospital it must be' reckoned as a full working day of eight hours.

The maximum working hours, if under 16, is 44 per week. Girls over 16 may be employed for 48 hours weekly, the maximum hours worked in one day being nine. If an offduty period is given during the day the over-all period must not be more than eleven hours. Work must not commence before 7 a.m. nor end later than 6 p.m. for those under 16, or 8 p.m. for those over 16. No night duty must be undertaken and if public holidays are worked an extra day off must be given in the preceding or following week.

The training allowance is £150 a year under 17, and £160 a year after that age. Meals when on duty and uniform are provided free. If resident, the Cadet receives £75 a year if under 17, and £80 if over that age ; or 15 / - weekly increasing to £ 1.

Duties Considered Unsuitable

Cadets may not be in any capacity involving contact with sick persons in cancer hospitals or homes for the dying, or in hospitals or departments for venereal diseases.

They may not work in wards of mental hospitals or mental deficiency institutions; nor in X-ray, physical medicine or out-patients departments of mental hospitals, isolation hospitals or tuberculosis sanatoria.

Those under 17 may not be attached to wards in any type of hospital. They may not work in hospital reception rooms, in outpatient departments of maternity hospitals, or in X-ray or physical medicine departments. Cadets of any age may not be employed in the operating theatre or in mortuaries.

Duties Considered Suitable

In any of the departments in which they are allowed to work Cadets may take messages, answer doors or telephones, act as guides to walking patients going to and from departments, play with waiting children and carry out simple clerical duties which are not of a confidential nature, such as filing and ruling up books for records. In addition, there are stipulated duties in connection with various departments.

In the Diet Kitchen they help to prepare and serve diets and to clean and check equipment.

In the Linen Room they sort clean linen, make lists for wards and departments, check and issue overalls to domestic and non-nursing staff, and assist with marking and mending.

In the Nurses' Home they help at the reception desk and take telephone messages, set and clear dining-room tables, look after cutlery and glass, arrange flowers and help with stores and linen issues, including uniforms.

In the Catering Department, the Steward's and General Office, the Central Records Office and the Almoner's Department they do clerical work that is not confidential.

In the X-ray Department they play with waiting children, take films and messages to and from departments and accompany walking

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patients. They help with filing, but they should not be present when X-rays are taken, or be exposed to X-rays at any time.

In the out-patient department there are many and varied jobs to be done, in addition to those that are common to nearly all departments.

The Cadets assist with the canteen, with the play arrangements in the children's welfare clinic and in the Mothercraft Department. They collect records, such as pathological reports, case papers, and X-ray films, for the nursing staff.

Some slightly more responsible duties are included for Cadets over 17. They help with marshalling children for exercises in the Physiotherapy Department and for artificial sunlight treatment. In the hospital reception room they help with receiving visitors' enquiries or messages, and they learn the use and care of the main telephone switchboard. The senior Cadets are often attached to wards , where they assist with the general care of the kitchen, bathroom, sterilising room and clinical room. They arrange patients' flowers, prepare trays of drinks, look after fruit plates, cutlery and condiments and help to serve meals.

It will be seen, therefore, that although contacts likely to cause emotional or physical strain are avoided, the work of Cadets is most varied and useful. They become accustomed to hospital life and discipline, and they see something of the work in all departments so that they eventually commence nursing training with a widened experience which leads to better understanding and co-operation with all othe r members of a hospital staff.

With regard to the continuation of their basic education, they usually attend a Technical College or Polytechnic. Classes are arranged so that the Cadets do not repeat work that they have done in school. This is especially the case with Cadets who already have the School Certificate. If they wish, the Cadets can sit for a Certificate of Education of the Royal Society of Arts. In the hospital itself, the Sister Tutor usually gives lectures on the professional aspects of nursing or on nursing history. It should be added that, at present, only a small number of hospitals employ nursing Cadets; but this number is increasing.

Public Get Unde,-takings Together

OVER two years ago the first meeting of first aid organisers in public undertakings and government departments centred in London was inaugurated by the British Electricity Authority. Since then they have met every three months to discuss the various problems found in organising first aid. Each organisation acts as host in turn, and arranges the meeting. Representatives of the St. John Ambulance Association and the British Red Cross Society also attend. Among the bodies repre-

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The items which have been discussed so far include first aid boxe s and their contents, first aid competitions, civil defence in relation to industry, and combined first aid classes.

First Aid in ,t\tomic Warfare (continued from page 9) feet above the ground, they would, as a rule, be dispersed without danger. However, in an explosion nearer the ground, on the ground or in water, they would be harmful, but the latter type of explosion would doubtless be in the nature of an accident as it would not cause sufficient damage to be of any advantage to the enemy. Even in an explosion at ground level, there is little danger in travelling quickly over the affected area, if protective measures are taken. The mere presence of radioactivity is not sufficient to cause death; all depends on the dose received, the means by which it is received and the time-factor.

The stages of the disaster will determine those of the radiological defence measures and it may be assumed that there will be three essential stages :-

(I) Complete disorganisation. Roads will be blocked and all transport systems will be out of action. There will be no means of transport to or communication with, neighbouring districts.

(2) Emergency control stage, when the surrounding streets have been cleared and communications partially re-established, so that information may be transmitted to a control room.

In the case of moderat e material damage, this stag e might start very quickly and last for a week or more

(3) Recovery stage. This would be reached when mos t people were out of immediate danger; it might be possible at this stage to start more thorough decontamination operations.

Gamma rays are the most dangerous radiations. Tests should be carried out by low-flying aircraft as by measuring the dosage of radiation at a known height above the ground, it would be possible to deduce the intensity of contamination on the ground. Ground monitoring with portable instruments could then be carried out.

The question of the duration of exposure to radiation permissible for control and rescue personnel will obviously depend on the circumstances, and certain risks will have to be taken. Over-exposure should nevertheless be avoided except in highly important missions. A person who has been exposed to residual radiation for an hour will not suffer any further appreciable injury by staying for several hours more, as the intensity of the radiation falls rapidly and continuously.

(to be continued)

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FIRST AID HANDBOOKS ANATOMICAL DIAGRAMS AND CHARTS FOR LECTURES

Queries and Answers to

The Textbook to which reference may be made in this column is the 40th (1950) Edition of the S.J.A.A. Manual of First Aid to the Injured.

Con espondents are requested to write on one side of the paper only.

Treatment of Crushed Foot

R. T. (Moulton).-In the 40th Edition of the Textbook I note on page 150 that the treatment of Crushed Foot requires us to apply a cold compress. On page 44 of the Textbook the instructions are that in application of a cold compress the dressing should be left uncovered. I ask if there would be any appreciable effect xf the compress is applied outside the boot as shown in Diagram 109.

The main points about Crushed Foot are given in the opening three lines on page 151 of the Textbook where you are told that this injury is commonly caused by the passage of a heavy weight over the foot. Even though there should be no external wound, there is likely to be extensive damage to the bones of the foot, and this may result in haemorrhage within the foot.

From the wording on page 44 you will see that the objects of a cold compress are to ease pain, to lessen swelling and to control haemorrhage from the bloodvessels within the foot. Although this compress (when applied over the shoe or boot) is not an ideal treatment, it will cause some of the effects of a cold compress and is certainly better than attempts to remove the boot or shoe which may easily cause further complications.-N. Corbet Fletcher.

Examination Howler

M. R. (Cannon Street).-In a recent re-examination I asked one candidate if he could tell me the probable cause of attacks of acute pain in the pit of the stomach with vomiting of blood-saturated contents of the stomach. I was amazed when he replied: "I would suspect a bleedin' ulster of the stomach! "

Good! Next please! !-N.C.F.

Treatment of Snake Bite

R. J. (Moulton).-On page 266 the Revised Textbook tells us that in the treatment of Snake Bite suction by the mouth may be tried, but that the bare lips should not be applied to the bite. It has occurred to me that if a tobacco pip'e is the bowl could be p:essed over the bzte. suctwn applied at the mouth-piece alternately tzltmg the bowl and blowing to expel any blood which has been collected.

There are two reasons against your suggestion. One is that the use of a pipe would be ineffective and the other is .that you infect the wound by using such a dirty thmg as a pIpe. You have evidently forgotten that some deep wounds are presumed to have been made before suction is attempted.-N.C.F.

Transport of Patient

F. C. (Bath).-Please tell me the correct wuy-head-first or take a patient on a stretcher trolley into the Out-pattent Department of a hospital and from the

Out-patient Department into the ward. Also how is a deceased patient moved from and into hospital ? Although there is no hard and fast rule, it is usual to transport a live patient head first and a dead patient feet first on a stretcher.-N.C.F.

Fractures of Both Thighs

A. B. (Burnley).- We have now had the opportunity oj studying the Revised Textbook. In common, no doubt with first-aiders everywhere, we are likely to h av; many queries of which we would like you to give the answers to the following two queries.

We have noted the new method of treating a patient for fractures of both thighs, and we really do not appreciate the purpose of the middle splint when t wo outer splints are to be applied. In t he September, 1944 , issue of " The S.J.A. Gazette" a correspondent suggested the inner splint as part of the treatment of this injury. In your comments you sta ted that the inner splint serves no useful purpose while it may cause discomfort to the patient. Please may we h ave your further remarks on this point.

. When both thigh bones are fractured there is gr eat nsk of movement and consequent complications as t he normal steadying action of one sound limb is lost. T he treatme?-t laid down requ.ires, first the placing in position of the mner padded splmt, the tying of both feet and ankles then the passing of all seven bandages und er the patIent before any of them are tied. During this p art the .there may be movement of the injured lImbs, and It I.S Just possible that this inner splint m ay ha,:e a. steadymg effect. However, provided that t his splmt IS properly padded, the inner splint can do no harm, and as it i.s in the Textbook the splint must, of course, be used m all competitions conducted on t he instructions of the Textbook.-N.C.F.

Burning or Scal4ing of Child

A. B. (Bu.rnley).-My second query concerns the burning 0 1' scaldzng of a young child. In view of the great liability of burns and scalds to cause sepsis, it seems surprising Textbook should still advocate placing the child zn. a warm bath without removing clothes. Clothing dzrectly affected by the burning or scalding wou ld probably, be sterile but other clothing away from the cause mzght be grossly contaminated and so render dir ty the whole bath and perhaps infect the burned or scalded area. Do the Revision Committee regard the prevention of shock of sufficient urgency to ignore this appare nt danger? Colebrook, in an article " What is the best first aid for burns and scalds," cannot approve this his was reprinted in the" Coun ty of Bnstol Fzrst- Azder" (March, 1949) so that his would appear to have the approval of this We would appreciate your remarks on this pomt.

Please again accept our thanks for help in the past and in anticipation of your help this time.

Sepsis arising as a result of burns and scalds comes from the effects of the damaged tissues of the body, and there is little risk of germ infection from water or clothes. The great danger is from shock, and it cannot be too strongly stressed that shock must have priority of attention. -N.C.F.

Four Queries from Textbook

H. M. (London, Ontario, Canada).-Enclosed are four questions which I would appreciate very much zl you would answer through the medium of FIRST AID. All are taken from the 40th Edition of the Textbook.

You will note that in many cases the rules for treatment as laid down in the Textbook do not conform ' with the illustrations. Therefore it is very hard for the new student to grasp the true m-eaning. Again, in Competition work it leaves a wide field for much discussion with an examining officer, even taking into consideration the permission for modification of bandages, and not forgetting the last paragraph on page 17, Chapter I.

Again, we in Canada have many other conditions which have to be taken into consideration : distance to be traversed, weather conditions (sometimes 35 per cent. below zero), clothing, etc., no free ambulvnce service like you have in England. So you will realize what the cost would be to transport the patient by ambulance say 30 miles.

Question 1.-" Bandage for the Elbow" (page 55).

" Bend the Patient's elbow to hem inwards along the base a right angle, fold a narrow of an open bandage J' lay the point on the back of the arm and the middle of the base on the back of the forearm, etc. "

The above in my estimation is a typographical error, but very confusing to a new student.

Your quotation from the Textbook seems to be a typographical error because it is not the same as in my copy of the Textbook. So your difficulty is not clear.

Question 2.-" (B) When the elbow cannot be bent without difficulty or increasing pain " (pages 139-40).

The treatment is very confusing especially in competition work and may cause much discussion with an examining officer. Therefore I would appreciate some clarification of paragraph 2 (page 140). You mention "Secure the limb to the trunk and lower limb by three broad bandages tied :-

One round the arm and trunk.

One round the elbow and trunk.

One round the wrist and thighs

ould it no bt:- better to raise the lowt.,r bandage to a point between tht wrist and elbow. Round the hips, this would allow the patient to sit with the hand by his side or recline in the back seat of an automobile ?

Also, would you consider an ambulance necessary for the transportation of an adult patient · suffering from such an injury ?

In view of the sub-heading on page 139 of the Textbook it would seem that there is more injury than the simple type of fracture because the sub-heading clearly states that the elbow cannot be bent without difficulty and increased pain. Further, the T extbook clearly states that

FIRST AID & NURSING, MARCH /APRIL 1961

patient must be transp6rted in recumbent position. In these circumstances it seems important that risk of movement at the elbow joint should be anticipated and prevented. To achieve this, one bandage must be pass ed round wrist and thighs and the patient must be transported in a recumbent position, even if this necessitates the u se of an ambulance.

Question 3.-" (C) When both legs are fractur ed and assistance is available " (page 147).

Need I say more when you look at Fig. 102, page 145 ?

You note that the ankles and feet are secured by a bandage. Then look at Figs. 105-106, page 148, you only show' five bandages.

Do I interpret this correctly? Rule 3, page 14 7, should read, "e.g., and do not let go until the splint has been secured by tying the ankles and feet together. " Therefore you would require six bandages.

Page 149, " (D) When both legs are fractured and no assistance is available."

Rule 4, " Tie the ankles and feet together."

Again Fig. 105 is mentioned, but yet you have used six bandages in this treatment.

Again the interpretation of Rules as laid down fo r treatment and figures are very confusing both to th e student not to say again Competition work, where some examining officers hold fast to the book or vice versa, taking into consideration the 4 paragraph, Chapter I , page 17.

The figures No. 102 to 104 in the Textbook refer to th e treatment when assistance is not available, in which cas e the first bandage must be round the ankles and feet When, however, reliable assistance is available one Beare r is instructed to hold the ankles and feet and not to let go until the splints have been secured. You will realize from this that the Bearer's hands tak.e the place of the firs t bandage round the ankles and feet. The five bandages shown in Figs. 105 106 are, therefore, perfectly correct.

Question 4.-" CD) Fracture of the bones of th e foot or toes," crushed foot (page 151).

May I ask what good the cold compress would do, if the patient was wearing knee-length leather or rubber boots, as worn by many in this country?

Would you recommend the application of a cold compress if this happened out-doors with the temperature somewhere around 15 to 30 degrees below zero?

Surely it would be better to apPZ'Y the bandage and then upon arrival at shelter to carry out the instructions as given on page 152. No doubt an X-ray would be necessary to determine if any of the tarsus, metatarsus or phalanges were broken.

The treatment as shown on page 151 qf the Textbook seems to me just a revival of the treatment for sprain5 as shown on page 83 of the 38th Edition, 1928.

The Textbook is used for the purposes of instruction in all parts of world and it is possible for a crushed foot to occur in a desert where, even if water were available, it would evaporate from the bandage very quickly. It is not possible for the Textbook to cover all exigencies, and it is expected that students will modify the instructions to meet local conditions. In the case quoted by you, therefore, the knee-length boot should not be removed and the cold compress should be omitted.-N.C.F.

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'IMMENSE OPPORTUNITY FOR AMBULANCE WORK'

Lady Mountbatten Talks about Her Overseas Tour

The Countess Mountbatten of Burma, Superintendent-in-Chief, St. John Ambulance Brigade, who had just returned from a 40,OOO-mile tour of Mrica, India and Burma, gave an interview to the press at her London home recently, and spoke of the Colonial Office's remarkable achievements in Mrica and the immense opportunity for St. John work in this field.

Lady Mountbatten's charming and lively personality is known thro ughout the ambulance movement, and her tour has obviously given a great fillip to the ambulance work in East and West Africa, where she has been able to see for hers elf the problems to be faced, and has brought home, it was quite obvi ous, a sound appreciation of the task to be done, and the way in which St. John can help to do it.

The tour of East and West African terri tories was undertaken at the req uest, and in collaboration with the Colonial Office, and .Lady Mountbatten spoke warmly of the rem arkable work in education and pub lic health which is being done out there. There is a great deal the ambulance movement can do, and while much has been achieved,

it is a drop in the ocean in the face of the great task ahead. All sorts of suggestions had been put forward as to the part the St. John's movement could play in this work. There is a big youth movement, and Lady Mountbatten spoke of the keen enthusiasm of the Africans, especially the women, who, only two or three years ago, had been completely unemancipated.

Turning to Burma, Lady Mountbatten said that there was a very strong organization there, known as the Burma Ambulance Corps. Hospitals had been improved enormously, and as evidence of the progress being made Lady Mountbatten mentioned that day nurseries had been started-a revolutionary idea as far as Burma was concerned. In India she had been astonished at whaf had been done. In the Delhi area, for example, the hospital accommodation had been doubled. The Indian authorities had taken a realistic attitude, and one of the measures introduced was a degree in nursing at the universities, which had improved the whole status of nursing. There is, of course, a strong ambulance and nursing movement in India.

Asked what we in this country could do to help the work Lady Mountbatten mentioned the adoption schemes which provided a link between home and the communities overseas. She added that in all this work St. John were working closely with the Red Cross.

If you are a logical person .••

Diseases of Kidneys

by A. D. Belilios, M.B., B.S. (Lond.), D.P.H. (Eng.)

THE recent publication of the 40th edition of the S.J.A.A. Textbook on First Aid made it necessary to suspend temporarily the articles on elementary medicine. It would be a pity, however, to leave this subject uncompleted, hence this month the series will be continued and devoted to diseases of the urinary system. As is customary, a brief description of the anatomy and physiology of the organs concerned precedes the diseases which affect them.

The function of the urinary system is to excrete urine of which from two to three pints are passed daily by the average adult. The quantity is increased by drinking and also by cold weather; it is reduced in hot weather and by exercise since these factors increase the amount of sweat hence more fluid is lost from the body through the skin.

The urine consists largely of water dissolved in which are various impurities such as urea and uric acid that have been produced by the tissues in the course of their action. These waste products must be removed if the body is to remain healthy.

The essential organs of the urinary system are the kidneys, two in number. They are situated on the back of the abdomen just below the level of the liver, one on either side of the spine. It will be noticed that their position in the abdomen is rather higher than most laymen normally appreciate. Backache occurring most commonly in the lower part of the back, therefore, is not often due to kidney trouble, as is so generally supposed, but to another ailment such as rheumatism or lumbago.

Each kidney is of a darkish red colour and measures approximately 4 in. in length and 2 in. in width and thickness. It is surrounded by a pad of fat which protects it from cold

and injuries and also serves to hold it in position. The inside of the kidney consists of a solid portion and a cavity. The solid portion consists of numerous small tubes, or tubules as they are called technically, made of cells. They are in close association with a capillary network which brings blood to the kidney to be purified. The cavity is known as the pelvis of the kidney and leads to the ureter which is a fine tube about 10 to 12 in. long running down the back of the abdomen and pelvis, finally entering the bladder. Each kidney having excreted its urine discharges it into the ureter along which it is conveyed to the bladder.

The bladder, rrade of muscle and lined by a mucOus membrane, lies in the front of the pelvis and when empty or even moderately full is well protected from injury. The bladder is normally described as being pearshaped in appearance with the stalk of the pear directed downwards where it leads into the urethra which is the passage that leads to the outside skin. The bladder acts as a reservoir for the urine in the intervals between micturition. It holds from 10 to 20 ozs. of urine.

Diseases of the Kidney

Inflammation of the kidney is called nephritis; it may be acute or chronic. Acute nephritis is liable to occur as a complication of tonsillitis or scarlet fever and sometimes results from severe burns, particularly those which have involved the abdomen.

The complaint begins suddenly with a rigor. There are the usual symptoms and signs of feverheadache, pains in the arms, legs and back with shivering and sweating. The urine is greatly diminished in quantity, highly coloured and frequently contains blood. It also contains large quantities of an abnormal ingredient called albumin.

A characteristic feature of the

FIRST AID & NURSING, MAY/JUNE 1951

article. A characteristic feature is increased frequency of micturition which means that the patient has to pass urine more frequently than is normal. This is noticed most particularly at night. The.re is an increased output of unne which tends to be paler than normal. The disease may last for many years but t he patient is liable to complications _ such as uraemia and cerebral haemorrhage (apoplexy).

and signs are very similar but the complaint develops slowly and is of longer duration. Cheyne Stokes respiration, attacks of shortness of breath at night and drowsiness are the main symptoms. Digestive disturbances are of frequent occurrence.

Stone in the Kidney

Surgeon-in-Chief dies on Confe re "ce

complaint is oedema or drops y which first affects the eyelids of the patient causing them to become extremely swollen to such an exten t that often in the mornings the patient cannot open his eyes. Oedema of other parts of the body may follow. In a satisfactory case, there is rapid progress toward s recovery but there is always a ris k that the disease may become chronic

The two main varieties of chronic nephritis are called parenchymatous and interstitial respectively. Thes e complaints are described by variou s authorities under different names.

In chronic parenchymatou s nephritis the kidneys are very much larger than normal and are of a pale colour. The patient develops extensive oedema involving not only hi s eyes and face but often a large amount of his body. Thus th e abdomen may become enlarged an d contain an excess of fluid, a condition known as ascites, whil e fluid in the pleural cavity may caus e difficulty in breathing except when the patient is sitting up in bed.

The disease is often progressive and may last for many years. Goo d results in treatment are sometimes obtained by diet giving the patien t liberal quantities of protein-containing foods, such as lean meat an d eggs, fish, etc.

In chronic interstitial nephritis th e kidneys become smaller than normal. Frequently they lose their smooth appearance, becoming rather granular to the touch. The condition may arise as a result of primary ailmen t of the kidney itself or through disease affecting the blood vessels which supply the kidney such as occurs in arteriosclerosis.

The disease develops very gradually and often for many years the patient is unaware that he is suffering from any complaint. Usually the first symptoms that he notices are those of high blood pressure which ha ve been described in a previous

Uraemia

When the kidneys become seriously defective in their function and fail to excrete satisfactorily,' toxic substances such as urea which would n ormally be removed from the body in the urine accumulate in the blood an d may set up uraemia. This co ndition may be acute or chronic.

Acute uraemia develops rapidly. T he patient frequently complains of he adaches and giddiness and also sy mptoms and signs of dyspepsia in th e form of hiccups and vomiting. Sometimes there are fits rather si milar to those of epilepsy but u sually the patient becomes increasin gly drowsy and ultimately passes into a state of coma. _

A peculiar form of breathing often ' occurs in cases of uraemia. It is called Cheyne Stokes respiration. So metimes it is noticed in other for ms of unconsciousness, such as cerebral haemorrhage while it also occurs in certain kinds of heart dis ease, e.g. chronic cardiac failure. It i s important therefore that every firs t-aider and home-nurse should be able to recognize this type of breathing.

Cheyne Stokes respiration is sometimes described as a 'regular irregular type of breathing.' If the ob server listens carefully, at first it will appear that the patient has entirely stopped breathing. Soon, however, a very shallow breath is ta ken, followed by one that is a little deeper. Each breath that follows is a little deeper until finally a deep in spiration occurs. Following this m aximum, however, each successive breath becomes more and more shallow until once again the breathing stops entirely. After a sh ort pause the cycle continues.

In chronic uraemia, the symptoms

This is called technically a renal calculus. One or more stones may be present and are generally situated in the pel vis of the organ. As to causes very little is known. It is generally assumed that for some reason or other a sediment from the urine forms a small crystalline body. Once this has occurred, the stone gradually increases in size as other deposits are formed upon it.

Symptoms and signs may be very variable; sometimes the patient may be unaware that he has a renal calculus for many years. Another may be liable to attacks of pain in the region of the loin; these are associated with frequency of micturition and sometimes a temperature.

A dramatic complication of a renal calculus occurs if a small stone endeavours to find its way down the narrow ureter. In this event the patient develops an attack of excruciating pain known as renal colic. The pain occurs in the back and side around the affected kidney. It is referred to the front of the abdomen and downwards to the groin and inner side of the thigh. The patient feels that he wishes to double himself up while there are symptoms and signs of shock, including vomiting; frequency of micturition generally accompanies the attack but only small quantities of urine are passed and these sometimes contain blood.

The duration of an attack of renal colic varies from a few hours to several days. It may end as suddenly as it began. Often the stone slips back into the pelvis of the kidney; occasionally if small it may find its way along the ureter into the bladder. It is a serious complication, however if the stone remains stuck in the or impacted as it is called. In this event, an operation may be urgently necessary to save the function of the kidney.

The Harrogate Conference of the Surgeons and Nursing Officers of the st. John Ambulance Brigade at Harrogate at the end of April was marred by the sudden death of the Surgeon-in-Chief, Mr. F. H. Edwards, F.R.C.S.(Edin.) On Saturday, 28th April Mr. Edwards had presided at the official dinner and had made a splendid speechmodest, sincere, and witty-with no apparent sign of ill-health. Early on Sunday morning he died. His death has been a great blow , for he was liked by everyone who came into contact with him, and his knowledge and humanity were great assets to the Brigade. He was appointed Surgeon-in-Chief in January of this year, and before that had been Deputy Surgeon-in-Chief. Mr. Edwards was an eminent gynaecologist and obstetrician. He took up work with the Brigade in 1928 as Surgeon to the Shrewsbury Division, and was later Corps Surgeon, then County Surgeon for Shropshire. In 1947 he became Commissioner for the County. A memorial service was held at St. Chad's, Shrewsbury, on 2nd May when Lord Forester represented the Order of St. John, and Lady DunbarNasmith, Deputy Superintendent-inChief, represented officers of Brigade Headquarters.

UNION BUXTON TROPHY

Casualties Union invites entries for the annual open competition in diagnosis and first aid, which will be decided in London on Sunday, 7th October 1951.

The competition will be realistic throughout. Copies of the rules can be obtained by sending a stamped addressed envelope to the Hon. Secretary, 29 Whyteleafe Hill, Whyteleafe, Surrey: last date for ordinary entnes IS the 31st August 1951 (although entries will be accepted until 7th 1951 if accompanied by a speCIal late fee).

Bed Cross Exhibition

THE British Red Cross Society's exhibition of the work of the Red Cross was visited by the Prime Minister on the opening day, May 8th-anniversary of the birthday of Henri Dunant. The exhibition is being held in the Boardroom of the London headquarters of the B.R.C.S., and remains open until September 28th.

The exhibition shows a complete record of the work of the British Red Cross in war and in peace. Work for the sick and wounded Serviceman in civilian hospitals, in the home, first aid on highways and byways, emergency relief, overseas branches work, Junior Red Cross international work, training. Ali these activities are demonstrated by means of beautifully and faithfully constructed models, made by members of the Society and not the of professionals, though that IS dIfficult to realize.

All this was inspected with great mterest by Mr. Attlee when he visited Headquarters. It was unfortunate that the sun was not shining, but the greyness of the weather accentuated the colour ·of the flags outside the buildings and of the uniforms of the

the first great thing about the Red Cross was the fact that it was international. 'War-time breaks down contacts and the Red Cross is ofte n the only thing that keeps any civilised contact at all. It is essential that those contacts should be strengthened in peace-time because the more the peaceful activities of the Red C.ross operate in differen t countries, the more the bond o f peace will be strengthened.'

The second great thing about the Red Cross was the fact that it was a voluntary organization and worked in with State and municipal activities Mr. Attlee said that both Lord Woolton and himself had, in the course of their lives, seen a great many activities pioneered by volunteers and taken over and extended by the State and municipalities. So far from that having done away with the need for voluntary effort, he thought that this need had increased, because, however good an official organization might be, it could never be sufficiently flexible to deal with all the changes that take place, and it was always difficult to attain the essential personal touch.

Me di c al New s: N ur s ing Film Strips

TWO film strips on eleme?tary nursing have been published by the Daily Mail in their Visual Aids to Teaching Series. They have been compiled from the lantern slides used by Doctor A. D. Belilios in his lectures on this subject.

Each film strip consists of approximately 25 slides which can be shown to an audience on a screen by means of a special projector. Supplied with these film strips is a small booklet

entitled Teaching Notes in which is given a full description on the subject of each slide shown to a class of students. A considerable amount of the syllabus of home-nursing is covered in these two film strips. There are pictures of the blanket bath, varieties of beds, nursing equipment, the nurse's report and many other subjects which can be illustrated by lantern slides.

* The Opinion

A MAXIM of first aid work is that the patient must be provided with the services of a doctor a s soon as possible; the first-aider is concerned with the immediate t reatment for saving life or preserving strength while medical assistance is coming.

Guard of Honour, composed of men, women and Cadets from the City of London, County of London, and Middlesex Branches of the Society. Lord WooIton, Chairman of the Executive Committee of the British Red Cross, Was at the door to welcome the Prime Minister, and after inspecting the Guard of Honour Mr. Attlee was conducted upstairs to the Boardroom. When he reached the first landing he paused to decorate Brian Banks, a Junior Red Cross Cadet from Sussex /29 with the Junior Meritorious Service Badge which he had been awarded for rescuing an elderly lady from the railway line at Eastbourne Station recently.

After being welcomed by Lord Woolton, who referred to the days when he and Mr. Attlee did welfare work, Mr. Attlee said that he had found his visit most interesting, because, although he had seen a good deal of the work of the Red Cross in war-time, he had previously had no idea of the extent of its activities in peacetime, and of all the developments which were depicted in the exhibition.

Mr. Attlee said that he thought

MORPHIA ON TRAINS

The Minister of Transport has said that it is not possible to amend transport regulations so that morphia could be included in the first aid equipment carried on all trains. He was answering questions in the House of Commons, following the widely reported suggestion by a doctor who was involved in the Doncaster railway disaster, that the guard's van should have morphia under lock and key for use in the event of accidents.

The Manchester Guardian, commenting on this matter, says that this is 'the sort of answer with which any efficient Government department will supply its Minister when something new and unexpected is demanded, it need not be taken as a last word on the subject. As for the security of the guard's van as a repository for small quantities of the drug, it could surely be made a good deal safer than some doctors' cars sometimes appear to be.'

The time interval between the occurrence of an accident and the m oment when medical aid is provided is obviously important, a nd all our training is concentrated on keeping it to a minimum. What must be the feelings, then, of the a mbulance workers when they find thi s vital period unnecessarily, and p ossibly dangerously, prolonged by officious Bumbledom ?

We refer to the widely-reported case of the Bradford five-year-old child who, after being badly burned, wa s taken by ambulance to three di fferent hospitals before being admitted. There can hardly be any good reason for this unhappy case, other than that dictated by the routine of organization which, one would have thought, is over-ridden in emergency.

But, apparently, such things as the ' bed state situation' can decide whether or not immediate medical attention is, or is not to be given, to a badly-injured person. People's lives can depend on these unimportant details.

_ The Bradford case may, of course, have been due to a genuine error of j udgment on the part of the hospital personnel, in which case the less

said about it the better. But the interest aroused by this accident shows how disturbed people are lest the State hospitals are in danger of becoming entangled in red tape. It seems unlikely, but the danger exists where hospitals' organization is controlled by statisticians who dislike their neat patterns being spoilt by emergency. Do we exaggerate the risk ? We hope not ; the fact remains that a badly injured person can be twice turned away from hospital and the medical care urgently needed.

and YOUfS

SIR, Are the judges making a farce of competition first aid? I submit, that by allowing to appear on their papers gross inaccuracies, and awarding marks for treatment that is contrary to that laid down in the Textbook, a few men are doing a great deal of harm to the Movement.

I can forgive the judge who, knowing that it was a police competition he was setting the paper for, awarded marks for, 'send for a policeman!" that caused much amusement but it showed lack of thought. The sort of thing that cannot be overlooked, however, is the paper set in a recent competition in which marks were awarded to teams who tied wet handkerchiefs over mouth and nose before entering a gas-filled room. To make matters

5

worse this judge, a doctor, by the way, in his criticism of the teams at the end of the competition said, , you must realise that it is dangerous to enter a room filled with gas, and you must protect yourself by tying a wet handkerchief over your mouth and nose. One team to-day tried to hold their breath and drag the man from the room by crawling on their hands and knees but I don't believe they could do it and I'm afraid that they would end in the churchyard and leave their wives as widows.' Apart from its bad effect on competitors, this is very dangerous talk for if anyone ever believed this learned doctor and placed faith in a- wet handkerchief to protect them from any gas that they are ever likely to come up against in peace-time there is little doubt that it would be they who would qualify for the coffin !

The Textbook is specific o n the subject and does state when a wet towel or handkerchief can be us ed but it is not for gas. Two further instances of bad papers used recently: in a competition for women police the patient had, among other injuries, a dislocated shoulder, and one of the signs given was Crepitus! Naturally , as soon as this was disco vered much valuable time was wasted by all the t eams looking for a fracture that wasn ' t there. I rather expect the judge wanted to stop competitors trying to move the arm (artificial respir ation was involved) but he ought not to have used Crepitus as a sign as it can mean only one thing and that, of course, is a fracture.

The next classic exa mple is where the patient has had a blow on the head and is unconscious, the eyes react to light but do not object to being touched and although the paper shows that the patient is in a state of coma he recovers jf a blanket is put under him early !

I could go on giving examples, but enough is as good as a feast, so may I close with the suggestion that with the coming of the new Textbook judges try and keep to it; also perhaps it would be a good if competition papers were exammed by someone else before use and mistakes put right.

Yours truly,

W. A. BARRETT.

MAIDA HILL, LONDON, W.9.

The Prime Minister with Lord Woolton passes through the Guard of Honour

Origin and Development of Day Nurseries

by Agnes E. Pavey, S.R.N., Diploma in Nursing (University of London)

HAVING discussed, in previous articles, the various aspects of trajning that is given to girls of 16 and over as nursery nurses, it may be of interest to consider how it came about that nurseries and nursery schools were first established, and the slightly different conditions and outlook that prevails in the various organizations. They were originally established, as were all movements to assist the worker, the distressed household, the homeless and the very poor, as the outcome of voluntary effort on the part of individuals who realized an urgent human need and were willing to give time, effort and often money to meet that need. Such movements have never been started by a Government, for voluntary organizations have an elasticity that is not possible in a State service. Their greater freedom and choice of action enables needs to be met more quickly and, when necessary, in an unorthodox manner. Only when the value of an experiment is solidly established can a Government or a local authority give stable support to a venture.

Development of Day Nurseries

Day nurseries, or creches as they were originally termed, appear to have been first started in France about 1844, as a result of the industrial development which led to the employment of married women in factories and workshops; and these French creches soon became very numerous. Some were well organized and were under the care of thoughtful and intelligent women working under the direction of a doctor; but many more were in the charge of ignorant and incompetent individuals, and they often proved to be hot-beds of infection particularly with regard to summe; diarrhoea-a disease that was responsible for a devastating mortality in nearly all countries during the nineteenth century.

English Day Nurseries

In England, day nurseries were part of a voluntary movement to protect child life by those who realized the needs of infants and young children whose mothers were unable, for various reasons, to care for them properly. During the war years they underwent great development and became a prominent factor in the organization of an urban community, and the majority of them were under the care of local authorities. In 1939 there were only about 100 such day nUJ;series in England. In 1945, tbere were about 1,550 and, in addition, some 400 residential nurseries had been established. The employment of women in industry, in hospitals and on the land rendered this great increase imperative. Not all of them have remained open. Probably about one-fifth were closed during the first two years after the war, and others followed suit as they proved to be unnecessary in a particular locality.

Present Organization of Day Nurseries

Every day nursery is now under the charge of a fully qualified nurse, with a staff of nursery assistants and nursery students. Most of them take about thirty children from the age of three months to five years, and often from 7.30 a.m. till 6.30 p.m. When first brought to the nursery each child is medically examined, and no ailing child is allowed to stay. Especially does this apply to a child with a heavy cold, for it is of paramount importance to prevent the spread of infection in a nursery. All children are subsequently inspected daily for signs of infection and for want of reasonable cleanliness; and they are weighed periodically. A record is kept of health progress and there is a special watch for commencing defects or deformities.

For the children between two and five years of age, who can be partly responsible for their own toilet, the proportion of wash basins should be one to six children, of water closets one to ten, and baths one to forty children. Hot and cold water are available and there are facilities for drying clothes. Each child has his or her own towel, toothbrush and other toilet equipment; and he is provided with his own portable stretcher bed for his afternoon sleep. In the cloakroom the pegs are not more than 3 ft. from the ground, with 12 in. between each. Every effort is made to establish healthpromoting habits. Meals are given, a balanced diet being arranged with an extra milk ration, cod liver oil and other special substances when required; in fact, the nursery provides a very happy routine of play, meals and sleep which is often followed by considerable improvement in health and spirits.

Finance

Usually the mother pays for the cost of food; but the rest of the expense is borne by the Ministry of Health or by the rates. Before the National Health Service Act was implemented day nurseries received a 100 per cent. grant from the Ministry, but since July 1948 the grant has been 50 per cent. As a result of this, many nurseries have had to raise the cost to the parents.

In twenty County Boroughs the average cost of a child in a day nursery was £2 lOs. Od. a week during 1949. This was higher than the cost of a nursery school; the reason being that infants need much more individual attention, especially in matters of personal toilet, and the laundry bills are considerably higher.

Need for Day Nurseries

Although primarily intended to care for the children of mothers who had to go out to work, day

nurseries have now become an integral part of the social provisions to help women whose husbands are sick or have deserted them; and also to help the unmarried mother who has been encouraged to keep her child but who must enter the labour market in order to earn her own living and to support the child. They are necessary, at present, to ease the housing situation, for there are still many families living in one ro om, for example in a large req uisitioned house, who could well affor d to rent a small house or flat if such were obtainable; and when the father is a night worker and must slee p during the day it is impossible to keep a small child in the room. The provision of day nurseries was inclu ded in all post-war planning schem es, especially in localities where it was proposed to build many -storied fiats. Many nurseries will take a child for a short period each day, in order to allow the mother to spend the necessary time in queues when doing the family shopping . They are excellent for , only' children, for they give ample opportuni ties for play and compani onship with other children. The great advantage of a day nursery over a residential nursery or a children's home is stated to be that the child remains, to a great extent, under the care of his parents, and thus the bond between parent and child remains unbroken. It is the child between the ages of one and four who needs to have one person to whom he indisputably belongs and upon whom he can constantly rely. If he is cared for all the time in a group of children of his own age and by constantly changing adults he loses the sense of stability and of his importance as an individual; and this may set the stage for him to become a problem' child as he grows older. Great changes have taken place in our knowledge and understa nding of young children in recent years, and our whole attitude towards child training and guidance has been modified accordingl y. This is seen particularly in the organization of residential nurse ries and children's homes-an acco unt of which will form the subject of the next article in this series.

*NEWS .FROM ST. JOHN

Mersey Docks & Harbour Board

On the evening of the 4th April 150 Dock Board first aid men attended a su pper which was presided over by Mr. R. J. Hodges, General Manager and Secretary. The first aid awards gained during the recent examinations were presented by the wife of the Chairman, and the evening terminated with six teams competing for a shield presented by the Board. The six competing teams were very keen and set a good standard. The winning team was one which had been entered by the Harbour Master's Department , and included Mr. T. W. Morris, Leader and Messrs. C. McCoy, J. Powell, E. Hulme. The test was staged by the Mersey Docks & Harbour Board (Ambulance Division) under the direction of Supt. W R. Clucas, B.E.M. The judging was by Doctors W. Duncan and G. G. W. Hay, who afterwards gave valuable advice to the assembly on competition work.

At a formal dress parade of the Division at the head offices of the Mersey Docks & Harbour Board on Wednesday, 2nd May, Mr. R. J. Hodges, General Manager and Secretary to the Board and President of the Division, presented to this year's winner, Pte. T. W. Morris, the A. G. Curry Cup, also prizes to Hon. Sgt. J. Campbell and Pte's T. W. Morris, J. J. Walsh , gained as runners-up in the Liverpool 'A' Corps Grace Trophy competition. Mr. Hodges was assisted by Mr. A. B. Porter, Engineerin-Chief to the Board; Mr. J. D. J. Saner, Assistant Engineer-in-Chief, Divisional Presidents; Captain J. A. Mackay, Senior Assistant Harbour Master; and Mr. T. E. Williams , the Board's Super visor of Labour Matters.

Presentation to Mr. W. H. Steel

Mr. William Henry Steel was recently honoured by the Barrow Ironworks whe:e he is chief of the ambulance and first aId service. Mr. W. Killingbeck , General Manager of the Company and President of the Barrow-in-Furness Centre of the St. John Ambulance Association, presented him with the Meritorious First Aid Certificate of the St. John Ambulance Association.

Mr. Killingbeck spoke of the accident at the works on the night of 5th / 6th November when a workman, Sydney Bannon , met with injuries, He wa,s struck by a

flying chisel causing severe injuries to the carotid artery, jugular vein and other bloodvessels.

By his instantaneous and skilful attention

Mr. Steel controlled the flow of blood and effected an expeditious transfer to the hospital.

The Company were appreciative of the manner in which this accident was dealt with by Mr. Steel, as a result of which Mr. Bannon, now fully recovered, was present at the function.

Mr. Killingbeck also presented Mr. Steel with a wristlet watch in honour of the occasion.

Tea was provided for the gathering and this was followed by a visit to a cinema by the ambulance staff.

Askern Main Corps

On Saturday 14th April the members of the adult Ambulance and Nursing Divisions of the Askern Main Corps held their annual social evening and presentation of awards for 1950. The guests included Area Officer E. Soar and Mrs. Soar, Area Officer M. LeBrun, Corps Supt. A. Wylde and Corps Supt. Mrs. Wylde, and Mr. and Mrs. C. H. Fenwick. Some of the guests were unable to attend owing to illness, these were Area Officer Mrs. LeBrun, Corps President and Mrs. Llewellyn Jones. Others who were absent owing to other appointments were Area Commissioner Dr. B. Hart, O.B.E., Area Officer J. Dearden and Mrs. Dearden.

Harlesden

The annual presentation of awards and trophies of the No. 135 (Harlesden) Ambulance Division took place on Saturday , 5th May in the of the Hon. President (the Mayor of WIllesden, Alderman F. G. Exton, J.P.), the Commissioner for the Western Area of London (Dr. G. R. H. Wrangham) and Mrs. Wrangham, Area Staff Officer A. E. Vaughan and Mrs. Vaughan Corps Staff Officer S. J. Green and Green, the Div. / Surgeon , Dr. H. M. Setna , Div. /Supt. J>:.. ;E. Hill. of Kingsbury Ambulance Dlv. / Officer Miss L. Po thus of Cncklewood Nursing Division, Councillor D. Donovan (Hon. President Harlesden. Cadet Division), together WIth many relatlves anc;l friends.

Inspired by the energetic efforts of the M.C., Mr. W. E. Langrish, the fun was 'fast and furious' all evening, and was halted only for the actual presentation of awards by Mrs. Vaughan (who kindly consented to making the presentations in the absence through indisposition of the Mayoress).

Miss F. Marsland, Worsboro' Divisional Superintendent Miss F. Marsland, aged 53 years, who was well known in the district for her long and distinguished service for the Brigade, and as a V.A.D. in the last died at her home on Friday, 20th Apnl 195 J.

A native of Worsboro', Yorkshire, she joined the Nursing Division as Ambulance Sister in 1916; she was later appointed

Cadet Superintendent, and in 1938 Divisional Superintendent. She became a Grade (1) A.R.P. Instructor, administrating for First Aid and Home Nursing Classes; she frequently acted as Captain in competitions. She attended camps at Rossell up to August 1939, and in September 1939, she reported for active service as a V.A.D., and later received the V.A.D. decoration and bar. She held the B.S.M. and three bars.

As a State Enrolled Nurse she was in charge of First Aid, Home Nursing and Handicraft Classes at the Worsboro' and Dodsworth Evening Schools for the past three years.

The Brigade provided a Guard of Honour and beare rs, there being some forty men and Nursing Sisters in attendance at the funeral service.

COMPETITION NEWS

National Road Passenger Transport Ambulance Association

London Transport were the winners of Southern Area Ambulance CompetitIOns, held at Plymouth on 6th May. City of Plymouth Transport came second followed by Cardiff, Aberdare, Portsmouth and Newport (Mon.) The first two teams • now qualify to enter the Final Competition for the 'Stirk' Trophy being held at Nottingham on 1st July.

All the teams were the guests of the City of Plymouth Transport St. John Ambulance Brigade Division and were entertained at a dance on Saturday evening, followed by a coach tour of the city and surrounding areas on the Sunday morning preceding the competitIOn.

The team test was judged by Dr. M. C. Cooper of Looe, Cornwall, and competitors had to treat an electrician suffering from electrocution, and injuries to his ribs arm hand and forehead. Other tests were by Dr. T. I. Sibbald and Dr. R. St. J. Narold, Plymouth.

Mr. G. Jackson, Plymouth Transport Manager, welcomed the guests at tea and presented the prizes. Mr. Alex J. Webb, General Supt. Staff and Training London replied and expressed' pleasure at bemg present and pride in that London Transport had won. Mr. S. W. Harden, First Aid Organizer for London Transport was also present.

Western Region, B.R., Competitions

Competitions have been held in each of the 16 districts of the Region, the total number of teams entering being 139 and eliminating rounds were at B,ristol and Newport. The teams whlch gamed the first nine places in the semi-finals competed in the final competition held in the Porchester Hall Paddington, on 1st May.

The tests were set by Doctor R. A. Dench, B.Ch. of York, Doctor W. L. M. Bigby, M.R.C.S., L.R.C.P., M.B., B.S. of Southampton, and Doctor C. T. Newnham M.R.C.S., L.R.C.P., D.O.M.S. of London: A large number of spectators including of. the Railway Executive and the ReglOn wItnessed the contest. The subsequent presentation of prizes a.nd trophies

Lady Forester Cup

Teams from North Devon and West SOf!1erset competed on 31st March, the trophy-the Lady Forester Cupbelllg won by the Taunton team which comprised Ambulance Officer A. Rosewarn , Cpl. P. Pinn and Ptes. S. Thomas and W Salter, with Hon. Sec. I. Bruford reserve : Pte. Thomas (Taunton) won the Hoerman Cup for the best individual performance and the Braunton team gained the Luttrel i Cup for the team with highest marks no t having previously won the Lady Fo;ester Cup.

Team placings :-

1. Taunton Division

2. Barnstaple Division

3. Braunton Division

4. Bridgwater Division

5. Minehead Division

British Railways and London Transpor t (Railways) National First Aid Competitions

1951

was presided over by Mr. K. W. C. Grand qhief Regional Officer, and the presenta: tlOns were made to the winning team by Mrs. Grand.

The result of the test was announced by the Regional Ambulance Secretary, Mr. P. Anstey, as under :Marks (Max. 630)

1. Swindon 'A' 529 (Winners of Challenge Shield)

2. Bristol D.O.S.O. 521t (Winners of Carvell Cup)

3. Taunton 471

4. Newport 'A' 466

5. Hereford Barton 444

6. Cardiff Docks 440

7. Barry 436t

8. Ystalyfera 433

9. Banbury 'A' 426t

The Henry Butt Bowl was presented to the Banbury' B team, who secured the highest position in Class 2 in this year's competitions.

Stanley Shield Competition

The finals of the Stanley Shield Competition, British Red Cross Society were held at Friends' House, London, 21st April. Results were :-

Stanley Shield for Women:

1. Angus (Scotland)

2. East Lancashire

3. County of London

Stanley Shield for Men:

1. Middlesex

2. Somerset

3. Bristol...

Hetherington Cup for Nursing:

1. Angus (Scotland)

Evelyn Wren Cup (Women) :

Mrs. E. Hammond, East Lancs

Georgina Morgan Bowl (Women) : Miss J. Cooper, East Lancs

Margaret Gordon Harker Cup (Men) :

The position in which the teams were placed in the Final Competition held st the Central Hall, Westminster, London, S.W.l , on 18th May, is as follows :-

Men:

1. Southern Region (Horsham No.1)

2. London Midland Region (Wolverton Works)

3. Western Region (Bristol D.O.S.O.)...

4. Southern Region (Exmouth Junction No.1) ... ...

5. Eastern Region (King's Cross Loco)

6. Eastern Region (Bishopsgate Goods)

7. North-Eastern Region (York C. & W. No.1)

8. North-Eastern Region (Dewsbury)

9. Western Region (Swindon 'A')

10. Scottish Regi?n (Motherwell)

11. London Mldland Region (Wyre Dock)

12. London Transport (Railways) (Lots Road)

13. Scottish Region (Falkirk) Max. marks obtainable

Women:

1. London Transport (Railways) (Broadway)

2. London Midland Region (Horwich)...

3. Scottish Region (Glasgow)

4. Southern Region (Dorking)

5. Western Region (Newton Abbot)

6. North-Eastern Region (Newcastle)

7. Eastern Region (Norwich) Max. marks obtainable

FIRST

AID & NURSING, MAY/JUNE 1951 9

We conclude from the last issue publication of an important article dealing with the effects of atomic weapons and the role of the Red Cross which appeared in the 'International Health Bulletin of the League of Red Cross Societies.'

FIRST AID IN ATOMIC WARFARE

With regard to the internal r adiation danger, it is not possible t o estimate the amount of radioactive material which may be ingested. Persons working where t here is most dust will be the most exposed. Children, because of their habits and closeness to the ground, would be expected to ingest more t han adults. As, moreover, the d anger of external contamination is complicated by the internal radiation danger, it is almost impossible to attempt to assess the possible u niversal contamination levels.

One point must be clarified for the public rescue personnel: Is radioactivity contagious ?

As regards radiation received at t he moment of the explosion (alpha, beta and gamma rays), the answer is no. Gamma rays are incapable of re ndering anything radioactive and victims can be touched without risk.

As regards radioactive dusts (fission products), the answer is yes, as these substances can fly around or be picked up by contact. But ra dioactive dusts are only to be fe ared after the so-called 'contaminating' explosions which would, no doubt, be exceptional.

Relief and detection personnel entering a contaminated area should we ar protective clothing.

Ordinary clothing is adequate protection against alpha and beta radiation. It is therefore preferable t o wear dungarees or smocks over the clothing. In washing-down operat ions, rubber clothing which can be washed and used over again should be worn.

If there is dust in the air, it will be necessary to wear masks. The type of respirator worn in the last two wars is satisfactory in preventing the inhalation of dangerous dusts.

Behaviour in the event of Attack

Let us suppose that the day of the bombing has come. What should be done? What is the duty of each individual ?

If warning is given :-

Put out the fire, turn off the gas and electricity. Shut all the doors and windows and draw the curtains. Go to the basement. If there is no basement, go to the central hall on the ground floor. Cover your neck, head and arms to protect them against flying splinters and flashburn.

If you are in the street, run to the nearest shelter or go into a house. If you are driving, pull up your car, leave the key and run to shelter.

In short :-

If the bomb explodes without warning, turn your back to the light ; throw yourself on the ground; protect your eyes, your head and your arms; assume the most suitable position for protecting the uncovered parts of your body. If you are out of doors, flatten yourself against a wall or a tree for protection against flying debris. If you are indoors, dive under a bed or behind a large piece of furniture.

Mter the bombing :-

As soon as you can, change your clothes. Take a shower, scrub yourself with soap and clean your nails and hair thoroughly to eliminate radioactive dusts.

Training of Personnel for Relief Services

As already observed, it is rare for a doctor or nurse, who can give immediate attention to the injured, to be on the spot when an attack takes place. The remaining medical staff is wholly inadequate to meet this circumstance and first aid by laymen, whose aid has always been admitted and appreciated, has hence taken on increasing importance. Efforts should be made therefore to give brief instruction to as man y persons as possible so that they may come into operation in the case of bombardment and ward off the danger of immediate death.

Red Cross duties in this connection are as follows :-

(1) To give right away summary first aid instruction to the largest possible number of persons and in particular to all those called upon to become Civil Defence personnel ;

Mr. S. Cheeseman, Middlesex

Lt.-Col. West Cup (Men) : 143

Mr. S. Suter, Middlesex ... 70

Middlesex won the Men's Shield for the second year running and Mr. Cheeseman the Margaret Gordon Harker Cup for the second <;onse<;utive time.

The distribution of prizes was presided by Lieut.-General Sir Henry Pownall (Vice-Chancellor of the Order)' the Challenge Shield and Corbet Cup (Men), the Challenge Rose Bowl (Women) and the individual plaques were presented by The Hon. Lord Hurcomb (Chairman of the Bntlsh Transport Commission).

Canvas boots should be worn over t he shoes and gloves should be p rovided. Ordinary cotton gloves are sufficient in most cases, but rubber gloves are preferable. A tight-fitting cap, of the type worn by surgeons, covering the hair as completely as possible, should be worn.

After the all clear, wait a few minutes before leaving the shelter. Do not eat food which was exposed, nor drink water which was not protected from radioactive particles (use tinned food and bottled drinks).

Keep calm, don't create a panic of which you would be the first victim. Render first aid to the victims near you. Help the rescue teams as soon as they set to work.

(2) To teach a large number of women and girls how to care for the sick and wounded, both at home or in first aid centres and emergency hospitals; teach the other duties necessary in training nurses' aids. Almost all the Red Cross Societies are already organizing first aid and nursing courses. They should be multiplied and the number of par ticipants increased. Not only classic first aid should be taught, but summary knowledge of the dangers and injuries peculiar to atomic weapons and modern projectiles should be acquired. The programmes and manuals on first aid and nursing should be revised and completed so as to conform to the requirements of modern warfare.

First-aiders only receive an elementary training; they are volunteers and for the rest of the time engaged in their private occupations Male and female nurses, on the contrary, are professionals and, in order to be able to carry out their duties, need more advanced instruction and training in the problems raised by modern weapons; in particular, radiation sickness, treatment of burns, blood transfusion.

The American and British Red Cross Societies are already helping to train civil defence personnel and to give higher atomic training courses to health personnel.

Organization of a full Blood Transfusion Service

This activity is well-known to the Red Cross, which in a great many countries is already responsible for the national transfusion service, while in others it helps the Government authorities (recruitment of donors , stocks, blood banks, sta ndardisation of equipment).

The Red Cross must develop its action in every country: by insistent propaga n da (prospectuses, articles, cinema, r adio) ; by mass determination of blood groups in the streets, in factories, administrations, schools, barr acks and working districts; by donor recruitment campaigns; by setting up blood banks.

First Aid Stations

Even in peacetime, the Red Cross directs first aid stations, dispensaries and emergency hospitals in almost every country. Its teams man the first aid posts during sporting events, on the bea ches a nd in the mountains. It therefore has extensive experience on which to draw in time of war. It ca n undertake the installation of first aid posts in the large collective shelters, in the underground corri dors, in towns and on the outskirts, in schools, public halls, hotels , etc. According to the means at its disposal the Red Cross can even build special first aid posts Earlier on we described what type of premises would be required so that such a post could resist atomic bombardment. The Red Cross network of highway first aid posts, its maps and equipment could be used. Emergency services such as those that exist in several Red Cross Societies should be established everywhere. They can come into action instantaneously in case of disaster 1

though for atomic bombardments they must be developed and strengthened. The variety of tasks to be performed necessitates some measure of specialization-teams of first-aiders, relief detachments and columns. Certain services will be entrusted exclusively with rescue work, others with transport of the injured, others with evacuation of the able, rapid communications, etc. Medical equipment, ambulances and other vehicles, must be perfected and stocks increased.

An example of ingenuity is to be found in the action of the Swedish Red Cross, which concluded agreements with the taxis in large towns and pays for their transformation so that they may, if required, be used as makeshift ambulances. By a slight modification of the back seat a stretcher can be introduced via the boot.

Red Cross action must be very rapid if it is to be effective. Leaders and auxiliary personnel must therefore receive regular training and arrangements be made to enable quick mobilization. National and regional co-opera tion in first aid must be generalized in each Red Cross Society. Competitions should be organized on the international level among a djacent national Societies.

We will only mention the Red Cross Services attached to the Army in passing. As stated above, it is the civilian populations which will need the Red Cross more than anyone in an atomic war.

Training and use of Young Members

Young people in certain countries, such as the United States, have already been initiated into the pacific uses of atomic energy by their teachers , and by documents and exhibitions which they can understand.

In our opinion t hey should also be taught the dangers of this energy, despite the fact that we should infinitely prefer to prepare children for living in a united and peaceful world. But the fact remains that the world, alas, is not peaceful, and children must face facts. They must know the elementary precautions for protecting themselves in case of atomic explosion. The older ones must be ready to take part in rescue work. This instruction can be added to their health and first aid pro gratnmes,

School children, members of the Junior Red Cross and young people in the overeighteen group could take part in the work of rescue and evacuation teams, in ambulances and hospitals.

To give them a task to perform on the spot would limit the danger of the sight of the catastrophe provoking a dangerous psychological shock.

Summary

In brief, Red Cross work in face of the possibility of a modern War includes three successive phases :-

(1) Preparatory phase: advance arrangements with public authorities; instruction of the general public; training of relief personnel ; training of medical personnel ; organisation of a national blood service; establishment of first aid posts; formation of emergency services and relief columns; social service activities; increase of stocks ; training and use of children and young people, etc.

The efficiency of the second phase will depend on the satisfactory execution on the first phase .

(2) The emergency phase when bombing occurs. According to its possibilities and the training of its personnel, the Red Cross mus t assume the emergency measures with which it is entrusted: rescue work, first aid and evacuation. It s volunteers, first aid teams, nurse s and doctors will have an important task in the organization of first aid posts, emergency hospitals, evacuation of the sick and injured, digging out those buried under ruins and organization of shelter-life.

After the bombing, the Red Cross will co-operate in fire-fighting , detection of radio-active zones, the supply of relief to victims, the supply of medicines and indispensable clothing, in evacuating the population and burying the dead , etc.

(3) Once past the emergency period , properly so-called, the Red Cross could also be entrusted with looking after victims, refugees and their families in temporary camps and lodgings, their registration , relief appeals, organization of an information service for these people, and press and radio releases keeping the public informed of the exact situation of the victims and of their needs,

In the treatment of sprains

A real waterproof canvas tent. seconds, making hardest form or seat com- Portable but very stout cloth. Comfortable and soft. For holidays, motorists, plete with all access., inc. valise. 22/6 inval ids or office use 3 for 15 - Post free. dep., bal. 25/- mthly. Carr. 5/-. Th e " FAMILY TENT." White duck. Complete with flysheet. 14ft. x 14ft x 7 ft h igh, 3ft. walls Every inch of this tent can be used 25 gns. or £4/4/0

NOTES FOB

FIRST AlDERS & NURSES

British Empire Campaign against Blindness

Readers must have been amazed and appalled in listening to the broadcast given by Lord Halifax on the eve of Empire Day to mark the opening of the British Empire Campaign against Blindness; for he revealed that no less than one million people in the British Colonies are blind and that, in addition, 10 to 15 per cent. of the general populations suffer from diseases of the eye. Three-quarters of these diseases are preventable, and yet a great number of people go blind every year for lack of simple treatment or from ignorance of the elementary rules of ophthalmic hygiene. Very little is at present being done to help the blind in the Colonies to become self-supporting, so that most of them are dependent upon their families or become wandering beggars. Many of the diseases that lead to blindness among these peoples are accompanied by terrible pain, which persists long after the sight is completely lost.

The objects of the campaign are to study the ' diseases that cause blindness in the various countries, to help each Colony to find the best means of preventing and of treating these diseases, and to assist those who are already blind to become self-supporting by teaching them suitable trades. Through the media of the film, the wireless and the printed word it will teach the people how best to preserve their own and their children's sight; and it will set up research centres, eye hospitals and clinics. It is hoped to give training to blind people from this country who are willing to go out to the Colonies to teach in special schools. These schools have yet to be established and provided with Braille books on all the necessary subjects ; , and then an employment scheme must be developed so that suitable posts may be found for all blind people who are qualified to fill them.

Training of Nursing Cadets in Hertfordshire

An excellent Nursing Cadet Course was commenced by the Hertfordshire County Council in 1942, and was reorganized several years later when the school-leaving age was raised. The present course is intended for girls from 15 to 18 years of age. Three days of each week are spent at Watford Grammar School for Girls, the subjects taken being English, social studies, arithmetic, science, art or crafts, music, physical training and religion. Apart from the general cultural value of this course, the teaching of all the subjects is related as far as possible to nursing training and work. In the second and third years more time is given to science, so that anatomy, physiology and hygiene can be included, and art or crafts replaced by domestic science. During the first year the Cadets spend two days of each week in day nurseries or nursery schools, where they are supernumerary to the established staff. They receive instruction from fully qualified teachers and nurses, and they carry out all the practical duties that are necessary for the health and comfort of small children. During the second year more advanced nursery work is undertaken and some of the time allotted to practical work is spent in infant welfare centres, minor ailment clinics or school dental clinics. In the third year, instead of work in nurseries, the Cadets go to hospitals, working in the kitchens under qualified dieticians, in the Nurses' Home or in the children's wards; but they are not allowed to assist with any nursing treatments. Weekly visits to other hospitals, to factories and to public utility services, such as waterworks, sewage-disposal plants or milk-bottling centres, help to widen their understanding of the theoretical instruction they receive in school.

The Nursing Cadet Course is recognized by the Ministry of Education as full-time education,

the Cadets wear the school uniform and join in all the school activities and sports. They are supplied wi t h overalls for their practical wor k. They have the opportunity of sitting for the General Certificate of Education in English and biology, and they are entered for Part I of the State Preliminary Examination of the General Nursing Council. All Cadets receive a maintenance allowance and their fares are pa id when they visit nurseries, hospitals or places of interest in connectio n with their studies.

The Stanley Shield Competition

A very high standard in first ai d and home nursing was shown i n the final round of the Stanley Shiel d Competition. It was held at Friends' House, Euston Roa d, before a large and enthusiastic audience. The scene of the contest for women was a bedroom where preparations were being made t o blanket-bath a patient with acut e sciatica. From the bedroom coul d be seen a well-furnished kitchen with a garden path leading up to th e door and a woodland scene in th e distance. Some commotion occu rring at the gate revealed the fa ct that the small daughter of the house, in running round the corner, had collided with an ancient pedla r and both had fallen and sustained injuries. So the blanket bath had t o be postponed whilst first aid was given to both the injured person s.

The excellent make-up and actio n of the members of the Casualty Acting Union rendered the presentation of the accident most realistic . The winning team was from Angu s IV, and they also won the Hetherington Cup for Nursing.

In the contest for men the scene was a pleasant country road where a car accident had just occurred, tw o male casualties receiving severe Injuries. The winning team was Middlesex 211; and the coveted awards to both men and wome n were presented by Lord Woolton.

The Dangerous Housefly

In spite of the tardiness of sprin g our English summer appears to hav e arrived, with its hey-day for lliesthe filthiest insects known. The y feed on the excreta of animals an d men, and also on any obnoxious o r

(continued on page 16)

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Queries and Answers to Correspondents

A Cockney's Comment

I. B. (Highgate).-Did you see the recent comment on the work of the Brigade which, on the occasion of the Royal Drive to St. Paul's Cathedral, was published in a leading London daily paper and which stated that a Cockney in the crowd, seeing the work done by St. John men and women, was heard to exclaim, Gor! Blimey !! the St. John Nurses are doing a roaring trade in fainting lVomen !' Good! Next please! !-N. Corbet Fletcher.

Examination Howler

N. O. (Plymouth).-In a recent Brigade examination, which was conducted on the 40th Edition of the Textbook, the surgeon asked one candidate to define a dislocation. He was considerably swprised when the member replied: 'A dislocation is the replacement of a bone outside a joint! '

Good! Next please! !-N.C.F.

Fractures of Humorus and Clavicle

P. N: (Harrow). - Please tell me how we should treat a patient who is suffering from simple fracture of left clavicle and compound fracture of left humerus. With such a combination of injuries shock will almost certainly be marked; and the patient will require removal on stretcher. Of the two injuries the compound fracture of the humerus is the more serious from the first aid point of view and demands priority in treatment. In these circumstances, if I were the first-aider, I would concentrate on its treatment, contenting myself with dressing the wound, with keeping the patient recumbent and the left upper limb in close contact with the body whereby the danger of aggravating both fractures is eliminated.-N.C.F.

Fractured Ankle

S. Y. (Cardiff).- We often hear that a patient is suffering from a fractured ankle, and are surprised to find that the Textbook does not recognise and describe the treatment of this injury. So once again we shall be grateful for y our kind help.

The term 'fractured ankle' is usually applied to fractures of the lower end of tibia and / or fibula at the ankle joint. Consequently the treatment should be as laid down in Textbook for fractured leg.-N.C.F.

Treatment of Insensibility

L. O. (Hounsditch).- We are taught to turn the head of an insensible patient. If the cause of the insensibility be apoplexy (which condition results from rupture of a diseased bloodvessel) is there any rule as to which side we should tum the patient's head? We await your kind solution of our problem and thank you in advance.

In cases of insensibility the patient's head is turned to one side or the other, lest he should vomit during the period of recovery. If he should do so before complete recovery of consciousness, there is a risk that some of the

vomited matter may pass backwards and cause asphyxiahence the instruction to turn to one side, and to keep so turned, the head of an unconscious patient. The fact that patient may be suffering from apoplexy does not affect the position of the patient's head.-N.C.F.

Humour in First Aid

M. A. Oxley, Commandant of the West Riding of Yorkshire 141 Detachment, B.R.C.S., writes: At a Boy Cadet examination held this week one candidate aged about 10 was asked by the S.R.N. what he would do if his little sister cut her hand on a tin. He replied, , I should fetch my mother-she's a nurse.' Thinki"!Jg to give him another chance, she asked, What would you do if she had been burnt ?' 'With my mother being a nurse I should send for her again,' was his firm reply.

Good! Next please! !-N.C.F.

Treatment of Epileptic Fit

S B. (Penarth). - Please tell me if we first-aiders can by any means prevent the onset of convulsions as part of our treatment of a patient who is passing through an epileptic fit.

The convulsive movements must run their course. An epileptic seizure is a 'brain storm' which is due to the sudden failure or loss of control of the highest brain centres. The outstanding symptom is sudden and complete loss of consciousness. This may (or may not) be followed rapidly by convulsive movements, interference with which is inadvisable, because it may create an unconscious resistance by the patient.-N.C.F.

The Textbook to which reference may be made in this column is the 40th (1950) Edition of the S.J.A.A. Manual of First Aid to the Injured. Correspondents are requested to write on one side of the paper only.

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'This dictionary keeps its place in the front rank of such publications can be unreservedly recommended to all members of the British Red Cross, and the Saint John Ambulance.' British Red Cross Quarterly Review.

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TOPICAL NOTES

(continu ed from page 12) rotting material, all of which contains germs. They deposit vomit and faeces on everything on which they alight- and everyone knows the attraction of the fly for the sugar bowl, the bread, the jam, the milk and the cheese ; all of which are foods th a t a re eaten uncooked. Foods contaminated with only a few germs provide an excellent medium for their incredibly rapid growth and multiplication, especially if moi st and kept in a warm room. The diseases that may be spread by typhoid, paratyphoid, epldeIDlc dIarrhoea, dysentery , poliomyelitis, tuberculosis and anthrax. The Ministry of Health Advice Note 2/ 51 contains practical suggestIOns for dealing with this menace. Breeding places are any moist and decaying matter, and a fly lays up to ten batches of 120 eggs each seas on . So k eep dustbins covered and see th a t they are emptied at least once a week Carefully inspect vegetables in store and remove any that are beginning to rot. Wash out empty milk bottles at once. Screen windows of larders with fine wire netting and keep the door shut.

The mother who sets her table in advance and leaves bread butter jam, sugar and milk unc;vered asking for trouble. The destruction of flies is a simpler task than it was a few years ago, for the spraying of rooms with Gammexane or D.D.T. will kill all flies in an hour or two. It is not necessary to spray all the waUso.nly such areas as windows, window SIlls and Jampshades. Care must be taken to extinguish all fires and naked lights before spraying with an oily substance.

STOP PRESS LETTER

DEAR SIR,

In connection with the article in the March /April issue of your paper entitled 'Sir Otto Lund Calls for Recruits,' I think perhaps you and he might like to hear the following: My son joined the st. John Ambulance Brigade in the year 1949. Later in that same year I commenced attending parade nights with him at the headquarters of the 17th (Wimbledon) Division. I passed in First Aid in December 1949 and Home Nursing in March 1950, at which latter date I was only

FIRST AID & NURSING, MAY/JUNE 195 1

years of age and young for that. I applied for membership to th e Division and was told by letter from the Divisional Secretary that I wa s too near the retiring age to b e considered as a candidate. My reason for applying for membership was twofold. One was becaus e I was interested in the subject ; another was that I could keep company with my son at variou s functions on duty.

If this is the attitude adopted by Divisions all over the country, do you wonder that it is necessary to make special appeals for recruits ? Surely I am not considered too old even at my present age, which is 58t years.

I should appreciate a reply to thi s letter with some indication as to whether or not the attitude of the local Division is endorsed by Brigade Headquarters and if not, whether you think my application fo r to a neighbouring DIVISIOn IDlght be considered if I decided to risk another refusal.

Yours faithfully, F. W. DUNMAN

13 COURTHOPE VILLAS, WIMBLEDON, LONDON, S.W.19.

of SHOCK

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The whole of our wide experience in all these specialised spheres is at the service of our c.lients, and enables you to place the commission of your orders in our hands having entire confidence that the completed job will be the best of its kind.

DYSMENORRHCEA

ARE the stars in their courses any more mysterious than the recurring cycle of the menses? As regularly and predictably as the phases of the moon, the average uterus sheds its endometrium every twentyeight days and the average woman experiences discomfort, pain and depression.

Measurable relief from these symptoms of dysmenorrhrea may safely be obtained at every period with ANADIN tablets. Anadin combines the benefits of two pain-relieving compounds with those of two mild stimulants. Anadin is not habit forming and is quite safe for self-administration by the patient in the prescribed dosage.

Two to four tablets, according to severity of symptoms, repeated every four hours as required.

a

If yo u a r e logical pe rson • ••

Then you will follow this point-by-point argument and reach the same conclusions as so many doctors, nurses, hospitals and clinics have done.

DO YOU AGREE ... that the causes of most skin infections are the common strains of STAPHYLOCOCCI, STREPTOCOCCI and B. PYOCYANEUS ?

IN THAT CASE . .. a treatment which is effective against all three will be indicated for cuts, abrasions, burns, scalds, boils and most inflammatory skin infections?

THIS IS THE TREATMENT

ANTIPEOL Cutaneous Vaccine Ointment contains the sterile vaccine filtrates of the three micro-organisms mentioned. The filtrates destroy the actual micro-organisms and at the same time act as a local immuniser against re-infection. This is a

purely biological action and there is no damage to delicate tissues_

RAPID HEALING is further expedited by the ointment base of proved efficiency. For burns and scalds, ANTIPEOL has special advantages. It is microbicide and non-adhesive. Therefore dressings do not have to be changed every day_

AND HERE IS THE PROOF.

Antipeol Ointment is proving and reproving itself every day in dozens of surgeries, clinics, hospitals and homes. Letters from the medical and nursing profession bear convincing testimony to its effectiveness.

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Be d Cross at St. s

T HERE was a colourful and impressive scene at St. Paul's Cat hedral on Friday evening, 20th Ju ly, when some 3,000 members of the Red Cross Society gat hered from all over the country to attend the annual service of dedication.

Outside the Cathed ral a Guard of Ho nour was formed of men, women an d cadets from the City of London, Ke nt, Middlesex, County of London, Sur rey, Essex and Hertfordshire bra nches, while a Red Cross band fro m the Fareham Division of the Ha mpshire branch played before an d after the service. This band is co mposed almost entirely of exRoyal Marines who are now membe rs of the British Red Cross Society_

Colour parties comprised members from Oxfordshire, City of

London, Gloucestershire, Middlesex and Somerset.

The Princess Royal, Commandantin -Chief, was greeted by Lord W oolton, Chairman of the Executive Committee of the Society ; the Lord Mayor of London; the Lady Mayoress and Sheriffs. As Her Royal Highness entered the Cathedral she was welcomed by the

Dean and Chapter The address during the service was given by the Rt. Rev. E. S. D.D., Bishop of Lichfield.

Before the service, some 400 members of the B.R.C.S., chosen by ballot, had tea at the Mansion House, where they were joined by the Princess, Lord Woolton and the Lord Mayor.

Diseases of the Urinary System

by A. D. Belilios, M.B., B.S. (Lond.), D.P.H. (Eng.)

THE la st article in this series described some of the commoner ailments which affect the kidne ys ; this month the diseases which a ffect the urinary system will be concluded and an opportunity tak en to mention some of the more import a n t accidents which may affect t he se orga ns .

Injuries to the Kidneys

These fortunately are not common. They are generally called by t he run o ver accidents,' crushes, e.g. bet ween tw o hard objects such a s buffers , or being struck in the 10m. Occasionally they result from a n external wound, for example that cau sed by a stab or bullet.

p atient complains of severe pam 10. the region of his kidney. Bo t h his abdomen and loin are tender to the touch . In the latter region a n ob viou s swelling may develo p bei ng caused partly by blood and by urine which has esca pe? from damaged organ 10 the unne, or haematuria as It IS ca ll ed, is not uncommon.

A s wo uld be expected, there is a severe degree of shock.

T his may be followed, sooner or later , by t he symptoms and signs of from an internal organ

It IS Important therefore that the first-aider should keep a careful watch. on the patient's pulse and S? the early signs of complicatlOn can be readily dIagnosed.

First aid for shock should be a dopted? but if there is the slightest SIgn of lOternal haemorrhage fluids

In any' event, It 'UnwIs.e t? gIve more than sips of Simple liqUids such as water since an .operation will probabiy be requlfe? to repair the injured kidney.

If s",:elli!lg develops in the loin, cold may be of value. When IS a wound leading down to the kidney, It should be treated on general principles

Pyelitis

This disease consists of infiammation affecting the pelvis of the kidney. It will be remembered that this is the cavity of the organ that leads into the ureter. The condition is generally caused by infection with germs which reach their destination the lymph or blood supply ; sometimes, however, the germs reach the from the bladder by ascendmg the ureter. Pyelitis is not uncommon during pregnancy.

The onset of the disease is usually sudden, beginning with a rigor, the temperature rising to 103 or 104. The patient complains of pain in his loin which is referred to the front of his abdomen and even downwards along the course of the ureter in a manner similar to that which occurs in renal colic. Often there is increased frequency of micturition which means that the patient has to pass urine much more frequently than normal.

There are the usual symptoms and SIgns .of fever, for example, loss of appettte, a tongue, sweating, aches and palOS and constipation. But the characteristics can be very variable as they are dependent on ' the cause upon which the treatment Penicillin and special vanettes of the sulphonamides are used by doctors for the treatment of this complaint which generally responds quickly.

Cystitis

. This the term applied to InfiammatlOn of the bladder. It is by infection with germs; thIS IS accompanied with some vanety of lowered resistance 1n the bladder, for example, the presence of a stone. Characteristic are painful and frequent IDlctuntlOn; there is also pain in the lower part of the abdomen over the region of the bladder. The general condition of the patient usually remains good although there

may be a slight rise of temperature loss of appetite and a general feelin g of fatigue.

A stone in the bladder causes similar characteristics to those The. pain is aggravated b y exerCIse particularly if this involves jolting of the body. A characteristic feature is that the patient occasionally finds the act of micturitio n _ suddenly interrupted even though h e has not been completed This IS due to the stone havin g blocked the opening of the urethra . It may be relieved if the patien t changes his position.

Ruptured Bladder

This is an unusual accident an d generally only occurs when the bladder is full. It may result from a crush or kick while occasionally It IS caused by a fractured pelvis when a sharp fragment perforates the organ.

The patient complains of pain i the region of his bladder an d expresses the desire to micturate bu t is unable to do so. He may however pass a small quantity of blood . Symptoms and signs of shock accompany the injury. A serious complication occurs if the urine ins tea of leaving the body in the usua l appears as a swelling in th e penneum under the skin a condition known as o f urine.

First aid is as for shock bu t fluids should be withheld.

Enlargement of the Prostate Glan d

The gland, present only 10 the male, IS about the size an d shape of a Spanish chestnut. It lies deeply in the pelvis at the base of th e bladder. Through it passes the on its way to the outside skin: consists largely 0f a tissue which produces a secretIOn.

. Enlargement of the prostate glan d IS not an uncommon complaint in

FIRST AID & NURSING, JULY /AUGUST 1951

elderly men. It is generally caused by simple and non-malignant growth known as an adenoma. As this i ncreases in size, it encroaches on the urethra The early symptoms and si gns include freq uency of micturition noticed particularly at night. T he patient m a y experience difficulty i n passing urine. He may be liable to attacks of cy stitis or this complaint in a chr onic form. Although the symptoms may improve from time t o time, t he y tend to be progressive u ntil ultimately, if the patient has n ot sought medical advice, he develops retention of urine. This m eans inability to pass urine. It may come on suddenly and is then a ssociated with extr eme discomfort a nd pain; sometimes, however, it develops more gradually, the bladder b ecoming fuller and fuller until it has b ecome stretched to its maximum ca pacity. The disten d ed bladder can u sually be readily observed in a t hin subject, since it forms an obvious s welling in the lower part of t he abdomen particularly noticeable when the patient is lying down. In a fat subject, however, it may not b e nearly so easy to see .

Acute retention is an urgent condition; the patient is in such great discomfort that he will demand medical advice wi t hout delay . While a waiting the arrival of a doctor the fi rst-aider can give h i s patient some relief by applying hot ft.annels to the lower part of the abdomen or perineum. Sometimes the p a tient will succeed in passing urine if he is p laced in a hot bath and the tap left slowly running The doctor will r elieve the acute retention by passing a n instrument called a catheter into t he bladder.

Chronic retention is not nearly so dramatic in its symptoms but if n eglected may cause harm to the patient through interfering with the f unction of the kidneys

Enlargement of the prostate gland is usually treated by operation. In t he past , this wa s a serious procedure and had to be undertaken in two s tages; it necessi t ated a long stay in hospital. In recent years , however , a new v ariety of operation has been introduced in Britain and is now being performed in all parts of the world. It was devised by a London surgeon and is giving most successful results. 0

Haematuria

This is not a disease; it is the name applied to the symptom when blood is passed in the urine It can be due to many causes, for example, diseases of the kidney and bladder including stones and injury , and diseases of the body as a whole such as certain ailments of the blood. Occasionally it is caused by poisons which irritate the organ, for example carbolic acid and turpentine

Sometimes the blood clots in the bladder and hence causes the patient intense pain when he attempts to micturate. Medical assistance i s required as soon as possible.

Albuminuria

This again is not a disease but the term applied to the presence of a protein called albumin in the urine. This can only be detected by a special test undertaken by a doctor or a nurse; it cannot be detected by observation of the urine itself. This is a point which should alwa ys be remembered since laymen are often apt to worry if they notice an unusual appearance of the urine

The causes of albuminuria are far too numerous to discuss in an article of this kind. Sometimes it is compatible with perfect health but it may indicate disease of the kidneys or other organs in the body.

Princess Margare t Visits Doncaste r Cad e ts

H .R.H. The Princess M a r ga ret watches Cadets making to ys during her recent visit to Do ncast er for the Rally of St. John Ca dets.

RECEIVES D EC ORATIO N F OR SA VIN G TW O MR. OW U SU, of Accra, Gold Coast , who is in t his country now was recently deco rated with the Society's Special Service Cross by Lord Woolton, Chairman o f the B ritish R ed Cross Society, for an ou tstan d ing piece o f first aid work. Mr O wusu went to the help of two men trapped in the cab of a lorry which had crashed from a raised embankment into a deep pool. When th e men were extricated one was ser iously i njured but still alive, and Mr. Owusu , who was carrying a limited amoun t of firs t aid eq uipment with him, was a ble o reduc e the bleeding and to arrange his imm ed iate d ispatch to h osp ital.

The second patient was found not t o be breathing I n th e face of consi derable opposition an d att empted interference from bystanders who wish ed to take hi!? .to hospital as well, M r. O wusu began artifiCIal respiration. He cleared mu d and water from the pa ti en t's air and wo rked on him until he wa s shOWIng signs of reco very. This wa s over a n hour a nd a half la ter. Mr Owusu the n treat ed h im for sh ock.

At this stage he began t o bl eed profusely from a sca lp wound T hi s to o M r. O wus u treat ed a nd final ly called a taxi which was standing by and t ook h is pa tien t to hospital. Both men reco vered.

ST. JOHN FINALS

Triumph for Weymouth & Horsham

THE Finals of the St. John Ambulance Brigade Ambulance and Nursing Competitions were held at the Central Hall, Westminster, on 20th July. Weymouth (Dorset) were placed first in the Ambulance Competitions, with marks out of a possible 400, and Horsham (Sussex) won the Nursing Competitions with marks. These teams win the , Dewar' Challenge Shield (Ambulance) and the 'Perrott' Challenge Shield (Nursing).

Final placings were :-

Ambulance:

l. Weymouth (Dorset).

2. (W.R. Yorks).

3. LewIs Merthyr Colliery (Wales).

4. Middlesbrough Central (N.R. Yorks).

5. Fleetwood (Lancs).

6. Horsham (Sussex).

7. March (Cambridge).

8. Taunton (Somerset).

9. Wimbledon & Merton (London).

10. Spalding (Lincs).

11. Redditch (Worcs.)

12. East Belfast (N. Ireland).

Nursing:

1. Horsham (Sussex).

2. Moseley 'A' (Birmingham).

,3. Dorchester (Dorset).

4. Whitley Bay (Northumberland).

5. Tredegar (Wales).

6. Croydon (London).

7. Belfast Post Office (N. Ireland).

8. Kendal (Westmorland).

9. Spalding (Lincs).

10. Cheltenham (Glos.)

11. Welwyn Garden City (Herts).

12 Hull Haworth (E.R. Yorks).

BeSIdes the' Dewar' Shield, Weymouth won the 'Ellis' Challenge to team leader hIghest marks in the section of the competitIons), and the 'Hingston' Rose

FIRST AID & NURSING, JULY /AUGUST 1951

Bowl (awarded to the team gaining the highest marks in the team test section). Saddleworth won the 'Symons Eccles' Challenge Cup (a warded to the team gaining second aggregate marks in all sections of the competition); Middlesbrough won the' Trimble' Shield (awarded to team gaining highest marks in the in dividual section); and Lewis Merthyr Colliery won the 'Hong Kong' Shield (awarded to the team gaining the third aggregate marks in all sections of the competitions).

The presentation of shields, cups an d prizes was made by Marshal of the Royal Air Force, Sir John Slessor, introduced by Commissi oner-in-Chief of the St. John Ambulance Brigade, Lieut.-General Sir Otto Lund, K C.B., D.S.O.

Sir John said that speaking as one wh o necessarily spent quite a lot of time in attending public functions he realized very well indeed what a debt the public in general owed to the Brigade.

, How many,' he said, ' remember or even know that the men in black an d white uniforms and the women wit h the eight-pointed cross on their ap rons, who always seem to be on t he spot when required, are not paid officials laid on by the Welfare State bu t are unpaid volunteers who from t heir love of service and sense of dev otion to the community give up their time after-or before-their n ormal day's work, not only to train an d keep themselves efficient but also to carry out public duties when re quired. In these days so many pe ople feel that all that is required of them is to do so many hours' work a day or week-provide for t heir families in so far as it is still necessary for them to do so and then sit back and say "That's not my jo b "----.:." Let the Government-or s omeone else get on with it" or " What is the pay?" The old idea of voluntary service-once so universal in this country-is, with the a dvent of an era when the State provides so much-from the cradle t o the grave-fast becoming a thing of the past. It is good to think though that the old spirit still lives on and is personified in its most virile form in such organizations as the St. John Ambulance Brigade.' Sir John added that with the evergrowing commitments of the Brigade there was an increasing necessity for volunteers and he for his part would

no effort encourage not only cLvllians working with the Royal Air Force, but also ex-officers to come forward to help.

The competitions began in 1893 and were formally instituted in 1897, when the Dewar Shield was presented by Sir Thomas Dewar who was then Sheriff of London . he gave the Shield to

Queen Victoria's Diamond Jubilee and the valuable services of the St. John Ambulance Brigade. Up to it was only Ambulance DIYlsIOns who competed for this ShIeld, but after this date the were opened to Nursing DIVISIOns and the Perrott Shield was presented by Lady Perrott in the name of her late husband and herself.

*The Editor's Opinion

MANY of our readers will no doubt have read with amusement and some instruction the recent correspondence in The Times relating to fainting on parade. The matter was first raised by Dr. E. P. Sharpey-Schafer, of st. Thomas's Hospital Medical School, when he pointed out that from time to time a great State occasion coincides with a break in the normal cool English summer weather. Under these conditions, he said, young soldiers on parade' may faint in large numbers. Serious or even fatal accidents have resulted; the head may strike the parade ground or, as happened on a recent occasion, a bayonet may pierce the body.'

He went on to say that there is a general feeling that only weaklings faint, but the most important relevant fact is that all normal men and women will faint, even in the supine position, if a sufficient quantity of blood is lost. The faint is due to a sudden fall in blood pressure which diminishes the blood supply to the brain. Dr. SharpeySchafer continued: 'The erect posture in man is maintained only precariously. Standing quite still for long periods causes blood to accumulate in the lower part of the body and is equivalent to a large haemorrhage; this effect is accentuated if the leg bloodvessels are dilated by heat. Indeed, there appears to be a direct relationship between the environmental temperature and the number of persons who faint.'

An additional factor was introduced by 'standing to attention,' which, said Dr. Sharpey-Schafer, causes obstr\lction to the great vein

below the heart, and further accumulation of blood in the lower half of the body. He added that in the course of his biological history man seems to have developed no defence against this posture: it is all the more remarkable that it should have been chosen for military ceremonial. enough, the military men flew to defend their ceremonial drill, and especially the position of attention. 'Ex-Guardsman' pointed out that fainting was confined to private soldiers, while officers and warrant officers, so he said, never faint. 'It is well known,' he wrote, , that if one or two men begin to go several others will follow their example: and a few strong words of encouragement from some noncommissioned officer in the rear rank will stop it at once.' Another correspondent, however, made the point that the reason fewer officers faint is simply because there are fewer officers than men. Moreover, officers do not remain entirely motionless throughout the whole parade, and they certainly do not do so throughout the long period of waiting beforehand.

First-aiders are mainly concerned with the treatment of fainting, but they are themselves' on parade' at times, and will perhaps feel that Dr. Sharpey-Schafer has raised a point which deserves sympathetic attention. We believe we are right in saying that most people enjoy taking part in a ceremonial occasion, and will be ready to take any risk involved in standing to attention for a while. But where younger people are concerned, perhaps there is something to be learned if mass fainting' -distressing alike to victim and onlooker-is to be avoided.

Saddleworth (W.R. Yorks) receive the Symon Eccles Cup

FIRST AID & NURSING, JULY / AUGUST 1951

Children's Homes and Residential N nrseries

by Agnes E. Pavey, S.R.N., Diploma of Nursing (University of London)

O NE of the pioneer voluntary efforts to provide a home for orphaned or unwanted babies was the establishment, by Capt. Thomas Coram in 1741, of the Foundling Hospital in Bloomsbury which, with its secondary school in Berkhamstead is, after more than two centuries, one of the leading organizations devoted to child care in this country.

The' big three' among voluntarily maintained orphanages are, in order of their foundation, the National Childrens' Home and Orphanage, which originated by the opening of a house in Lambeth for destitute children, in 1869, by Thomas Stephenson, and now cares for 3,500 children; Dr Barnardo's Homes , which developed from a Home for Destitute Boys opened by Dr. Barnardo at 18 Stepney Causeway in 1870, and at present accommodates 7,500 children; and the Church of England Children's Society which was started in 1881 by Edward Rudolph as the Waifs and Strays Society, and now has 5,600 children in its care. Among others that were established during the nineteenth century and are still actively developing their work may be mentioned the Shaftesbury Homes and Arethusa Training Ship, with several residential homes sheltering about 1,100 children. Nevertheless, it was estimated by the Care of Children Committee (popularly known as the Curtis Committee) that in 1945 there were 125,000 children in Jhis country who were 'deprived of normal home life,' although at that time the voluntary societies were providing for over 40,000 homeless children, supporting them entirely from their own funds. In addition to the many residential nurseries founded and governed by these societies, a number have now been established by local authorities, and in all of them the guiding principle

is the realization of the importance of providing conditions as near to those of normal family life as is possible.

Residential Nurseries

As their name implies, these are nurseries where children reside for long or short periods, according to need. If they are orphans or homeless they may remain in the nursery until they reach school age, -but there are various reasons why, for a time, a child cannot be cared for in his own home. The illness of a mother, her absence from home for any cause, a case of active tuberculosis in the family for whom sanatorium treatment is not yet available, are all factors that render it desirable that a temporary home shall be found for a small child.

Changes in Outlook in Child Care

The days when children in Homes -speIt with a capital 'H '-were dressed in ugly uniforms, received much religious instruction and were taught to be quiet, tidy, respectful and obedient, but were starved of love and had every aspect of their lives regimented, are now long past. All research into child psychology and training shows that community life for a small child, however good this may be, can never be equal to life, even in a poor and indifferent home, under the guidance of a mother from whom he receives a sense of security, stability and affection, for it is essential for his normal development and sound mental health that he should feel that he belongs to someone, and that person values him and bothers about him. The loss of a mother has the most marked effect upon children between the ages of one and four years, and it is essential that an adult should be found who will take the place of his mother and to whom he feels that he indisputably

belongs and upon whom he can constantly rely. If he js cared for by numerous and frequently changing people, especially as one of a group of similarly bereaved children of his own age, he may develop neurotic or even delinquent tendencies. He lacks the continued stimulus that comes from the ordinary events in the home, watching his mother prepare food in the kitchen, working about the house or doing ber laundry work or mending, helping mother and learning to help himself-and asking questions nearly all the time. It is the realization of the child's needs that has brought about a new conception in organizing the statesupported residential nurseries and children's homes, although in many of the voluntary organizations this principle has been understood since their inception.

The General Organization of Residential Nurseries

Whether residential nurseries are run by local authorities or by voluntary societies they are all open to inspection ·and approval by the Ministry of Health and the Ministry of Education. The children over one year of age are divided into groups of not more than eight or ten, each group including both sexes and all ages that are present in the nursery, and having one person who is responsible all the time for their care. The group has its own table and often its own room for meals. Only when there is a party' do the children in a number of groups take a meal together. A place for his private possessions is allotted to every cbild and, as soon as he is old enough, he has pocket money, for it is so often the child who is demed personal possessions who steals in order to satisfy his normal possessive instinct. If there is a nursery school the older children attend for lessons,

while the smaller children meet and play with each other, as would the

children of families in the same nei ghbourhood.

When new residential nurseries are built a number of small houses is cons idered to be preferable to a lar ge house, each group having its own house. Contact with the outsi de world must be maintained, th e children are taken for walks m small groups, they are allowed to play in public parks and to enter sho ps and spend their pocket money as they choose. In many residential nurs eries pets are kept. included cats, dogs, white TIllce, ra bbits, chicken, geese, tortoises, hedgehogs, pigs, and even a goat or a donkey. The preponderance of women in the nursery should be counteracted, as far as is possible, by allowing the children to ha ve contact with men, as in normal home life. For example, gardeners and porters in a residential nursery sh ould be men who are in small children and will talk to them an d answer their questions. In itself this provides insufficient contact 'and may be unsatisfactory because of the full working day that these men must put into their own j obs. Men living in the neighbourho od who have the welfare of chil dren at heart are encouraged to act as 'uncles,' and very often older children of both sexes can be invi ted to spend an afternoon in. a resi dential nursery and to entertam the nursery children in their own hom es. When the children are old eno ugh to attend ordinary schools they often become scholars at the loca l schools and wear the school uniform. All these contacts help t?e child to adjust to normal home life in later years.

Many children are' boarded out' with foster parents, and some are adopted. It has been stated, authoritatively, that more people desire to adopt children than there are suitable children to adopt. . It is the unsuitable or children who provide the mam problem. In modern residential nurseries the child usually sper:ds the first few weeks under observatlOn until a decision can be made as to whether he shall be adopted, boarded out or brought up in a residential or a special school.

RED CROSS NEWS

County of London

The annual general meeting of the Branch was held on 5th June. The quoted are a dear indication that sterlmg work has been done throughout the year; 8,000 cases were treated at one first aid post 161 training courses were arranged m Divisions ' and 247 drivers of the Hospltal Car Service (administered from County Office and four area offices jointly by the Society, the Order of St. and the W.V.S.) travelled 1,787,541 miles. These are some of the outstanding festures of year's activities, which covered a very wlde field.

Cambridgeshire and Isle of Ely

The Royal Show gave the and Isle of Ely Branch opporturuty of interesting the public Red Cr?ss activities, and it was especlally p.leasmg that on the opening day Her Royal The Princess Royal paid an unofficlal to the B.R.C.S. tent. It is ?-? exaggeratl?n to say that thousands of VlSltOrs called m, at peak periods at the rate of hour. Unfortunately, it is not. posslble m the space available to mentIOn all the exhibits on show, but reference be made to the Palace School of handicrafts done by the severely Is These included most beautlful glr b d d t smocking, knitting em ery an ar., also needlework and a palOtmg by a who works with her Lmk Members and Cadets provlded a display.

North Riding of Yorkshire

EasLngwold took in the local Festival of Bntam !hey formed seven tableaux deplctmg The History of the Red Cross from the C:-m:tea to 1951.' It is evident from. descnptlOn in the local Press th!/t the not took the opportunity of attl(ntlOn

to the work of the Society in the past (Florence Nightingale and Henri but clearly illustrated its present for their exhibits included Cadets takmg a deaf and dumb woman for a ride in her chair.

On May 20th last the Branch was honoured by a visit from The Princess Royal on the occaSlOn of the Presentation of New Colours. H R.H. had originally presented Colours to the Branch in 1936, but unfortunately these were destroyed during the war. Very careful arrangements were made for. the ceremony, which was held in the beautiful old church of St. Mary, Scarborough. Detachr?ent Officers , Members, Cadets and travelled from all parts of the. RldlOg to take part in the ser,vice, ar:d col<?urful uniforms made an Impresslve picture m the church. The service was the Bishop of Whitby, who at ItS close dedicated the Colours, which were presented to the Branch by Her Royal Afterwards the Princess Royal mspected the Branch on the square a barrack:s some three miles away. MUSIC prOVIded by the Band of the 4th Battalton the Howards, who had travelled some 30 mIles at their own expense to attend the ceremony.

South Lincolnshire

Members of the Boston active part in the local Festival of celebrations. A pageant was orgaruzed representing 'The Coming of B.otolph from A.D. 654 to 1951,' and 10 t.his connection they formed a tableau to The Nursing Sisters of St. Leonards.

The Red Cross outing this year was to Blenheim Palace. Members, who greatl,Y appreciated the Du.chess of Marlbo f<:mgh s ki dness in allowmg them to VISlt the had a thoroughly enjoyable day, but fl(lt tirl(d when they got home,

The scene at Horse Guards Parade, London, when Admiral Sir Harold Kinahan took the salute at the n:arch past of the County of London Branch, B R C.S

Reports from St. John N. LANeS.

l\'orthwich

At a social of Northwich Ambulance and ursing- Divisions, awards were made to Mr. R. L. Rait (Vice-President's badge), Div. Surgeon C. D. Hough, Corporal J Parkes and Private W. Oakes (long service medals), and the Misses B. Penny, D. Murpby, A. Bratt, A. Watts, B. Deakin, E. Slaney, K. Jakeman and M. Harrison, who received home nursing certificates. These ladies are pupils of Mrs. M. M. Mottershead, who is in charge of the ursing Division.

Birkenhead

Birkenbead were the winners of the Northern Area Ambulance Contest organized by the National Road Passenger Transport Ambulance Association, and they qualified, with the runners-up, Liverpool, for the Stirk Trophy Contest at Nottingham (reported elsewhere in tbis issue)

After tbe contest the members of the Birkenbead team, J. Charsley (Captain), E. Platt, W. Haldon, A. Jones and G. Berry (reserve), each received a miniature silver cup, and the team were awarded the 'Micbael Halligan' Trophy, which Ald. Halligan bas presented to tbe Transport Ambulance Association to commemorate Birkenbead s Municipal Transport Jubilee.

Organization of tbe event was in the hands of the Birkenbead centre of the St. John Ambulance Association and officers and members of tbe Birkenbead Corps of the St. Jobn Ambulance Brigade. The Birkenhead team were trained by Div. Supt. J. E. Wallace and Sgt. S. H. Lomax.

Bradford

The annual inspection of the Bradford Corps took place at Belle Vue Barracks, Bradford, on 8th June 1951. Inspection was under Area Commissioner Dr. R. Chester, M.D., Ch.B., M.Sc., M.R.C.S., L.R.C.P. ; Lady Dist. Supt. Mrs. Lodge; Nursing Cadet Div. Officer Mrs. Dickinson; also present were County Officers, Messrs. Hill Mitchell and Mason; Corps Surgeon Dr: W. E. Alderson; President, Mr. J H. Wilkinson; Vice-Presidents, G. WhyteWatson,. F.R.C.S., C. A. Gadie; and SJr Geoffrey Burton, K.C.S.I , K.C.I.E., and Lady Burton-about 250 Officers, Nurses, Ambulance and Cadets (Ambulance and Nursing). Tbe Parade was under Corps Supt. H. Bray.

NQrth Lancashire

St. John's Day, Sunday 24th, was a redletter day in the No. 7 Area to mark the of Pooley, retiring Asslstant CommIsSIOner, after 54 years as a member of the Brigade.

Col. Pooley joined the Brigade in 1897 as Surgeon, and served for some years as Dlstnct Surgeon, and became Assistant Commissioner in 1919. He was made Honorary Life Member of the Association in 1887, Honorary Associate in 1906 and Knight of Grace in 1921, In the 1914- 18 war he served in France with tbe R.A.M.C.

In order to sbow the esteem in which the retiring Assistant Commissioner was held, one of the largest parades ever seen in the district took place at Dalton, where he has resided for 59 years. The Parade represented past and present members from the whole area, which extends from Morecambe in the south and includes Lancaster, Grange, Ulverston, Dalton, Barrow and Millom.

Headed by the Army Training Corps band the Parade marched through the old town to the Parish Church where the Assistant Commissioner was presented with a pair of solid silver candlesticks, suitably engraved and bearing the St. John Badge, subscribed for by the members of the whole area. He immediately handed them to the Vicar of Dalton to be placed on the Altar, where they were subsequently dedicated by the

R ural D ean of the district, Canon C. E. Nurse, Vicar of St. George's, Barrow-inFurness. In his address, Canon Nurse said Col. Pooley had served the Brigade with diligence and loyalty for all those years, and the Church also honoured him for 53 years' service as a Lay Reader.

On leaving the cburch the Parade formed a hollow square in front of tbe old Market Cross, when the Assistant Commissioner, who was accompanied at the saluting base by District Officers Major W. G. Pearson and J E. Helme, addressed members and thanked them for their loyalty whilst serving under him Afterwards, he presented the Long Service Medal to Superintendent Mrs. Wells of Grange Nursing Division, and a cigarette case and ash tray to Corps Staff Superintendent R. E. Murthwaite, of Ulverston, for his services as Secretary to the Area Officers' meetings and competitions.

The Assistant Commissioner, who is in bis 88th year, bore the ordeal very well, and all parading members, who included Ambulance, Nursing and Cadet Ambulance and Nursing Divisions, about 400 strong, were greatly affected as the Assistant Commissioner took the Salute for the last time at tbe march past.

BRIGHOUSE CORPS CELEBRATES

THE Brighouse Corps of the St. John Ambulance Brigade began its fiftieth anniversary celebrations on 5th July with a dinner at the Ambulance Hall attended by almost 200 guests including many highranking officers, both of the Brigade itself and of tbe Order of St. John.

The speakers included Lt.-Col. Sir Frank Brook, H.M. Inspector of Constabulary, who is also Chairman of the Council of the Order of St. John; Mr. J. W. Barnett, the Chief Constable of Leeds; and Commissioner H. L. Thornton, O.B.E., K.StJ. Many tributes to the untiring work and the record of almost fifty years' service with the St. John Ambulance Brigade by Commissioner H. L. Thornton, who joined the movement at B righouse shortly after its inception, and was at one period Corps Supt., were paid by several speakers.

An outline of the history of the Order of St. John o f Jerusalem from the twelfth century up to the present time was given by Ald. W. Whiteley (the Brighouse Cadet President) who proposed the toast to the Order, he offered his congratu lations to the Brighouse Corps on its Ju bilee.

Responding, Sir Frank B rook said it was well that the members of the St. John Ambulance Brigade should be reminded that the days of chivalry, when the O rder was first set up, were still with us, the same inspiration and urge voluntarily to do good to one's fellow men, the motive force behind the old Order of crusading times made present members carryon the B rigade's work, it was also responsible for the devoted service given to t he Movement by such men as Commissioner H. L. T h ornton.

Proposing the toast 'The St. John Ambulance Brigade' Mr. J. R Liddle (Town Clerk of Brighouse) pointed out that the Brigade was universally recognized as an essential unit of civil life. In the past fifty years the Brighouse Corps had treated no tba.n 30,000 cases, so from these

FIRST AID & NURSING, JULY/AUGUST 1951 " TINS STIRK TROPHY

THE Final of the Stirk Trophy First Aid Competition, arranged by the ational Road Passenger Transport Ambulance Association, took place at the Meridian Sports Ground, ottingham, on Sunday, 1st July.

The winners and runners-up of the Northern, Midland and Southern Area events took part in the final competition. The setting for the team test was an accident to a man who fell down the stairs of a double-deck bus when the driver swerved to avoid a dog. The man suffered concussion, a fracture of right humerus. a graze on the left leg and a fractured left knee cap.

The contest was watched by a large audience, and was followed by an excellent tea at the Co-operative Hall in Nottingham. The function was presided over by Mr. B. England, General Manager of Nottingham City Transport, who introduced the Chairman of the City Transport Committee.

BRIGHOUSE-cont. from p. 8

The General Manager who is also President of the ational Road Passenger Transport Ambulance Association, announced the results and presented plaques and prizes to the teams. A number of officials from other undertakings were also present.

This is the first year that tbe competition has been organized under the auspices of the St. John Ambulance Association, also the first time that the event has been open to women's teams. The leading men's and women's teams will now represent the N.R.P.T A.A. at the Grand Priors Trophy Competition in November.

The result of the contest was as follows :-

1. ottingham

2. London

3. Liverpool

4. Leicester

5. Plymouth

6. Birkenhead

7. Trent Motor Traction

8. London (Women)

HOSPITAL SERVICE APPEAL

PRESENTI G badges recently to the first members of the Ministry of Health to qualify for the ational Hospital Service Resene, Mr. Arthur Blenkinsop, Parliamentary Secretary to the Ministry , said that a terrible responsibility would rest on us if we were found unready to deal with heavy casualties re ulting from some attempted knock-out blovv on this island.

• You have given a lead in this important matter of joining the Hospital Reserve, the only first aid and nursing service connected with Civil Defence,' he declared.

482 423! 407-

396 396 351 25H 283-

We hope that all employers v, ill, like the Civil Service, allow special leave for H.S.R. members to take their hospital experience consecutively and see the round-the-clock working of a hospital day.' Miss Elizabeth Cockayne , Chief ursing Officer of the Ministry of Health , in welcoming the new members said: • ot only are you now ready in this Reserve should war come, but you have taken a training which will be of use to you all your lives.'

figures it would seem that there must be millions of people in the world who bad reason to be grateful for the work of the Brigade.

Commissioner H. L. Thornton, responding, said he thought one thing not sufficiently driven home to the public was the fact tbat the work was entirely voluntary, 'I mean that doing work without hope of monetary reward is a strange thing in modern public life, but in this we in the Movement have a very great advantage over other organizations, all our work is done for love.'

'The Brighouse Corps' was proposed by the Mayor of B righouse, Ald. G A. Stellingfleet, and responded to by Corps Supt. Dr. K. B. Ashe. Assistant Commissioner H. Harrison, of Huddersfield, toasted the guests, and Mr. Barnett responded.

All the speakers stressed the point of the valuable and voluntary service rendered by the St. John Ambulance Brigade to the community at large Among the members present were three who had remained active with the Brighouse Corps since the day they joined, two have 50 years' service and one 45 years' service, they are Divisional Supt. W. Fisher, Ambulance Officer J. R. Saunders and Reserve Officer J. Brockless.

Ju bilee BaH

The Ambulance Hall was a very gay and charming place on Friday night, 6th July, when a Jubilee Old Time Ball was held. The Embassy O rchestra played for old time dancing from 8 p m. to 2 a m. and the M.C.s were Mr. and Mrs. C. Hartley.

Amongst those present at the Ball were the Corps President, Mr. A. Marsden and Mrs. Marsden, Councillor and Mrs. Broomhead, Corps O fficers and their wives, Div. Supt., and D iv O fficers and their wives

A r ea Ins pection

An Area Inspection of Ambulance, Nursing and Cadet Divisions at Wellholme Park, Brighouse, on Saturday, 7th July, by

Major General The Earl of Scarborough provided the culminating event in the Jubilee celebrations of the Brighouse Corps. Unfortunately heavy rain marred the final event, and members of the Brigade on parade had to beat a hasty retreat before Lord Scarborough, who is President of the West Riding Council of the Order of St. John, could complete the inspection.

The Parade was made up of units from Huddersfield, Dewsbury, Eiland, Sower by Bridge, Penistone, Holmfirth, Spen Valley, and Colne Valley. Lord Scarborough was assisted during the Inspection by Commissioner H. L. Thornton, O.B.E. K.StJ., District Supt. Mrs. G. W. Lodge and County Cadet Officer Mrs. J. Cumming Bell. Among the others present were the Mayor and Mayoress of Brigbouse, Ald. G. A. Stellingfleet and Mrs. Newman, Mr. L. J. Edwards, M.P. for Brighouse and Spenborough, Ald. W. Whiteley, Coun. A. Broomhead, Mr. A. Reeve, J.P., and the Town Clerk, Mr. J. R. Liddle and Mrs. Liddle.

After the Inspection had been curtailed, and the march past abandoned, the weather improved sufficiently to permit the presentation to Mrs. M. Birkbeck, O.B.E., a former District Superintendent in the West Rid.ing, of a testimonial which had been subscnbed to by Ambulance and Nursing personnel of West Riding to mark esteem gratitude for her long service and devotlon to duty. The presentation consisted of a large silver tray, a picnic basket and .a cheque, the total amount received .lD response to the appeal made by Commissioner Thornton being £138 lOs Od.

After the presentation Lord Scarborough congratulated the Brighouse Corps on obtaining their 50th 'I that you are doing splendId work. m devoting your time to the service of mankind in this way,' he Said.

Earlier in the afternoon the men and boy Cadets had assembled in the Brarnston Street recreation ground and marched to Wellholme Park headed by the band of the Brighouse Corps. Spectators who braved the elements saw a smart and alert parade of men and youths who marched with soldierly precision. The Nursing and Nursing Cadet Divisions did not take part in the Parade but took up their stations in the park. When the procession reached the park, the various contingents took up places on their markers, the Officer In charge of the Parade being Area Commissioner H. Harrison.

Folkestone

The Folkestone Corps held their annual Church Parade and Service on Sunday 24th June at St. John's Church. The Parade, in charge of Corps Officer L. B. Easton, O.SU., was lead by the Cadet band of the Ramsgate Division both to and from church.

The service was conducted by the Rev. L. Hickin, Vicar of S1. John's, the address being his last as Vicar. The Lessons were read by Col. Sir Bertram Ford, DirectorGeneral of Ambulance, Knight of Grace of the Order, and Corps Officer Easton. .

Among the congregation were Bng. Mackeson, M.P. for the Borough of Hythe ; Councillor J. Moncreiff, Mayor of Folkestone, and members of the Town Council; Miss M. Crowther, M.B.E. (Matron of the Royal Victoria Hospital), and nurses; Lt.-Col. Gray, O.C. No. 10 Company R.A.M.C., Shorncliffe, and members of the

WINGS

R.A.M.C.; together with nursing sisters from the Military Hospital: also representatives of the Old Contemptibles and Royal Naval Comrades Associations. Members of the Brigade present were the Viscountess Allenby of Megiddo , County President for Cadets; Lady Fisher, President Cheriton Nursing Division ; County Officer Mrs. Jay; County Officer Cadet Records, Miss Curzon Smith: Corps Officer R. Moat , O.SU. ; and Corps Officer Miss M. Davis.

The Parade consisted of officers and members of Folkestone Ambulance and ursing Divisions , Cberiton ursing Division Folkestone Ambulance and Nursing Divisions, and Cheriton Nursing Cadet Division, numbering approximately 100 in all.

After the service the Parade was inspected by His Worship the Mayor and Sir Bertram Ford but the march past was unfortunately owing to heavy rain.

Leicester

The Gipsy Lane Ambulance and Boy Cadet Divisions gave their annual supper and concert on 11 th July for the old-age pensioners a total of 140 sitting down to the supper: Mr. L. Miller, President of the Ambulance Division, welcomed the guests and wished them a very enjoyable evening. On conclusion of the supper, Div. Supt. T. Hames, B.E.M., addressing the company on behalf of the Divisions, said they ,?,ere proud of having so many guests, espeCIally as there was a bigger company than any previous year.

TOPICAL NOTES FOR

FIRST AlDERS & '. NURSES

Training as a House-mother or House-father

When opening Burdon Hall, in Sunderland, as a residential nursery last month, the Home Secretary, Mr. J. Chuter Ede, stressed the importance of securing conditions as near to those of normal home life as possible for children, who, through no fault of their own, were deprived of the security and happiness of family life. He said that where, for one reason or another, , boarding-out' is not practicable much may be done to reproduce the atmosphere of a home by housing children in family groups under the care of a house-mother and housefather . Many people were willing to act as unofficial uncles or aunts to a particular child, taking him home to tea sometimes, remembering his birthday, and generally providing the link between the child as an individual and the outside world .

Readers who are interested in child care may like to know of training courses that have been arranged in various centres in England and Wales in order to meet the growing demands for qualified staff in children's homes.

The cour se lasts for 14 months during which six months is spent in study and the rest of the time in practical training; but the first two months is considered as a probationary period, at the end of which final arrangements for the course are made. Women candidates must be over 18 and men over 21, and preference is given to those under 35 years. They should be of good education and it is an advantage to have had some experience with children. Joint applications may be considered from husbands and wives, and those who are accepted will be eligible, where need is shown, for grants to cover tuition fees, maintenance, travelling and residential expenses. Further particulars and application forms may be obtained from the Central Training Council in Child Care, Home Office, Princetown House, 271 High Holborn, W.C . I.

Florence Nightingale Film Premiere

The new film 'The Lady with a Lamp,' in which Miss Anna Neagle takes the part of Florence Nightingale and Michael Wilding portrays Sidney Herbert, is to have simultaneous premieres throughout the British Commonwealth. The London premiere is at the Plaza Cinema on 22nd September. It will be attended by their Royal Highnesses, the Princess Elizabeth and the Duke of Edinburgh. Student nurses from all parts of the United Kingdom will be present and so also will representatives of St. John and British Red Cross nursing personnel. The proceeds of the performance will be given to the Royal College of Nursing Educational Fund. Duplicate copies of the film are being prepared so that they can be shown at the same time as the London premiere in Edin burgh, Cardiff, Belfast, the Isle of Man and the Channel Islands as well as in Australia, New Zealand, Canada, South Africa, India, Pakistan, Malaya, Malta and various other places.

'Life in Her Hands'

This is another new nursing film, which had its first performance at the end of July at the London PavjJion. Kathleen Byron is the student nurse who takes up training after her husband has been killed in a motor accident. Many of the scenes were filmed at the Watford Peace Memorial Hospital. The film lasts nearly an hour and ends with the birth of a baby by Caesarean section. On the whole, the technique is very good, although one or two instances-as where Ann Peters touches dirty swabs with her handsshows faulty nursing detail. The film shows hospital life in an attractive way and should help in the recruitment of student nurses.

The New Drugs for Rheumatoid Arthritis

In answering questions in the House of Commons recently the Minister of Health, Mr. Hilary Marquand, " id that 56 hospitals in

England and Wales are now receiving monthly supplies of cortisone and A.C.T.H. During the first six months of this year 4,500 grammes of cortisone and 3,600 grammes of A.C.T.H. were imported from the American manufacturers. Supplies are distributed as they become available for use in hospitals and for continuing clinical research under the control of the Medical Research Council. Mr. Marquand emphasized that the use of these drugs is still experimental and requires very careful continual biochemical investigation of the patient during treatment. For this reason it is inadvisable to attempt to treat patients away from hospital and laboratory facilities. Carelessness in the use of the drugs and omission of these precautions can have serious and unpredictable results.

A New Filmstrip

One of the greatest aids in the learning of anatomy and physiology is the drawing of one's own diagrams and the naming of the various parts. Moreover, examination questions often demand an illustrated answer, and the facility which the student gains in making diagrams during his study period will then stand him in good stead. A new Unicorn Head filmstrip, made in co-operation with the National Committee for Visual Aids jn Education, and entitled Biology II, contains 24 simple drawings which, when thrown on a screen, could be copied by members of a class into their own notebooks. Twenty-one of these diagrams relate to human organs and structures. Of the remaining three, one is devoted to different kinds of foods and their uses, and two to comparative biology. The filmstrip may also be used as test material, when answers to questions regarding an individual diagram can be written in the pupils' notebooks under examination conditions. A number of suitably chosen questions are given in the leaflet accompanying the filmstrip, and these can form a means of quick revision of large portions of the syllabus when candidates are preparing for an examination. All lecturers and teachers of biology who have access to a projector would be well advised to obtain this filmstrip. Its price is 12 /6.

(continued on col 31 next page)

5/6 post free

of SHOCK

Hot axa - so qUickly and eaSily prepared, is an excellent stimulant in cases of accident or shock. Warmii1g and sustaining, it gives the patient a feeling of 'well-being,' and is invaluable in convalescence.

Twelfth Edition, revised by Margaret E. Hitch, S.R.N., late Sister Tutor, Saint Bartholomew's Hospital, with a Foreword by Sir Cecil Wakeley, P.R.C.S. A complete encyclopredic and pronouncing dictionary of the medical terms in common use-in a pocket-sized volume. T wenty-one appendixes cover a variety of important subjects, including Poisons, Splints and Bandages, Abbreviations, Diets, Blood Transfusion, Anti-biotics, etc. There are 496 pages and over 200 illustrations.

, This dictionary keeps its place in the front rank of such publications can be unreservedly recommended to all members of the British Red Cross, and the Saint John Ambulance.' British Red Cross Quarterly Review.

MEDICAL DICTIONARY post this form

DALE, REYNOLDS 8r CO. LTD. 32 tFinsbury Square OR London EC2

BAILLIERE, TINDALL 8r COX 7-8 Henrietta Street London WC2

Please send me copy/ies of Bailliere's Nurses' Medical Dictionary, for which I enclose remittance of.

Name · Address FAj 2Si ···

FIRST AID & NURSING, JULY / AUGUST 1951

I.C.A.P. EXAMINATION RESULTS

T HE following members of the Institute of Certified Ambulance Personnel passed the Institute examinations held in April 1951 -

Final Examination

Adams , R. S., Eskring, Newark, Notts

Adams, S. L., Ashbourne, Derbyshire.

Barker, D. N., Sinfin Derbys bire.

Fisher, J. A., Allenton Derbyshire.

Fowell, F., Leicester.

Kindregan, H. G., London.

Lowe, Miss M. A., Beeston Notts.

Proudlock, R. , Newcastle-on-Tyne.

Rymer, F. C. A., Harrow, Middlesex.

Yeomans, L., Derby.

(Miss M. A. Lowe and Mr. L. Yeomans tied for first place.)

Preliminary Examination

Barnes, H. J S. , Swatfham Norfolk.

Barnes, J. , St. Annes-on-Sea, Lanes.

Bourne, S . H ., Shrewsbury, Sbrops.

Bramley, H., Belper, Derbyshire.

Brook, H. , Formby, Lanes.

Carson, H. , Liverpool.

Coupland , R. , Fleetwood, Lancs.

Davies W. M. Shrewsbury, Shrops.

Donworth, A. M., Hounslow, Middlesex.

Fiddy, W. F., Formby, Lancs.

Gallacher, W. J., Liverpool.

Graves, F. E., Graves end, Kent.

Hayes, A. B., Matlock, Derbyshire.

Hesketh, J. E., Southport, Lancs.

Hughes, F. H., Shrewsbury, Shrops.

Hurst, J., Manchester.

Kennedy, Miss A. J., Billingham, Co.

Durham.

Kidd, J. M., Reading, Berks.

Kirk, A. , Isleworth, Middlesex.

Lloyd, A. W. , Liverpool.

Meagher, D., St. Annes-on-Sea, Lanes.

Medcalf, J. D., Lytham St. Annes, Lancs.

Musker, W. B., Maghul , Lancs.

Medical .lVotes: lin,,,sual Electric Shocks

WRITING to the British Medical Journal recently, a doctor described how one of his patients complained that every time he got out of his motor car and closed the door with his hand, he received an electric shock. This recurred on so many occasions that he took to using his handkerchief to close the door.

Following this report, other doctors have written to the B.M.J. giving their experiences. One describes how he has received shocks even through lined leather gloves. On one occasion he jumped out of his car to buy a newspaper, leaving the door open. When he handed a penny to the paper man, they both got a shock, much to the latter's surprise! Similar shocks have occurred when a motorist gets out of his car and shakes hands with one of

Newport, V. D., Rornford, Essex. Nutter, L., Southport, Lancs.

Powles, E. W., Liverpool. Shawcroft, C. B., Southport, Lancs. Walker, P. G ., Kidderminster Worcs. Wells, R. c. , Harrow, Middlesex. (Mr. R. C. Wells won first place in the examination.)

LOI,don Transport Ambulance Centre

THE presentation of first aid awards was held at tbe Assembly Rooms , St. Pancras Yown Hall , N.W.I, on Thursday, 7th June, and was accompanied by a dance, social and cabaret.

The presentation was made by Mrs.

A. B. B. Valentine, who was introduced by the Centre Chairman, Mr. Alex. J. Webb, C.St.1., General Superintendent (Staff and Training) Railways. Mr. Valentine, member of the London Transport Executive, was also present. Some 300 out of about 600 awards gained recently were presented to members and were followed by special awards and long service medals to the undermentioned :-

Certificate for the furtherance of First Aid to

Mr. B. E. Holthusen

Mr. A. Glover

Mr. E. V. Fryer

Mr. C. B. Cherry

Mr. J. Ricbards

Hammersmith Branch. Dunton Green Branch. Sutton Branch. Charlton Branch. Baker Street Branch.

Team Plaques were awarded to : Camberwell 'A' Team. Chiswick 'A' Team.

Long Service Medals were a warded to :

15 Years-

J. Larkin, J. Cox, J. Jackson, W. Best.

20 YearsH. Edginton, D. Simpkin, F. C. Morgan ! D. Young, H. Venner.

25 Years-

F. Nightingale, H. Ashford, W. Searle.

35 YearsJ. Denman, J. Gravestock.

Hally Tablet Medals were awarded to : G. E. Foley, T. Clift, J. Tuckey.

The excellent dance, social and cabaret under the direction of Mr. Ted Making of Camberwell Garage, was thoroughly enjoyed by a gathering of some 850.

After the distribution of awards Mrs Valentine was presented with a bouquet by Mrs. R. Cole, leader of the Chiswick Dr. L. G. Norman, O.SU. Chief Medical Officer and a Vice-President of the Centre, passed a vote of thanks to Va.1entine <l:nd spoke of the growing mterest ill first aId amongst all sections of the Executive. He also paid tribute to tbe Centre Secretary, Mr. S. W. Harden S B.St.1., for his work in increasing ?f the Centre and for the excellent orgamzahon of that evening's function.

his friends. Sometimes a faint hiss can be heard but the shock IS insufficient to cause injury. The phenonemon is explained by the fact that the human body can receive and temporarily retain a charge of ylectricity. This can be generated in various ways such as frictiem between the person's clothes and the leather car upholstery and from certain moving parts of the vehicle, e.g. the tyres on the road. The risk is greater on a hot dry day and if the motorist wears rubber soles. One doctor reports that he has carried the charge for over a hundred yards.

Another doctor reports he has received shocks from patients lying in bed and using electric blankets. On one occasion, he was surprised to get one when examining a lady's pulse.

TOPICAL NOTES (cont.)

Barnett Hill Courses for September

185. An Intensive First Aid Course, for prospective V.A.D.s and nursing members. From Saturday, 1st September till teatime on Friday, 7th September; but students may stay until the following day if they wish. An examination will be held at the conclusion of the Course and certificates awarded to successful candidates.

186. An Intensive Nursing Course, on the same lines as the First Aid Course, commencing on Saturday, 8th September and terminating on Friday, 14th September, but students may stay overnight if they like. An examination will be held and certificates awarded.

187. Instructors' Course.- Thursday, 20th September to Monday, 24th September. This is open to all officers and members who are eligible to attend-see Revised Instructors' Course, Form C, paragraph 77. An examination will be held at the end of the Course.

188. First Aid and Nursing Competitions Course.-Open to men and women officers and section leaders. The Course is intended to cover all aspects of the practical use of First Aid and Nursing knowledge, and the training of teams for competition work,

A perfect present for every St. John Cadet THE FRIENDS

INSTITUTE OF CERTIFIED AMBULANCE PERSONNEL PROFESSIONAL EXAMINATIONS

The next examinations of the Institute will be held in October, 1951 :

PRELIMINARY-Saturday, 13th October, London. The examination will also be held in one or more other centres according to applications received. 'Wr itt en paper on Anatomy, Physiology and Hygiene. Oral.

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Closing Date for entry, on form provided, 1st September.

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Queries and Answers to ()orrespondents

Fractures of Spine and Leg

R. L. (Darton).-A man is found lying on his left side suffering from fracture of spine and compound fracture of his left leg. Before moving patient on. to his back and treating his injuries should gentle tractwn be maintained throughout the period until pati ent is transferred to a stretcher? Also in a competition with a team of four men if gentle traction has to be maintained should this be carried out by two members of the team whilst the remaining two members attend to the injuries ? Your kind ruling will be much appreciated.

In Rule 2 on page 124 of the Textbook you are told that 'whenever the patient is about to be moved it is necessary to apply traction.' It follows, therefore, that the members of the team would not apply this traction until they start to turn the patient on to his back but if there is any fear of the injured part being bent, twisted or over-extended during the treatment of the fractured leg this extension must be continued for that period. The extension is not necessary during the time that the patient is quiet and not being moved. You should certainly use trained men for the application of traction.-N. Corbet Fletcher.

Examination Howler

E. M. (Highgate).-At a recent re-examination the doctor asked one candidate to explain /what is meant by the term' artificial respiration.' He was hardly amused when the candidate replied: 'Artificial respiration is what you make a patient go through when he is only just dead /'

Good! Next please! !-N.C.F.

Silvester's Artificial Respiration

J. P. (Doncaster).-In the 40th Edition of the Textbook the instructions on Silvester's Method of Artificial Respiration are somewhat confusing and contradictory. On page 84 for the second movement we read: , Bring his flexed arms slowly back along the same route, and press them firmly against the front and ribs of his chest. This forces air out of his lungs, i.e. expiration.' This movement should take two seconds, but we find that it takes longer to perform than the method taught in the 39th Edition. Then a little later in the clause on rhythm we read, 'each completed circle, etc.' How can it be a complete circle of movement when we have to Draw his arms upward, outwards and towards you,' and then 'Bring his flexed arms slowly back along the same route' ?

We would appreciate your remarks on these points.

The instruction on page 85 of the 40th Edition of the Textbook (Movement 2) and on page 151 of the 39th Edition are identical except that different words are used to convey the same meaning. The time taken for this movement, therefore, should not be longer.

The instruction on Rhythm given on page 85 of the 40th Edition and in Rule (c) on page 151 of the 39th Edition are the same except for a change in the wording. I agree with you that the word ' circle' is somewhat misleading as two movements along parallel lines cannot constitute a circle. If a change was necessary, the word , cycle' would have been better than the word ' circle,' and in my view the old instruction was clearer than that now given in the latest edition of the Textbook. -N.C.F.

Fractures of Thigh or Leg , J. P. (Doncaster).-In the 40th Edition of the Textbook we are told on page 145 to apply a splint when a patien t has to be carried long distances over rough or uneven ground as part of the treatment for patient suffering from fractures of thigh or leg when the fracture is confined to one limb. Will you please tell me how many bandages should be applied and their order of application with the thigh splint. Also please tell me how many bandages and their order of application with the leg splint. To adopt Rules 1 to 4 apply the splint then further follow Rules 5 and 6 with a fractured thigh. It would seem to me that the part of the splint above the fracture would not be secured.

The order of bandaging is given in the instructions on page 145 of the Textbook; but it seems from your questions that your difficulty is with the way in which the splint is secured. You should read the instruction given in black type in Chapter 1 on page 17.

In the General Rules for the Treatment of Fractures it is laid down in Rule (c) on page 117 that in those rare cases where a splint is required it should be firm, long and wide enough to keep the joints immediately above and below the fractured bone at rest, and this wording is repeated in full a few lines lower down in the same Rule. Further, in Rule (a) on page 45 it is stated that bandages are required to retain splints in position.

From these instructions, it is clear that you must secure the ends of the splint by bandages although this means using more bandages than are mentioned on page 145.N.C .F.

Phosphorus Poisoning

A. T. (Birmingham).-Page 175 of the Textbook states that the simplest antidote in general use for swallowed poisons is mille Please tell me if there is any reason why the prohibition of the ·use of milk in phosphorus poisoning is now omitted from the Textbook.

As milk consists of 87 per cent. of water and less than 3 per cent. of fats, it is unlikely that milk would come under the heading of oil or fat' as mentioned in the 39th Edition of the Textbook. On the other hand Rule 5 on page 172 of the Textbook states that in all cases of poisoning milk should be given to the patient.-N.C.F.

The Textbook to which reference may be made in this column is the 40th (1950) Edition of the S.J.A.A. Manual of First Aid to the Injured. Correspondents are requested to write on one side of the paper only.

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AID &: NURSING

DYSMENORRH<EA

ARE the stars in their courses any more mysterious than the recurring cycle of the menses? As regularly and predictably as the phases of the moon, the average uterus sheds its endometrium every twentyeight days and the average woman experiences discomfort, pain and depression

Measurably relief from these symptoms of dysmenorrhcea may safely be obtained at every period with ANADIN tablets. Anadin combines the benefits of two pain-relieving compounds with those of two mild stimulants. Anadin is not habit forming and is quite safe for self-administration by the patient in the prescribed dosage

Two to four tablets, according to severity of symptoms, repeated every four hours as required.

on their feet with makeshift meals.

The Red Cross, too, recorded sixteen' immersions,' in other words, people who had taken involuntary duckings in the Exhibition lakes and ponds. Mr. Bolton said that they had provided a drying room for these unfortunates, with spare pairs of pyjamas while clothes were being dried.

There were the usual cases of fainting, but an interesting point made by Staff Officer Bolton was the number of cases of fainting in the Health Pavilion, where the photographs displayed of hurns, smallpox, etc., were perhaps a little too much for some sensitive people. Headaches were constantly being treated at the post, and some 11,000 aspirin were used, a figure which, Mr. Bolton assured me, astonished the Princess· Royal, Commandant-in-Chief when Her Royal Highness paid a' semiofficial visit to the post on the last day of the Exhibition.

The major accidents met with were mostly suspected fractures, deep cuts, etc., while a number of

Invalid chairs were provided for old people by the Red Cross cases of suspected appendicitis were evacuated to hospital. The Red Cross used the London County ambulance service, and were Impressed by its speed and efficiency. N?rmally, the ambulance took mmutes to arrive after a call and about 7 minutes to get the from the post to St. Thomas' hospital.

The Red Cross post was manned by members from all parts of Great

Britain, altogether 629 members were on duty. Most of them served for a week or fortmght, and some of them gave up their holiday to do so.

The permanent staff, under Staff Officer Bolton, was: Miss Lidstone Anderson, S.R.N., and MISS S.R.N. (Sisters); Mrs. PereLra, Mrs. Harris, and Miss Ballard (Nurses); Mr. Courtney, Mr. Cox, and Mr. Epple (Red Cross Members).

A popular service inaugurated by Red. Cross post was the provision of lll,:,alId .chairs to enable old people and lllvalids to see the Exhibition. Two chairs were originally used but there was so much demand fo; them that eventually ten chairs were kept going, and at one time were booked a week ahead. Some 600 trips were made.

First aid work in the Red Cross post is summarized in these figures : number of patients 10,952, of there were 3,300 minor 21 major injuries, 668 famtness, 690 digestive, 2,734 nervous, 41 ear, 85 nose bleeds 11 16 immersion, 3 infectious dIseases, 10 epilepsy, 11 diabetes, 3,362 others.

FI RST A1D & NURS[NG, SEPT.IOCT. 1951

Mrs. Durrant went on to say that long hours of travelling were probably t he cause of the large number of headaches and gastric troubles treated at the post.

She particularly emphasized the comparatively few cases of fainting treated during the Exhibition. This was a tribute to the careful way the crowds were regulated at the Exhibition, and especially the crowds inside the Dome of Discovery.

The St." John post also used the London County Council ambulance service, and were much impressed by its speedy efficient service.

The casualties treated by st. John are broken down as follows :---

3695 accidents, comprising

1,357 wounds

293 burns and scalds

662 blistered feet

280 sprains

31 suspected fractures

268 bruises

709 foreign bodies in eye

95 foreign bodies elsewhere;

1,486 defects of the nervous system comprising

1,443 headaches

5 hysterics

36 epilepsy cases

The Editor)§ Opinion

great South Bank Exhibition

IS now a memory. During the summer of 1951 it was the focal point of the Festival of Britain, and as such became part of our national life for a few months. Thousand8 of people visited it, from all parts of this country, and from the countries overseas.

In any concourse of people mishaps and accidents are likely to occur, and the South Bank was no exception. Fortunately, there were no serious mishaps, but there were plenty of those insignificant but nonetheless disturbing incidents which can mar a day's enjoyment-blistered feet, 'Exhibition stomach,' cuts and bruises, sprains, and grit in the eye. The figures are given elsewhere in this issue.

On the lighter side, and not included in the official reports, is the true story of the man who at one of the posts requesting vaselllle. When it was suggested that he should bring the patient to the post for treatment, he declined on the ground that it would be difficult to bring over a cow from the Countryside pavilion! The animal, one of those lovely creatures which made such an impression on Exhbition visitors, was suffering from toothache, and its attendant had turned to the first aid post for help.

At the S1. John first aid post at the South Bank Exhibition, for which Mrs. Margaret Durrant, S.R.N., Chief Nursing Officer, Greater London, was responsible to the Commissioner, 8,141 visitors were treated. The permanent staff at the post included Sister Florence Peacock, S.R.N., C.S.M., J.P., and Sister N. Luxa, S.R.N. Mrs. Durrant's Deputy, Mr. John :Vaterer, S.R.N., played a big part In the organization of the post.

Mrs. Durrant told me that the of treated involving bOd.les in the eye' was noticeably hIgh. She considered that this had little to do with the site of the Exhibition, rather she thought that the 'foreign bodies' were picked up on the way to South Bank while travelling, or under simila; circumstances. She quoted the case a man who came to the aid post WIth a bad eye which was diagnosed as a weld burn. The man admitted that this was so, and that the mishap had occurred the day before, but that he had. not to do anything about It until he had arrived at the Exhibition. ""-

2 Meumieres disease

563 defects of the circulatory system, comprising

443 fainting and syncope

35 heart attacks

85 nose bleeds ;

846 defects of the digestive system, comprising

202 indigestion

523 gastro-intestinal disturbances;

193 defects of the respiratory system, comprising 63 colds

29 a sth rna cases

91 sore throats;

J ,230 infections, including

114 eye

262 skin

339 sepsis and boils.

219 people were sent to hospital, and of this number 115 were accidents, and 104 sickness. Twentythree of the cases were employees at the Exhibition. There were 9 pregnancies.

There were 18 members on duty, with two sisters. Some of the St. John members had given up their holiday in order to go on duty.

These minor casualties- there were nearly 20,000 in all- remember with gratitude the aid they obtained from the St. John and Red Cross first aid posts Headaches and sore feet do not figure very much in the First Aid Manual, but they are important enough to those who are unfortunate enough to suffer with them, and at the first aid posts these minor casualties of a great Exhibition found the same friendly hel}: and competence as was given to the few major casualties which occurred.

One scans the figures to see if any particular type of accident emerges, but apparently the story follows the familiar pattern of a large number of people gathered together in one spot. Rather a large number of eye troubles, noticeable, too, were the gastric disturbances, due perhaps to lengthy travelling, unusual meals, etc. An unusual type of incident, surely, were the 'immersions' reported from the Red Cross post. The St. John post does not seem to have been called upon to deal with this sort of thing, but perhaps such a mishap would be included under some otber heading. On the other hand, the St. John post reported nine pregnancies, but the Red Cross make no mention of this.

What does emerge from these figures, however, is the great success achieved in the control of crowds. Altogether, there were only 1,100 cases of fainting recorded during the whole run of the Exhibition, and considering the large crowds and rather restricted site, this is an astonishingly small number. The arrangements were excellent, and those who had the responsibility of controlling the visitors did a splendid job, and are to be congratulated.

The result of the Casualties Union Competition, held at Kings Cross Station, London, on Sunday, 7th October, was as follows :Buxton Trophy Max. 350

1. British Red Cross Society, Kent 99A Det. 172!

2. St. John Ambulance Brigade, Southgate 118 l66i

3. St. John, Walthamstow29 161 1

Diagnosis Trophy Max. 150

1. B.R.C.S., Kent 99A 57!

2. St. John, Southgate 25 (C.N.) 55

3. St. John, Southgate 118 53

First Aid Trophy Max. 200

1. St. John 183 (Shirley) 123

2. B.R.C.S., Woolwich L.29 121!

3. st. John, Walthamstow 29 1I8!

Twenty-three teams competed, including those from the G.P.O., the Metropolitan Police, Boy Scouts, and Territorial Army.

A happy picture outside tbe St. John First Aid Station. From left to right: C/Sgt. Richard Baldw· N j M Mrs. M. Wood, N/M Mrs. C. Pointer, Mrs. E. Jakins, Sister F. Peacock, Cdt. Maureen

Giants and Dwarfs

by A. D. BeJilios, M.B., B.S. (Lond.), D.P.H. (Eng.)

T HERE exist in the body three distinct kinds of glands. Those of the digestive system, well-known to every reader, include the salivary and the pancreas. They produce secretions, called juices; these are conveyed along channels known as ducts to the digestive organs where they act on the food-stuffs which have been eaten.

The lymphatic glands-small bodies about the size of a bean-are very numerous and situated in all parts of the body. They are organs of the lymphatic system and form an important line of defence against germs.

The third group of glands-the endocrines-about which this article has been written are not so well known to the general pu blic although they have most important functions. They produce substances called internal secretions or hormones; these they pour directly into the blood hence they are commonly known as the ductless glands. They include the pituit?-ry, thyroid, parathyroids, suprarenals and thymus ; in addition, other organs in the body produce hormones as well as undertaking their obvious function, e.g. the testes, ovaries, pancreas, etc.

The endocrine glands puzzled the medical profession for many years and although, nowadays, a great deal is known about their function there is much more to be discovered. The knowledge so gained may well exert a profound influence on the progress of medical science. Moreover there is evidence that the activities of the endocrine glands exert an influence on the development of the personality of an individual which includes his temperament, character and sexua l characteris tics.

The

Pituitary Gland

This was originally thought to be the seat of the soul and is of such importance that it is commonly called the 'master gland' since it influences the activities of other endocrines in the body. No larger than a big pea, it lies, well protected from injury, within a small cave in the base of the skull; it is attached to the base of the brain. The pituitary gland consists of two distinct portions, front and back-called the anterior and posterior lobes respectively. Of these, the anterior lobe produces no less than ten hormones, each of which exerts its special function on bodily activity. It is obviously impossible to describe these in detail, but as an example the growth hormone may be mentioned since it controls the rate and amount of growth of the human body.

Ductless glands are liable to two chief kinds of complaint-over and under secretion of their hO rmones, and by study of the diseases which are so produced the value of the hormones can be understood.

Acromegaly

Over-production of the growth hormone of the pituitary gland causes the disease known as acromegaly in which the patient becomes over-grown. Often his attention is first called to his disability by a gradual increase in the size of his head which causes him to buy larger sizes in hats. At the same time his feet and hands become larger, the latter ultimately huge and spade-shaped. Apart from his increased size, his face becomes egg-shaped with a lower jaw which is unusually prominent. The eyelids and nose become coarse and thick while "the ears are enlarged.

In spite of unpleasant symptoms and also complications which he may develop, it is a characteristic feature of the disease that the patien t retains plenty of energy both in his mental and physical powers.

Gigantism

If acromegaly begins in early life, i.e. before puberty, its results are much more marked and the patient develops to such a size that his condition is called gigantism. He is, in fact a giant, but it is unlikely that he will live to ripe old age. Most giants die in early middle age from some complication. The tallest giant is reputed to have been 8 ft. 6 ins. in height.

Dwarfism

Under-secretion of the growth hormone produces a very different picture and causes a slowing down' in the rate of growth which may cease entirely at an early age.

1n normal ch ildren, from six onwards, the lower limbs increase in length at a rate greater than that of the remainder of the body. When, however, the growth hormone is deficient in early childhood, the patient develops with legs that are permanently short and out of proportion to the size of his head and trunk. If the deficiency occurs at a later age, the disproportion may not be so marked. So fa r as mental development is concerned, it may not be obviously affected; indeed, sometimes these children develop a higher intelligence than normal.

Dwarfism, as this condition is called, may result from disorders other than those of the pitui tary gland, for example complaints such as rickets and nephritis.

Another result of insufficient secretion of the pituitary gland in

FJRST AID & NURSrNG, SEPT./OCT. 1951

childhood is a variety of obesity, often associated with lack of development in other ways. Many readers will have met the unusually fat child. Often he possesses a characteristic personality, charming, popular and happy-go-lucky. Intellectually he may be above normal; he is often musical and imaginative. The condition may improve with growth into adult life.

Goitre

This term is applied to enlargement of the thyroid gland which is situated at the front of the neck just below the larynx or 'Adam's apple.' The disease is not uncommon particularly in certain parts of the world. In England, it was formerly called' Derbyshire neck' owing to its prevalence in this area while it has also been particularly noticed in deep mountain valleys such as those of certain parts of Switzerland.

Goitre is supposed to be due to a deficiency of the iodine-containing hormone of the gland This is reputed to be caused by insufficient iodine in drinking water and food a nd had led to the addition of iodine to table-salt in Switzerland with the object of prevention.

Apart from the disfigurement that they produce, many goitres do not cause symptoms; often, in young people they disappear within the course of a few years. Occasionally, however, they are responsible for severe shortness of breath through pressure on the air passages, w.hile sometimes they may develop Into more serious conditions.

Exophthalmic Goitre

This complaint often called Thyrotoxicosis ?r Grave:s disease, is due to exceSSIve secretIOn of the hormone called thyroxine. It may be precipitated by anx iety and mental strain.

The characteristic feature is prominent eye balls which to bulge from their sockets, the patient a startled and stanng appearance. He nervous and irritable, often subject to sleeples.sness and alarming dreams. RapId pulse involuntary trembling movements of the fingers and pronounced loss of weight are additional signs. Promising results in treatment are being obtained by giving a new drug called Thiouracil.

Medical News

ACTH AND RHEUMATOID ARTHRITIS RECENTLY

the Minister of Health the public that treatment of Rheumatoid Arthritis with the American drug ACTH is still in its experimental stage and that patients must be kept under careful observation while it is being given.

.

Rheumatoid Arthritis is a chromc and crippling disease, which attacks women more frequently than men; often it begins quite early in life. The characteristic feature is swelling of the joints, commencing usually with those of the fingers and gradually extending to others in the body. Severe deformity and loss of use slowly develop and in addition there is wasting of muscles with general ill-health. .

Until recently there was no satISfactory remedy for this disabling complaint, but in 1949 Dr. Henchyf the Mayo Clinic, Rochester, Mmnesota, U.S.A., in conjunction with his colleagues reported spectacular results in treatment by daily injecti')ns of a drug called' Compound

Myxoedema

This results from under-secretion of the thyroid gland which usually becomes much smaller than normal. The complaint is more common in women than in men and usually occurs between the ages of 30 and 55. The patient gradua1ly becomes excessively fat and her appearance changes. The pale and puffy with baggy although there is often a pmk flush of the cheeks. The hair is coarse and brittle and the tongue broad and thick causing the patient to speak in a manner that suggests that her tongue may be too big. for her mouth. In spite of her 1l1creased size, the patient complains that she feels the cold.

There is often a change in mentality; thus the memory is poor and the intellect d i mmed. Excellent results in treatment are obtained by giving tablets containing an extract of thyroid gland.

E' or Cortisone. This is derived from part (cortex) of the suprarenal glands and can also be made in the laboratory although its manufacture so far is very difficult and expensive.

ACT H ( Adrenocorticotrophic hormone) is a protein extracted from the pituitary glands of pigs. When injected into the human body, it causes the suprarenal glands to produce Corti sone and hence gives similar, perhaps superior, results . These drugs may be of value in other complaints besides Rheumatoid Arthritis. It is claimed that rheumatic fever, gout and asthma patients are relieved. During administration, unpleasant complications may occur such as faintness, vomiting and even unconsciousness. It may be some time before ACTH is available in sufficient quantities for general use and before its toxic effects have been overcome. Nevertheless, it may ultimately prove to be a tremend?us discovery in the re a lm of medlcal SCIence.

Cretinism

Deficiency in thyroid occurring from birth results 111 a child being so stunted in its growth that it is called a cretin. The face is ugly and said to be moon-shaped; the cheeks appear to hang down. The voice is harsh and squeaky and in every way the child is backward; often, however, it has a placid affectionate disposition. Once agam, success in treatment is obtained from giving thyroid extract.

The diseases which have been described in this article demonstrate a few of the more obvious disorders of the ductless glands. There are, however, many others; moreover they exist in all sorts of degrees of severity. Often they do not produce a characteristic picture and can be very difficult to recognize. The field of Endocrinology, as study of the ductless glands is offers to the medical man a bIg research with the opportumty of coveries of great benefit to the pubhc.

Australians Lost! thi.s Test lJ1atch

I N a written paper competition, Exmouth Junction Motive Power team of British Railways, Southern Region, secured a win against Hobart team of Tasmania Government Railways

Major A. C. White-Knox, Principal Medical Officer, of the St. John Ambulance Association, London, set the tests and despatcbed them to the Referees, Dr. T. H. Goddard of Hobart, and Dr. W. J. Walters of Exeter, who opened the sealed envelope when the teams were ready to take the tests. Allowed one hour to write the answers, the teams' papers were collected by tbe Referees and sent to the Judge.

The result was Exmouth Junction 203, Hobart 139. Possible marks 250.

Tbe Questions were as follows

No. 1.-You are in charge of an amateur stretcher squad of four bearers carrying a patient by stretcher from Downing Village in the vaHey to Upping Hospital near the top of the hill, a distance of half a mile. On the way you have to cross the ford over the small stream Ninny and the stile at Farmer Giles' ten-acre field and the journey takes you 25 minutes. On arrival at

Region in the Inter-Railways Competition in 1950, gaining second position in this national event. The team are all members of the Motive Power Department, at Exeter, and are: No.1, Mr. F. Salter; No.2, Mr. C. Dare; No.3, Mr. K. Carpenter; No.4, Mr. H Stratford; No.5, Mr. F. King.

Hobart team were the winners of the Tasmania State Ambulance Competition in 1950. The members' period of training in first aid varies from twelve months to eleven years.

Team members: No.1, Mr. J. E. Lynch; No.2, Mr. L. P. Tierney; No.3, Mr. T. N. Eddie; No.4, Mr. J. J. Harvey; No.5, Mr. T. H. Byron.

The teams have demonstrated their appreciation and enthusiasm in the Competition by sending presents to each otber, this has also extended to the Ambulance Secretaries. Hobart team sent serviette rings made from Tasmania woods embossed with small gold maps of Tasmania, and the Exmouth Junction reciprocated with gifts of Devon pottery.

* Red Cross NEWS

County of London

IN the Headquarter's Annual Report for 1950 there is a reference to the first aid posts which are manned at University of London examinations. Now the County of London Branch has received a letter of appreciation in this connection. An invigilator writes that the presence of a first-aider must have made all the difference to at least two candidates taking examinations at the Imperial Institute, South Kensington. One was a girl , who looked desperately ill , having been sick all night and unable to take breakfast. The Red Cross member gave her a draught and glucose at intervals. It was due to this treatment that she was enabled to continue the examination. The other was a negro who had something of a sharp, gritty nature in his eye. The member realised he required hospital treatment and quickly arranged this. Arrangements were subsequently made for the boy to take the paper he had missed, on the following day.

travelled some 24,000 miles. It will be remembered she went to the Far East at the invitation of the R.A.F. to gain firsthand knowledge of the casualty evacuation scheme as well as to see the Service Hospitals The route was as follows:

Lyneham - Luqa (Malta) - Habbaniya

araq) - Mauripur (Karachi) - egombo

(Ceylon) - Singapore - Saigon (IndoChina) - Hongkong - Japan - Korea

Mrs. Bryans visited all the Service Hospitals en rOllte, and was satisfied not only with the hospitals themsel ves, but with the arrangements for the reception of patients. At Saigon tbe Aight was delayed, due to engine trouble. This however, afforded her an opportunity of seeing the French Red Cross at work. Mrs. Bryan s was amazed at the close promixity of the war there; one could hear the din of battle, and the Red

Cross are doing fine work under great Mrs Bryans reports that tbe BrItish ServIce Hospital in Kure (Japan) is the finest she has seen Casualties both from Kore a and Malaya are evacuated to base. hospita.ls by helicopter. In Malaya special cleanngs have to be made in the for this purpose, and she felt the pilots deserved special praise for the way they carried out this rather hazardous task. The purpose of Mrs. Bryans' \isit was to see everything for herself, and so she travelled as a patient' in a helicopter, and reports that it was quite comfortable. In the smaller planes one patient is carried, but there are larger ones \\hich will take up to four. Her return journey was extended and arduous. She is satisfied, hmvever. that everything possible in the way of welfare for the patients is being done.

Upping Hospital, Matron tells you to take the patient to the. ward on the first floor and put him in bed No.9. The patient's injuries are a bad compound fracture of right arm with a constrictive bandage controlling haemorrhage above it. Slings are provided. Instruct the squad throughout.

No. 2.-A man while walking along a pavement falls and complains of an injury to his right knee. How would you arrive at a conclusive diagnosis of the injury, mentioning those possible and eliminating those not present.

No. 3.-This patient is unconscious with a red face. What may he be suffering from, and how would you differentiate between the conditions ?

No. 4.-Give the treatment of all types of wounds involving the abdominal wall.

No. 5.-You are called to a woman who has her head in her kitchen gas oven, with gas turned on. What would you do ? (a) If is absent; (b) if breathing IS present.

The Exmouth Junction team have had much experience in competition work, they represented the Southern

The Competibon was arranged by Mr. F. A. Trott, Reglonai Ambulance Secretary, British Railways, Southern Region, in conjunction with 1r. R. Wallace, Ambulance Officer, Tasmanian Government Railways.

* British Transport Police Contest

The position in which the teams were placed by the Judges, Dr. G. M Shaw Smith, of Dr. F. H. Taylor of London, 10 the Fmal Competition at the Borough Polytechnic, London, S.E.I , on 13th September 1951, was as follows :-

1. Darlington (Northern Area)

2. Liverpool Street (London Area)

3. Dover Marine (South-Western Area)

4. Preston (Midland Area)

5. Parkeston (Eastern Area)

6. Edinburgh (Scottish Area)

294 28H

261 236(Maximum Marks obtainable 400)

At the distribution of prizes at the conclusion of the. Competition, the chair was taken by Lieut.-General Sir Henry Pawn aU, K.e.B., K.B.E., M.e. (Chancellor of the Order),. and the prizes were presented by John EllIot, Esq., Chairman of the Railway Executive.

Hurricane Disaster in Jamaica

The hurricane which hit Jamaica on 17th August has s hown another fine exa mple of the way the Red Cross goes promptly into action in the event of disaster. On the day of the 17th, the Branch established and manned 21 centres in Kingston and St. Andrew, which were increased to 44 by the following day, when mercifuUy the hurricane had abated. Reports since received indicate that the Branch is doing magn ificent work in feeding and help ing the homeless; in addition, 63 welfare enquiries, received by London H.Q., have been dealt with by the Branch. The moment the news of the disaster reached H.Q. £1,750 was cabled. (£500 of this came from the Scottish Branch .) Other Branches in the West Indies also sent aid-the Trinidad and Tobago Branch once again flying relief supplies to the island, and the Antigua, Bahamas , British Honduras and Bermuda Branches sending immediate aid in the form of hurricane lamps, blankets, food and clothing. The League of Red Cross Societies acted at once and the American and Canadian Red Societies went to the scene of disaster with supplies and offers of help. The American Red Cross has allocated 10,000 for relief. All relief supplies given for Jamaica are being handled by the Society's Stores Department. These, together with parcels sent by the public, are being shipped free to the Governor 's Relief Fund Jamaica.

Mrs. A. M. Bryans' Far East Tour

Mrs. Bryans (Director, St. John and Red Cross S-ervice Hospitals Welfare Department) is back from the Far East and .Korea. She arrived at the R.A.F. StatIOn at Lyneham on Tuesday, 28th August, after a tour lasting nine weeks, during which she

A Railway Presental1tion

LAST August, Signalman Herbert Scott, of Bierley, Bradford , was on duty in Hall Lane Signal Box, Laisterdyke, when he heard two women shouting and discovered a three-year-old boy floating beneath the surface of the water in a small dam twenty yards away. By lying on his stomach and grasping the boy's hair, Signalman Scott got him out immediately and applied artificial respiration (Schafer's metbod) until he began to breathe. Tbe boy, Tony Bautenbach, was taken to Bradford Children's Hospital by ambulance where he recovered completely. Signalman H. Scott then returned to his signal box in time to pass a

passenger trajn two minutes later. The sequel was the presentation to Mr. Scott of the Meritorious First Aid Certificate at a recent ceremony in the Board Room of the NorthEastern Region Headquarter's offices at York. In the picture Mr. H A. Short, Chief Region al Officer, N.-E. Region British Railways, is making the presentation.

Left to right, Mr. C. Cooper, Regional Staff Officer, York; Mr. H. A. Short; Mr. E. W. Rostern, Operating Superintendent, Eastern and North-Eastern Regions, Marylebone; Mr. F. H. Petty, Motive Power Superintendent, York, and Mr. Herbert Scott.

The sllccessful Exmouth Team

Nursery Training Colleges and Nursery Schools

by Agnes E. Pavey, S.R.N., Diploma of Nursing (University of London)

M ANY of the Nursery Training Colleges in this country are affiliated into an Association. In order to qualify for affiliation the minimum number of trained staff must be five-a Principal, a Hospital trained nurse, a College trained nurse, a Nursery School teacher and a Domestic Science teacher. The Illiillmum number of resident children must be twenty, at least six of whom should be under one year; and the minimum number of nursery students must be twelve, there being at least one student to two children in order to safeguard the individuality of the child . Colleges applying for affiliation must have been established on the accepted lines for at least one year, and they must be open to inspection by a representative of the Association.

The Association of Nursery Training Colleges was founded in 1925 in order to encourage a high standard of training in Nursery Colleges and to promote the welfare of Nursery Nurses. Each College has its own methods, but the syllabus covered is that of the Royal Sanitary Institute Examination for Nursery Nurses and also that for the National Nursery Certificate. In addition, the College usually gives its own certificate and recommends successful candidates for suitable posts. In order to qualify for the higher posts College-trained nurses may undergo a post-graduate course of three months, arranged in conjunction with the Hospital for Sick Children, Great Ormond Street, and the Kensington Public Health Department.

The fees charged to resident students for an eighteen to twentyone months' course varies from £110 to £240. In Edinburgh the fee for a twelve-months' resident course is £128, but a two-year non-resident course is available, for which the fee is £100. There is one Nursery

Training College in England that gives free training-the Warwick County Nursery Training College, Warwick.

The Norland Nursery Training College

This may be considered as the pioneer in such forms of training, for it was established at Chislehurst, Kent, in 1892, by Mrs. Walter Ward, one of the earliest advocates of the Fr'oebel System. As headmistress of the Norland Place School Mrs. Ward had formed the opinion that, from babyhood to school age, children should be cared for by educated and cultured women, and that girls who were particularly suited for this work should have the opportunity of undergoing specialized training.

The curriculum drawn up aimed at giving the students a balanced knowledge of the physical as well as the educational and psychological needs of children from ten days to five years of age. The College buildings consist of four large houses with extensive gardens wherein most of the fruit and vegetables for the College are grown There are nurseries and a nursery school attached to the College and the students gain additional practical experience by visiting outside nursery schools and by attending the doctor's sessions at Infant Welfare Centres. In order to gain some knowledge of the care of sick children each student spends three months of her training course in the children's wards of a hospital. The residential nurseries are modelled as near to the normal home life as is possible in a large establishment, and after two years of age the children attend the nursery school.

College is recognized by the MlDlstry of Health and the Ministry of Education. Students are accepted from the age of eighteen, and the fees for the whole of the course

amount to £260. Many educational bodies give financial assistance to suitable students, and there is a scheme by which candidates of limited means may be accepted by the College at reduced fees if, after reaching the age of seventeen, they help in the domestic duties of the College for one year previous to the commencement of training. These girls are called' maidens' until they become 'students.' A Memorial Fund which was raised to the memory of the first Principal of Norland College- Miss Isabel Sharman - is used to help students or maidens with the payment of their fees, and also to help suitable Norland nurses to specialize in some branch of child welfare work.

The Mothercraft Training Society

This was founded by Sir Truby King in 1918, and was another wellknown member of the Association of Nursery Training Colleges. It is a matter of very great regret that, on July 31st of this year, it had to be closed for lack of funds.

NURSERY SCHOOLS

One of the earliest nursery schools to be established in this country was at Stafford in 1873. It was free to children between the ages of two and six, who were given meals, baths and general care. There were good facili.ties for play, rest and sleep, but no organized teaching or training was given to the children; in fact, it was more like a day nursery than a school.

The Rac h el McMillan College

The real founders of nursery schools in this country were Rachel and Margaret McMillan- two sisters who spent their lives in the service of poor children in crowded cities, and in awakening the well-to-do women of this country to a realization of the needs and sufferings of the poor. Rachel had qualified as a Sanitary Inspector and Margaret had had

both a stage and a finishi ng governess's training before they devoted themselves to the welfare of needy children . The work for which they became famous was carried out in Deptford , where the medical records of that time show that 80 per cent. of the children had dckets. Like all East End suburbs, Deptford abounded in crowded slums, and the McMillan sisters felt most strongly that any improvement in standards and outlook of the slum dweller must come through the children, and that all children could be interested through art. Early in this century they established an open-air school for toddlers, a school clinic, and a school for older children at Evelyn House, Deptford. They took children from 8 a.m. till 6 p.m. At first, most of the time was devoted to bathing, playing, sleeping and eating, for the general condition of the children had to be improved before training or teaching could be given. In company with all pioneers, they experienced many difficulties and setbacks. The children were all physically if not mentally retarded , but eventually it was found that only 7 per cent. of the children who ha d attended the open-air school for three years were afterwards unable to continue their education at an ordinary school. A great number of nursery schools exist to-day that are modelled on the one originally founded at Deptford; and in May 1930 a Training College for sixty students, called the Rachel McMillan College, was opened by Queen Mary. It now takes 145 students from Britain and many other parts of the world. The course of traini.ng i.s for three years and the students gain the Teachers' Certificate of the National Froebel Foundation and the Teachers' Certificate of the Ministry of Education.

Nurser y Schools Under Social Services

According to recent legislation nursery schools should be available for all children over two year of age. They may be for mor.nings only, but if open aU day a midday dinner should be provided The school should be under the charge of a qualified Nursery School Teacher for every forty children, with young, untrained assistants. Furpiture, play materials, room and lavatory accommodatIOn

mllst be suitable, and floor space must conform to Ministry of Health specifications. The school may take from eighty children upwards, but there are usually twenty to thirty in each class. Little formal education is given although efforts are made to establish health-promoting habits. Group singing and games requiring organized action are taught and also other activities t hat have a value in the form a tion of character. A n umber are open air schools and

9 have long veranda that can be closed against the elements when necessary. The untrained helpers may be girls from fifteen to eighteen years of age. Continuance of general ed ucation is arranged for them; but the Nursery School under a local au thority gives no training that leads to a quallfication. It is a useful occu'pation to fill in the time between leaving school and commencing training as a nurse or a Nursery School teacher.

News I,-om , St. John

Harlesden ' I FAINTED for the first time in my life and w.,as treated by St. John Ambulance men who, after bringing me round, found me a seat at the front of the crowd watching the Royal procession.'

With these word') , the Mayoress of Willesden , Mrs. Trevor Evans, described how she first came into contact with the good work done by the St. John Ambulance

Bri gade on the occasion of the Royal Jubilee in 1935 Since then she had been full of admiration for the enormous amount of voluntary service given by Brigade members in their spare lime throughout the country.

The Mayoress was speaking at a Social Evening held in Neas den, and organized by the Harlesden Ambulance D ivision, for the purpose of presenting certificate.s to the successful candidates of a first aId c1as recently held by the Division. In making the the Mayoress gratulated the recIpIents on p3ssmg theIr examination. thus gaining knowledge which could not fail to be useful to t hem throughout their lives; she hoped that they the Brigade and so keep their first a id knowledge up to date and put thems':!lves at the service of the public.

O t her guests were: Mrs Wrangham (w fe of the Area Commissioner, Dr. O. R. H. Wrangham), Mrs. H. C. (President, Willesden Nursing DI VISion), Area Staff Officer and Mrs. A. E. Vaughan Lnspector H C. Leppa.rd (i /c First Aid Training, X Dlvl slo n, MetropiI tan Special CounCillor D. Donovan (PreSIdent, H.arlesden Cadet Division), Di v Supt. J Pattman (Wi llesden Nursing Di VISIon), Dl v. Officer Miss L. Pothus (Cricklewood Division), Div. , Supt. E C. Penfold (Cnc.klewood Ambulance DI VISIOn), and varIOUS Brigade members a nd friends.

In welcoming the guests and visitors, Div. Supt. C. A Lifford said how much they all appreciated the prese nce there of Mrs. Wrangham who had made the journey by herself while her husband was out of the country on holiday. He a ls? explallled that the tuition for the first aId class had been shared by the Div. 'Surgeon, Dr H Setna, whom they were glad to have WIth

them for the evening, and Dr. C. H. Woods, of the Central Middlesex Ho spital Park Ro yal, who had sent apologies for his absence and congratulations to the successful candidates.

The Mayoress presented F irst Aid Certificates as follows: 1st year - Iris Harket, Richard Adams, Douglas Rosewarne, Arthur Barrett, Stephen Gladden, Maurice Bri ght, Maurice Bizeray. Arthur Fowler, William Bassal : 2nd year- William Dane.

British Railways : N.E. Region

The Reg ional Secretary of the Ambulance Centre in his report for the year ended June 1951, says that 2,904 students successfully passed the examination, an increase of 1152 on the 1949 50 session

The first aid returns for the year ended 30th June 1951, are as follow

Di strict Leeds District

Di s trict

Di strict

SAT-NOV 10

FIRST AID & NURSING, SEPT. fOCT. 1951

TOPICAL NOTES FOR FIRST AlDERS & NURSES

A Hospital for Leprosy

Contrary to popular opinion, most cases of leprosy are curable, and the disease is by no means as infectious as many people suppose; but, as with tuberculosis, no one measure is sufficient to arrest the progress or cure the disease. Building up of the patient's resistance by rest, good food and good personal hygiene are essential, and two drugs are available which give excellent results-chaulmoogra oil and sulphetrone, the latter now being considered almost as a specific remedy. Other treatments include massage and electrical treatment for muscular wasting; and surgical measures for conditions of the eye, the throat, nerves or bone are often required. It is important to locate and remove any septic foci-such as infected teeth or tonsils, or intestinal worms.

Formerly, lepers in this country were treated at the Hospital for Tropical Diseases in London. The Jordan Hospital, Earlswood, Surrey, has recently been opened for these cases, with 28 beds ; and all trained nurses taking the special six-months' course in tropical diseases at the Hospital for Tropical Diseases in London will now spend two weeks of their course in nursing leprosy at the Jordan Hospital. The Matron Miss Casswell, was formerly matron of a leper colony in India.

Exhibition of District Nursing in London

H.R.H. Princess Marie Louise, a grand-daughter of Queen Victoria who is keenly interested in nursing and social welfare work, will open an exhibition of 'District Nursing in London' at the Burroughs Wellcome Foundation, 183 Euston Road London, N.W.l, on 23rd October: it will be open for four days: untIl 26th October. The theme, A Day in the Life of a District Nurse' - will be illustrated by photographs and other display material supplied by the Queen's Institute of District Nursing and the Ranyard Nurses. Demonstrations of injection surgical dressings, medical nursmg and barrier nursing for

infectious cases will show how District Nurses treat patients in their homes, while equipment and uniform will be specially displayed. Exhibits also deal with training, which includes supervised experience in home nursing, and opportunities after training for public health and social nursing. It is hoped that parties of trained nurses, student nurses, home helps and senior school children will visit the exhibition. Individual visitors will also be welcomed but they will be admitted by ticket only, which is obtainable, free of charge, from Miss Hilda McKeague, B.A., SecretaryAccountant, Central Council for District Nursing in London, 25 Cockspur Street, London, S.W.1 ; who will also arrange for parties, and all visitors will be shown round by fully-qualified District Nurses.

Waste in Hospitals

In a recent circular to hospitals the Minister of Health states that if every hospital saved £100 a year in what seems to be trifling waste it would be possible to maintain an extra 600 beds on the money saved. An appeal for a cut in unnecessary waste and an overhauling of major engineering plant in order to improve economical running is advised.

The 20 p.c. cut in estimates for the Maintenance of Buildings, Plants and Grounds, made for 1951-52 will be operative also for 1952-53.

Whilst everyone realizes the tremendous cost to the Exchequer, and to the private purse, of the National Health Service and aHhougll no one would deny that small economies and avoidance of waste in all little things would result in considerable saving in the long fUn, it is an undeniable fact that all workers in hospitals are aware of the enormously increased expenditure upon non-medical and non-:lUrsing

In many hospItals the clencal and secretarial staff have been multiplied five or six times the number who were employed before nationalization of the hospitals; and only too often wards and other accommodation

formerly used by patients have been converted into commodious offices for this additional staff. Equipment for these offices has been, and still is, a heavy item of hospital expenditure; and although it is understandable that the establishment of a new bureaucracy is a most expensive process this does not appear to benefit those for whom the hospital service was primarily intended-the patients'.

New Filmstrips,

Among the new filmstrips recently produced by the Unicorn Head Visual Aids Ltd. are two on respiratory diseases, one on isolation technique and one on the diagnosis of threadworm infestation. Following their usual practice, Unicorn Head Visual Aids Ltd. have published interesting and comprehensive commentaries on each of the filmstrips and these are supplied with them. Thus, any lecturer or instructor who has access to a suitable projector can be sure of providing both instruction and pleasure for his class when dealing with the particular subject of one of these filmstrips. They can be obtained direct from Unicorn Head Visual Aids Ltd., Broadway Chambers, 40 Broadway, Westminster, S.W.I. Those mentioned are :-

e8. Acute Respiratory Disease (price 10 / -). All the research work for this filmstrip was carried out at Borden Camp, Ontario, by the Royal Canadian Army Medical Council Research Unit. It was shown that the greatest single cause of hospitalization in the Canadian Army was acute respiratory disease for, in an army of 200,000 an average of 35,000 men entered hospitals with these infections every year, spending half a million days in hospital and about the same time in convalescent leave. The first part of the filmstrip gives graphic statistics. It then deals particularly with streptococcal and virus infections of the respiratory tract and the complications that ensued. The causes of the epidemics are then analyzed, and it is established that the infection is largely air and dust-borne. The last portion of the filmstrip and of the commentary describes the measures that can be taken to reduce this infection.

(continued on page 12)

FIRST AID & NURSlNG, SEPT.fOCT. 1951

HOUSEHOLD PHYSICIAN

FIRST AID:General Rules

Examination

Fractu res

Dislocations

Sprains

( UP-TO-DATE -)

NEW EDITION

Describes in simple language, with helpful coloured plates and diagrams

The COMPLAINTS OF MEN, WOMEN AND CHILDREN

Their Cause, Treatment and Cure

A few of the Subjects treated:

How to Keep Well, First Aid

What to Do in Emergencies

Influenza, Colds. etc.

Measles, Mumps, Corns and Warts

Phys ical Cu Itu re, Self Defence

Treatment for all Skin Diseases

The Lungs, Pleurisy Hygiene, Anatomy. Pharmacy Fevers. Bladder, Kidneys

Pregnancy, Childbirth Home Remedies, Diet

MOVABLE MODELS OF

Principles of Nursing PRESCRIPTIONS

Eye, Ear.

C14. Control oj Respirc:tory Disease (pdce 10 -). This IS a longer filmstrip than C8. is more popular and amusLDg, It presumes no previous knowledge of medical or nursing work and it is intended for the rank and file of the army in the early part of their training. Its teaching is equally applicable to schools, scout camps, or any other conditions where people live in close association with each other; for both the film and the commentary are designed to appeal to a younger age group or to those with less background of scientific knowledge than those who will fully appreciate e8.

CW. Isolation Technique (price 10/-). This is an excellent filmstrip and commentary fbr any group of people who wish to understand the various ways in which infection can be spread from one person to another, and how that spread may be prevented when nursing patients suffering from infectious diseases. The shots are particularly good, and deal with every aspect of the subject in adequate detail. This filmstrip should be shown to all classes who are taking a Home Nursing course, for all the information given is as useful in the home as in a hospital.

U16. Diagnosis of Threadworm Infestation (price 10/-). Although it is both interesting and instructive this filmstrip is more suitable for the doctor, his clinical assistant or the laboratory technician than for the First Aid or Home Nursing students. As an 'extra' for senior members of a contingent it is likely to be very well received.

Civil Defence

GUIDANCE on meeling Civil Defence responsibilities which would fall to public health departments in wartime is contained in a memorandum (published by the Stationery Office, price 6d.) issued by the Ministry of Health.

The purpose of the memorandum , which has been prepared in consultation with the Home Office and the Ministries of Local Governrnent and Planning and of Food , is to give members and officers of local authorities who are concerned with Civil Defence and public health an outline of the wide range of wartime medical services which, because of their interdependence, need to be considered in relation to each other in the development of Civil Defence plans.

The subjects covered are the hospital and first aid services, medical and public health

Weedon Fi,·st Fine WOl·k at Bail Disaste,·

Within half-an-hour of the crash of the Liverpool-Euston Express near Weedon, Northants, on Friday, 21st September, eleven men of the Weedon Division, St. John Ambulance Brigade, were already hard at work rescuing and treating injured passengers.

They had left their various employments and came, in some cases, over five miles, just as they were in their working clothes; thus having neither uniform nor badge they truly worked anonymously.

'It would be invidious to single out any particular names,' writes Dr. S. J. S. Hughes, Di visional Surgeon, ' but two of them were the first and second people to arrive at the scene, and were thus a great help to the doctor on the spot . Our Ambulance Officer did wonderful work-particularly in the cab of the

administration prob lems involved in evacuation and the care of the homeless the control of infection, purity of food and drink and water supply and sewerage.

These responsibilities would have to be discharged under all the difficulties with which experience of the war of 1939 45 has made medical officers familiar, with much of the peacetime work having to be maintained by smaller staffs and to the accompaniment of numerous requests for advice and guidance on public health matters from the public and from other branches of local administration,' says the memorandum.

, The moral is clear. Anything that can be done now, by way of designating officers to be responsible for particular tasks, training them to cope with these tasks under war conditions and improving their contacts with corresponding officers of ot her authorities, would be amply repaid .'

Christnlas Allpeal

THE Grenfell Association of Great Britain and Ireland rely upon the sale of Christmas Cards to carryon their work for the fishermen of Labrador. An illustrated leaflet may be obtained from the Association at 66 Victoria Street, London, S W.l, on receipt of 1

Apart from the strain of maintaining our general work,' writes the Secretary, we can no longer delay building a Sanatorium at our Headquarters in the North and so check the heavy toll of life caused through tuberculosis.

overturned engine, superintending, under medical instruction, the digging out and removal of the engine driver who was buried under coal. Many people remarked on his good work elsewhere and although reporters tried hard he would not disclose l-us name.

, Later during the operations two of our men were sent to a local doctor's surgery where they dressed innumerable minor injuries sent there by vans and Army trucks, thus relieving much of the congestion alongside the track. These people were later picked up by 'bus and so continued their journey.'

In these and in many other ways Weedon St. John Ambulance Division were able to play an important part in the very rapid disposal of the injured.

* NEllr BOOKS

Bailliere's Nurses' lv{edical DictioJ/ary, 12th editioll. Revised by Margaret E. Hitch, S. R. N., and published by Bailliere, Tindall & Cox, price 5s. 6d. post free. MANY of our readers will know this handy dictionary; although it is primarily designed for the use of student nurses it is of greatest assistance in ambulance and first aid work, as many instructors will testify.

The new edition has been carefully brought up-to-date, and gives every appearance of scrupulous revision. It does not merely confine itself to medical terms, but provides in most cases brief explanatory information regarding them. Twenty-one appendices give information on such things as surgical instruments and technique, antibiotic drugs, anaesthetic apparatus, blood transfusion and first aid.

The dictionary is handy for the pocket or bookshelf, and a point which should appeal to first-aiders is that the pronunciation of medical terms is given.

Very warmly recommended.

- LATEST SUCCESSES-JUNE 1951-

lnsfltllie a! PublIC Health alld Hyg;ene.

Th. Course 0/ lessOIls tltat I had from ),ollr College was mosl help/III ami

It wa, Indeed a pleasure 10 work with you.

Gnce aga1l1 Iilallki"g you fay all YOllr help."

E. II. (Bucks)

7th Aug., 'SI.

" am plcas,;d 10 inform J OU thai I was success!1I1 pass lit£!. the pre· llminary examination of Th. In stillite of Certified A mbulallcc Persollllel. and thauk for the help you gave 11 "'.

"

]V ill you please semi me YOIU speCial lcafld girllzg full delazls of YOllr course /01' Ihe final exami1lalion.'

A. J. K. (Yorks)

10th August, 19SI.

I alii writmg 10 thank YaH for your conci.,e an.d hdP!ulnotes that helped

1I1e 10 pass the Diploma SelViol Hygiene.

When I saw the e.ramiflation paper I l'eallsed how well "our College knoUJs the type a! ql1eslions yelurll tlze noles ii'ith this letter.

Tha'lk }'Oll again!or your help."

J. W. (Norfolk)

10.8.S1.

I ]lIsl heard loday Ihal I ha"e ban success!lIl til IIlV Diploma 0/ the Royallilstltute of Public Health and H.vgiene thanks 10 YOllr College. Jam wOl/dering I! it IS pos'<lble for me to still relaill the /totes as hope to take the Royal SalHtll} y l>lsti/lI/e Exalllinatioll in October. I t"wk this 011<' covers a cc"laill amoullt 0/ Ihe same groHltd. Tlzaltkingyollalioliceagain." N.S.( urre)')

"Vhv not write now for further details,

CLAY Trith 35 photographs alld 17 diagrams. 5 -

Living Anatomy: A Photog. aplzic Atlas of .r1Iuscl es in Action and Sll7jace COJ2tOltJ s

R. D. LCCKHART Revised editioll. Wilh Jj.J plates. 125.6d.

A Medical Handbook for Athletic and Football Club Trainers \\ " D. JARYI With 19 dra7.L illgs and.J palYes oj pholocYraplzs. I()-, 6d.

24 RUSSELL SQUARE W.e.1

II

FIRST WAll AID DIAGRAMS

In the treatment of sprains

Strips of Paragon adhesive sponge rubber, ;\ in. wide and 2b in. long rna\' be applied to the concavities on both sides of the telldo A chzllls and curved round and beneath the malleoli.

An Elastoplast Bandage finnly applied over the resilient sponge rubber pads effectlvely relieves pain, controls swelling and rrevents hrematoma formation.

The remarkable S-T-R-E-T-C-H and REGAIN properties of the woven bined with the particular fabric of Elastoplast, com· 1 1 E a s to p

FIRST AID & NURSI G, SEPT ./OCf. 1951

Queries and Answers to Correspondents

Thanks to the Doctor

Once again we have the pleasure of thanking most cordially our Honorary Medical Adviser, Dr. N. Corbet Fletcher for the valuable services he renders us and our readers in conducting the 'Questions and Answers to Correspondents' column.

For thirty years Dr. Corbet Fletcher has been his advice and guidance to readers through the medlUm of tills column. He is widely known and respected throughout the ambulance movement, and his column is gre a tly a ppreciated by all.

He has contributed to this journal through the' relgn ' of five editors . It is a grand record, and we join with our reader s in sa ying, once again, 'Thank you' to the Doctor.

F lu s hed Face with Compression

M N. ( Barrow-Haven ) . - Pleas e tell us wh y the face is fl ush ed in ca ses of compre ss ion of the brain, and a ccep t our bes t thank s-for y our useful af1Sl VerS to our qu es tion s

With comp r ess ion there is increased pressure within the skull. This affects the vasomotor centre in the medulla and causes diletation of all blood vessels including those of face and trunk. Consequently, there is flushing of the f a ce a nd loss of beat from the body which we seek to minimise by wrapping patient warmly with blankets. - N . Corbet Fletcher.

Examination Howler

M. R. (Cannon Street).-In a recent examination the doctor as k ed one candidate what happens to th e ches t \vhen \I'e tak e a deep breath. He \Vas vastly amu se d \l' hen the candidat e replied: 'The chest fir s t expands and then expires! ' Good! Next please! !- N.C.F.

FIRST AID HANDBOOKS ANATOMICAL DIAGRAMS AND CHARTS FOR LECTURES

H. K. LE W IS & Co. Ltd.,

136 Gower Street, London, W.C.I

EUSton 4282 (7 lines)

FIRST AID & NURSING. SEPT.fOCT. 1951 5/6 post free

Treatment of Compound Fracture

P. S. (Wellington, New Zealand).-Recently \I e had a heated discussion as 10 \vhether or no we should apply cold water dressings on a compound fracture of th e leg. As \ve could not agree \ve decided to submiflour difficulty for row' kind ruling.

Emphatically no! A compound fracture, being a fracture and a wound, you should first treat the wound and then the fracture. - N.C.F.

Treatment of Epilepsy

M. O . (Castleford). - R ecently \l'e were di s cussing th e treatment of a patient in an Epileptic attack and we wondered {/ there \\iQS any treatment by which \I'e first-aiders could prevent the convulsive movements. So once again we ask your kind help.

The convulsive movements must run their course, and there is no means by which we can stop them. Epilepsy is a 'brain storm' which is due to sudden failure or loss of control of the highest brain centres. The outstanding symptom is sudden and complete loss of consciousness. This may (or may not) be followed rapidly by convulsive movements, interference with which is inadvisable because it often creates an unconscious resistance by the patient.-N C.F.

Rupture of Muscle

A K. (Luton). - Please tell us {f it is po ss ible /0 ruptur e a muscle and y et to have an external lI'oul1d. At our last practice this problem proyed to b e a stumblin g block.

Rupture of a muscle may occur' withoul an external wound' as the result of spasmodic muscular effort. A common example i s rupture of plantaris muscl e which is a small muscle in the calf of the Jeg and which may be torn right across during acts of jumping and running.N.C.F.

(continued on page 16)

Miscellaneous Advertisements

Advertisements with remittance should be sent to First Aid & Nursing, 32 Finsbury Square. London, E C.2 Rate 3d. per word, minimum 45. 6d. Trade Advts. 4d. per word. minimum 65. Box numbers I s. extra.

SCENT CARDS, 250 17 /6, 1,00052/6. Tickets, Posters, Memos. Samples free- TICES, 11 Oaklands Grove, London, W.12. HOW to Stop Smoking. Save Money. Safeguard health . Thousands cured. Send stamp for Booklet of World Famous Remedy. Stanley Institute Ltd. (Dept. 75), 24 Hotborn, London, E.C.l.

pATENT NO. 603113 for "Apparatus for Determining jf and to what Extent Air Contains Carbon Monoxide." Owners desire to meet all demands for the utilization of this patent and invite enquiries from manufacturers and others in Great Britain prepare to assist in its commercial exploitation. Address in first instance Messrs. Pollak, Mercer & Tench, Chartered Patent Agents, 134 Cheapside, London, E.C.2.

Twelfth Edition, revised by Margaret E. Hitch, S.R.N., late Sister -Tutor Saint Bartholomew's Hospital, a Foreword by Sir Cecil Wakeley: A c?mplete and pronouncing dictionary of the terms 10 a pock.et-sized volume. Twenty-one appendIxes cover a vanety ?f subjects, including Poisons, Splints and Bandages, AbbreVlatlOns, DIets, Blood Transfusion, Anti - biotics etc. There are 496 pages and over 200 illustrations.

, This dictionary keeps its place in the front rank of such publications ... can be unreservedly recommended to all members of the British Red Cross and the Saint John Ambulance.' British Red Cross Quarterly Review. '

MEDICAL DICTIONARY

DALE, REYNOLDS & CO. LTD. 32 Finsbury Squil,'e OR London EC2

post this form

BAILLIERE. TI NDALL & COX 7·8 Henrietta Street London WC2

Please send me copy/ies of Bailliere's Nurses' Medical Dictionary, for which

I enclose rerninance of..

Nal1te Address "

A

PATENT

"PORTLAND" AMBULANCE GEAR

The Gear IIlustrated(A.B.C.D.) carries two stretchers on one side of Ambulance, leaving other side clear for sitting patients.

The UP AND DOWN action is quick and easy for loading or unloading.

A. Shows the two stretchers in position.

B. Shows the top stretcher lowered ready for loading.

C. Illustrates the same Gear with the top stretcher frame hinged dowtl for use when only one stretcher case is carried.

D. Shows the same position as in "C' only with cushions and back rest fi tted for con valescen t cases.

Where Ambulances are required to carry four beds two Gears are fitted, one on EITHER SIDE, and the same advantages apply as described above.

Full of Ambulance Equ pment No 7A will be sent on request

Use of Petrol for ' Vo und s

P. B. (Glasgo\\).-Recenfly I heard it stated that in an emergency petrol can be used in [he treatment of wounds and that in factories in lI'hich petrol had been inll'oducedfor This purpose the number of re-dressings had been cOl1siderablr reduced. We welcome roul' ruling on this poim -Petrol is certainly an antiseptic; and it ha been used by some surgeons for the preparation of the skin previous to operations. Further, to some extent it will control bleeding. The chief drawback to its use, however is that it may prove an irritant; but this is negligible, it has been claimed. Petrol can be relied upon to ward off tetanus in motor accidents in which wounds are contaminated by soil from the road.-N.C.F.

Diagram of Heart (Fig. 56)

A. T. (Birmingham).-May I point out an error in the diagrammatic illustration of the heart (Fig. 56) on page 87 of the Textbook if this has not already be en noted. The dotted Tines representing the pulrnonary veins passing behind the aorta show the uppermost vein emptying into the pulmonar), artery! The pulmonary artery to the right lung is dotted to the left auricle Il'ith a small arrow at each end pointing in opposite directions. Obviously, this is a printing error!

In view of the fact that you have the course of the blood clearly indicated by the letters P.A. and the arrows leading from the right ventricle there need be no confusion in your mind as to the direction of flow. Further, the dotted lines to which you refer are applicable to the pulmonary veins and not to the pulmonary artery !-N.C.F.

Bee and Wasp Stings

A. T. (Birmingham) -Page 183 of the Textbook gives the I.vell-known alkaline treatment for stings of plants and II1sects, and the bee sting is mentioned in paragraph 1 of the Stages of Treatment. I am aware that th e bee s ting contains formic acid but I hal'e read other opinion s regarding the wa sp s ting. For example, the Boys Brigade Handbook recommends rubbing in v/lZegar and Imt er and the application of a cold compress Is therefor the It'asp sting alkaiine ?

The venom. from both bees and wasp _ is a complex su?stance Wh.lCh cannot be regarded as definitely either aCld or alkaline. Experience has shown however that the application of fluids (which are in Rule 2 on page 183 of the Textbook under Stings of Plants and prove beneficial in treatment of both types of stings.

Authorities do not agree that the acid contained in the venom .from. a bee ting is formic acid, although it has a defiOlte aCid reaction.

Treatment of Fractures of Both Thighs

R. L. (Vancouver, Canada).-Tize Textbook on page 147 tells us in Rule 3 (Ivhen both legs are fractured and help is available) to dralV the feet together and not to let go sP.lints are fixed and in Rule 5 it gives the order ZIl whlch the bandages are to be applied. In the March-April issue of FIRST AID you carefully

FIRST AID & URSJNG, SEPT. , OCT. 1951

explained that the hands of the first -a ider take the place of the first figure of eighT bandage round ankles and feet. I 1I'0uid like to knoll' if [he same method would apply in the case of fractures of both thighs provided that reliable assistance is available; and I thank )'OU ilZ advance for your kind reply.

Page l-l3 to 149 of the Textbook. are devoted to the treatments of fractures of thigh and leg and are under four headings: (a) when fracture i confined to one limb, (b) when both thighs are fractured, (c) when both legs are fractured and a istance is available, and Cd) when both legs are fractured and no assistance is availal5le. From this it can be seen that the instructions in (c) appl \vhether or not assistance is available. In either case, therefore, the feet must be tied together as soon as the feet has been drawn gently into po ition. The hands of the bearer cannot be used in place of this first bandage because there i no sound limb against wmch the fracture can be steadied as in the ca e when only one femur is fractured. - N.C.F

Treatment of Fractures of Both Legs

R. L. (Vancouver, Canada).-On page 149 of the Textbook we are told in Rule 4 that II'hel1 we have to trear a patient for fractures of both legs and assistance is nOl available to tie ankles and feet lOgether and in Rule 5 to apply bandage round both limbs in the order shown in Fig. 105. Please tell me If, ill this instance, the 1I'0rd limh includes ankles and feet. Fig. 105 s hOll 'S fil'e balldages , C, E, A, Band D II'hich Il'ith the bandage already round ankles and feet make six bandages altogether Bandage D, however, covers the figure-ol-eigln bandage round ankles and feet This bandage (D) appears to me to be unnecessary as it is giving no further support to ankles and feef. So I suggest thal Rule 5 should read: 'Apply bandages round both limbs in The order ShaH'll il1 Fig. 105 omitting Bandage D.'

This second bandage round the ankles and feet mu t be applied because it is the one which ecures the end of the splint, the first bandage applied having been placed round ankles and feet only. If the end of the splint j not secured there i a risk of ubsequent movement at the seat of the fracture. - l c. F.

Humour in First Aid

H. S. (Brighton). - In a recent competition a fireman was standing 012 a ladder directing a stream of water at high pressure into a burning building and at the foot of this ladder a patient was being treated. A member of one team , desil ing a bandage Il'etted, called to the .fireman and asked him to direct the water 011 to his bandage, l7luch to the amusem ent of the mal11 ' spectator s Il'ho could picture the efte ct 011 hot-h members and par;ent had such a jet of Il ater beell directed their lI'a)'.

Good! ext please! !-N.C.F.

The Textbook to which reference may be made in this column is the 40th (1950) Edition of the SJ.A.A. Manual of First Aid to the Injured. Correspondents are requested to write on one side of the paper only.

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The whole of our wide experience in all these specialised spheres is at the service of our clients , and enables you to place the commission of your orders in our hands having entire confidence that the com pleted job wi II be the best of its kind.

Long waits In queues are not only exaspera ting, but often detrimental to health. Fully exposed to the rigours of the weather one IS an easy prey to colds and chills. These can often be dispelled at the onset by the timely use of ' Anadin' Tablets.

, Anadin' Tablets relieve headache and reduce fever. Two tablets may be taken at the beginning of the cold or chill and repeated every three hours, if required.

... Then you will follow this point-by-point argument and reach the same conclusions as so many doctors, nurses, hospitals and clinics have done.

DO YOU AGREE ... that the causes of most skin infections are the common strains of STAPHYLOCOCCI, STR EPTOCOCCI and B. PYOCYANEUS ?

IN THAT CASE . .. a which is effective against all three will be indicated for cuts, abrasions, burns, sca lds, boils and most inflammatory skin infections?

THIS IS THE TREATMENT

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purely biological action and there is no damage to delicate tissues.

RAPID HEALING is further expedited by the ointment base of proved efficiency. For burns and scalds, ANTIPEOL has special advantages. It is microbicide and non-adhesive. Therefore dressings do not have to be changed every day.

AND HERE IS THE PROOF.

Antipeol Ointment is proving and reproving itself every day in dozens of surgeries, clinics, hospitals and homes. Letters from the medical and nursing profession bear convincing testimony to its effectiveness.

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Bed Cross Girl will help

Recruiting Drive

THE Red Cross girl pictured here meeting Miss Pat HornsbySmith, Parliamentary Secretary to the Ministry of Works, is Mrs. Eileen Frances Warwick, a member of Kent 196 Detachment of the Dartford Division, B.R.CS. Her face will be fa miliar all over the country this winter, for she is one of Lhe members of the National Hospital Service Reserve whose portraits will appear on posters and in newspaper advertisements to publicize the Reserve.

Mrs. Warwick met Miss Hornsby· Smith when the latter launched a new recruiting drive for the Hospital

recruitin g campaign for the Hospita Reserve Reserve. The drive for members is being supported by advertisements and posters featuring personalities in the Reserve.

Mrs. Warwick joined the Red Cross in 194 I. She began as a fulltime CD. instructor, but there noL being enough to do during the early part of the war, she got a job with the local government in Bucks and did CD. work at the Control Centre. She did voluntary duty at the King Edward VII hospital. Windsor, on the wards as a Civil Nursing Re servist

for three years, mostly week-ends, Sundays and two evenings during the week.

Her husband who wa s in tbe R.A. F. was shot down and missing for about six months . So Mrs. Warwick went back to rull-time nursing duties at the Military and Civil Convalescent Home , Upton Park. The war avel she transferred from the Buckinghamshire Branch of the British Red Cros s Society to the Kent Branch.

.fyou are a logical person ••.

Notes on Fractures

by A. D. Belilios, M.B., B.S. (Lond.), D.P.H. (Eng.)

FOR the benefit of those who are revising their knowledge or learning the subject afresh, this month's article is devoted to pure Fhst Aid, and the subject of fractures has been chosen for this purpose.

The first point to notice is the definition of a fracture. The 40th edition of the S.J.A.A. Manual emphasizes that this term means that a bone has been either broken or cracked. A cracked bone is a special variety of fracture which will be referred to la ter.

The causes of fractures are described as (a) direct force, (b) indirect force, and (c) muscular action.

Direct force is the cause if the bone breaks at the spot where the violence is applied ; thus a blow on the hand with a hammer may cause fractured carpals, meta-carpals or phalanges, a bullet may break any bone in the body which it hits willIe a wheel passing over the leg may break the tibia.

In fractures resulting from indirect force, the violence is conveyed along intermediate bones which themselves escape Injury. Examples include falling on the hand and breaking the wrist or collar bone, falling on the foot and breaking the ankle or neck of the femur.

Fractures caused by muscular action are due to an unexpected and violent contraction of the muscles attached to a bone. A broken knee cap is the best example and may result from an attempt to prevent a fall backwards when the patient braces back his knee. An interesting example is provided by , the cough fracture.' This may result from a severe fit of co ughing such as occurs in whooping cough particularly if it affects an elderly person.

Types of Fractures

Three main types of fractures are distinguished namely (1) simple or closed, (2) compound or open, and (3) complicated.

For many years, the medical profession have endeavoured to teach the use of the words closed' and 'open' to describe fractures. A closed fracture is one to which air cannot enter. But when the fracture is open it is exposed to the air. Hence germs which are present in the dust, on the skin, on the first-aider's fingers, and on the instrument that has caused the accident can enter the wound. In an open fracture, therefore, there is always a risk of sepsis which may retard the patient's recovery and even endanger his life.

Open fractures occur when there is a wound leading down to the fragments (direct open fracture), or when the sharp jagged ends of the broken bone protrude through the skin (indirect compound fracture).

Sometimes a fracture becomes open in a more subtle manner than the injuries described above, for example when there is a fracture of the base of the skull together with perforation of the ear drum, or an open wound in the nose or at the back of the throat. Similarly, a broken jaw may be open if the gum has been torn.

A complicated fracture results when there is also an injury to a major bloodvessel, nerve, joint or vital organ. In the case of a joint, the fracture may even extend right into its cavity or, there may be a dislocation as an additional injury. This possibility must always be consi dered when a fracture is suspected at the end of a bone. A complicated fracture may also be open or closed.

In addition to the three main varieties above descri bed there are several other important types of fracture which often cannot be distinguished from the others except by an X-ray examination, although they should always be diagnosed as suspected fractures by the first-aider. These are as follows :-

(a) Fissured.- This is the term applied to a cracked bone. It may be a most important fracture and unless

diagnosed and treated can cause unpleasant after-effects to the patient. Fissured fractures can affect almost any bone in the body particularly those of the hands and feet. They are characterised by few symptoms and signs hence are only recognized by the first-aider who examines his patient thoroughly.

(b) Commil1uted.-This occurs when the bone is broken into several fragments; indeed there may be many. Contrary to what would be expected, a comminuted fracture may heal more readily than the simple variety. It may also be of the open or closed variety.

(c) Depressed.-One of the fragments is depressed below its normal level. This should always be suspected in fractures of the base or sides of the skull when pieces of bone may be forced inwards causing compression of the brain.

(d) Impacted.- The fragments of the fracture may be driven into each other and wedged firmly together. This type usually occurs at the end of long bones, for example, the upper end of the humerus, in the well-known Colles fracture at the wrist, and the Pott's fracture at the ankle. Many fractures are impacted and this is one of the reasons why the use of splints is often unnecessary; indeed, the fragments are frequently wedged so firmly together that the doctor has to disimpact them with the patient under an anaesthetic in order to the bones in a desirable position.

(e) Greenstick. - In children, usually under the age of twelve, bone tends to bend and possibly split rather than to break completely across. This is due to the fact that children's bones contain a large amount of cartilage (gristle) which is elastic. As they grow older, however, the bones become harder and more brittle.

FIRST AID & NURSING, NOV./DEC. 1951 Separated Epiphysis

In childhood there is a plate of cartilage, called the epiphysis, situated between the end and the shaft of each long bone. From this epiphysis new bone is formed and the bone increases in length. The epiphysis disappears when growth is complete.

Displacement or separation of the epiphysis from the shaft of the bone is an important accident in childhood. It must always be suspected when an injury has occurred near a joint. Failure to diagnose the condition and arrange for its treatment may interfere with the growth of the bone and result in serious deformity in later life.

Diagnosis of a Fract.ure

In many cases this is easy and the first-aider can quickly make a provisional diagnosis. If for an example he . is called to a patient who complains of severe pain in a bone and there are symptoms and signs of shock it is more than likely that a fracture has been sustained. In this event first aid should be given and the final diagnosis made by the doctor either when he arrives on the scene or when the patient is taken to hospital.

In more difficult cases, an accurate diagnosis can be made by considering the general and local symptoms and signs of the case together with the history. The general symptoms and signs refer to the condition of the patient in himself, namely his temperature, pulse, colour, etc. This generally means, in fact, the characteristics of shock. Local symptoms and signs are those which occur in the affected part of the body.

The history of the accident is often important Thus the patient or witnesses of the accident may describe direct or indirect violence. A snap like that of a bone having given way, may have been noticed. In an unconscious patient, observers may have noticed that he rece.ived a blow on his head or fell on thIS part of his body before he became insensi ble.

Symptoms

Of these there are only two, namely pain at or near the seat of fracture and limitation of natural So far as the former is concerned, at first the pain may be

somewhat deadened by the shock; later, however, it becomes more severe. The doctor may give an injection of a pain-relieving drug such as)llorphia to re1ieve it and incidentally to alleviate the shock.

Limitation of natural movement means partial or complete loss of use of the injured limb. The patient himself will have observed this symptom but he should never be allowed to test for it. If there is a suspicion of a fracture, the affected part should be supported and steadied, and the patient warned that on no account should he attempt to move it.

Signs

Two points shou ld be mentioned before these are considered. Firstly, it should be emphasized that the first-aider must not expect to find all the signs which are described below present in every fracture. In a suspicious case if one sign only is detected, it may supply enough evidence to justify a first-aid diagnosis, and the first-aider should not waste time looking for others ; he should make a provisional diagnosis and proceed at once to treatment.

Secondly, whenever a patient is examined to discover physical signs, the injured part should be compared with its fellow of the opposite side since this is the only way in which a sign. such as slight deformity can be detected.

The signs of a fracture can be conveniently divided into two groups, namely (a) those that can be seen (visible) and (b) those that can be felt (palpable). If the firstaider can make his diagnosis by discovering the visible signs, there is no object whatever in proceeding to touch the patient, except for the purposes of treatment.

(1) Visible Swelling.-:This is due to brUlsll1g and fiUld under the skin and partly to the displacement of the fragments. It may not appear imme diately after the accident but may develop slowly in the course of hours.

(b) Deformity.-The injured part appears out of shape when with its fellow of the OppOSIte SIde. Sometimes the deformity is very obvious for example in a fractured femur when the foot lies rolled over

on to its outer side; this then provides positive evidence of a fracture.

(c) Shortening.-An injured limb may be shorter than its fellow. This is obvious in the case of a fractured femur, when the shortening may be of several inches in amount. It is caused by the contraction of powerful muscles which pull the lower fragment upwards.

(d) Unnatural Movement.-Sometimes the injured limb will be seen to move in an unnatural place for example at the middle of the leg in a fracture of this region. This again is positive evidence of a fracture but it should never be sought.

(2) Palpable Signs-(a) Tenderness.-This important sign means that touching the bone at or near the seat of injury causes pain to the patient. It may be the only sign in a fissured fracture. The golden rule in first aid is that if, after an accident, tenderness is found on a bone a provisional diagnosis of fracture should always be made. Examination for tenderness involves carefully feeling the bone suspected to have been injured throughout its length, gently pressing it and asking the patient as each inch is explored if he feels pai n.

(b) Irregu!arit)'.-As the bone is being carefully felt a sharp edge, bump, or other irregularity may be detected on its surface. This is not present on the opposite side. irregularity is generally pOSitive evidence of a fracture, but the firstaider Will not usually need to examine for it specially, at any rate in a conscious patient, since he will discover tenderness far more quickly.

(c) Crepitus.-A. grating or creaking sometimes noticed when eXamll1IDg an injured part. It is caused by the sharp jagged ends of rubbing together. It IS pOSItive evidence of a fracture but should never be deliberately sought. Sometimes it can actually be heard.

Occasionally there are other signs of a fracture which may develop within a short space of time. These include bruising which may becor,ne extensive and blistering of the skll1.

3

FIRST AID & NURSING, NOV. /DEC. 1951

Association in 1897, and the increase in the number of competitions is a measure of the extent to which first aid training has expanded.

Besides British Railways and St. John Ambulance Brigade, the following took part in the competition : National Police, British Transport Police, British Electricity, Gas Industry, National Road Transport, General Post Office, Fire Brigades, Ministry of Supply, and the Miners' National First Aid Competition.

At the distribution of prizes at tbe conclusion of the competitions, the Chancellor of the Order, Lieut.General Sir Henry Pownall, K.C.B., K.B.E., D.S.O., presided. The Women's Trophy and individual medallions were presented by H.R.H. Princess Alice, Countess of Athlone, G.c.Y.O., G.B.E., and the Men's Trophy and individual medallions by the Chancellor, in the unavoidable absence of MajorGeneral The Earl of Athlone.

Results were :-

GRAND PRIOR'S TROPHY COMPETITION

Railway Teams are Champions

THE Grand Prior's Trophy Competitions, held in London on 20th November, were a triumph for British Railways teams, for both winners were representing British Railways and London Transport (Railways). Tile men's Championship Trophy was won by Horsham, and the Women's Championship Trophy by Broadway, L.T.E. In these competitions the finalists of all national first aid competitions organized by the St. John Ambulance Association compete, so that the winners are truly the champions of the year, and carry away with them the 'blue ribands' of first aid training.

The Grand Prior's Trophy Competition was inaugurated for men in 1950, and the trophy is an equestrian figure in silver of a Knight in full armour. This year women competed for the first time, and the trophy in their case is the Arms of the Order.

The introduction of these competitions, state the St. John Ambulance Association, has brought about

a very close liason between the S.l.A.A. and the organizations represented. The first national com. petitions were introduced by the

Men's Competition- Max. 400

1. British Railways and London Transport (Railways) (Horsham) 317

2. National Police . (Brighton) 295

3. The St. John Ambulance Brigade (Weymouth) 261 i

4. British Transport Commission Police (Darlington) 246

FIRST AID & NURSING, NOV. /DEC. 1951

5. British Electricity Ambulance Centre (Worthing) 240

6. Miners' National First Aid Competition (Duffryn-Rhondda)

7. Gas Industry (Liverpool) 211}

8. National Road Passenger Transport Ambulance Association (Nottingham) 207

9. General Post Office (Barrow-in-Furness) 19 1t

10. Fire Brigades (Cardiff) ...

11. Ministry of Supply (Farnborough) 147

Women's Competition-Max. 400

1. British Railways and London Transport (Railways) (Broadway L.T.E.) 279

2. The St. lohn Ambulance Brigade (Horsham) 253

3. National Road Passenger Transport Ambulance Association (Chiswick L.T.E.) 251

4. British Electricity Ambulance Centre (Sussex) 236t

5. Ministry of Supply

(Elstow)

6. General Post Office Cardiff P.O.A.C.) 163t

Other Competition News

Post Office Competition

The General Post Office National First Aid Competition, held in London during October, was the third annual competition · for employees of the General Post Office. It was organized by the St. lohn Ambulance Association. The Lord Prior of the Order, Lord Wakehurst, presided at the prize presentation ceremony.

Results were :Men-Max. 400

1. Barrow-in-Furness H.P.O. 285! (Messrs. M. Murrey, J. Robson, J. W. Clarke, G. M. Anderson, E. H. Almstrong )

2. Birmingham P.O.A.C. ... 268l (Messrs. C. E. Pitt, E. L. Aizlewood, 1. R. Ford, C. Hartless, A. E. Weller.)

3. North Area T.M.O. 255 (Messrs D. A. Robinson, C. H. Charlwood, R. A. Lee, 1. W. Bensted, A. F. Ross.)

4. Nonhern Ireland Region, Belfast T.M.O. 285 (Mesdames A. Roseman , A. Campbell, H White, S. M. Black, A. N. Dunlop.)

Best pair: Nos. 1 and 4, London Telecommunications, S. W. Area. Gas Jndustry National First Aid Competition, 1951

The position in which the teams were placed by the judges, Dr. E. 1. Selby of London, and Dr. B. Rosefield of London , in the Final Competition held at the Bishop sgate Institute, London, E.C.2, on 22nd October, was as follows :_

I. North - Western Gas Board... 269i

2. South-Eastern Gas Board

3. West Midland Gas Board 234

4. Eastern Gas Board

5. North Thames Gas Board

6. East Midland Gas Board 191 {

7. North-Eastern Gas Board 166i

8. Southern Gas Board 163

9. Northern Gas Board

10. South - Western Gas Board ... 154i

Maximum Marks obtainable, 400

5

4. Regional R.O., Bristol... 250 (Messrs. J. 1. Newman, V. W. Lock, D. A. Hawkins, A. Wride, 1. L. Collings.)

Best pair: Nos. I and 4, North Area T.M.O.

Women-Max. 400

1. Welsh Border Counties Region,CardiffP.O.A.C. 313 (Mesdames G. M. Wedlake, J. M. Richards, B. Clarke, D. Freegard, A. E. Norris.)

2. Scottish Region, Glasgow H.P.O. (Mesdames 1. McCall, E. Henderson, H. M. Nimmo, R. Bain, C. Beverley.)

3. London Telecommunications, South-West Area T.M.O. 304 (Mesdames A. M. Ridley, E. M. Soper, P. Askew, D. Watson, B .T. Batty.)

At the distribution of prizes at the conclusion of the Competition, the chair was taken by the Lord Prior of the Order of St. John (The Lord Wakehurst, K.C.M.G.), and the Championship Trophy and jndividual plaques were presented by Colonel H. C. Smith, C.B.E., D.L., J.P. (Deputy Chairman of the Gas Council).

* New Films

Your Children WalkinJ? (20 minutes running time).

Your Children's Play (20 minutes rqnning tim.e).

S"rprisp Attack (l0 minutes running time{. These films are available for showing at welfare clinics or meetings of local clubs, Associations and Insti tutes. Borrowers who own 16 mm. sound projectors can obtain the films from the Central Film Library, Government Buildings, Bromyard Avenue Acton, London, W.3. AppllcatlOn should be made well in advance : no charge may be made for admission to such sessions. A few 35 mm. sound copies are also available but cannot be used for showing in cinemas during programme time. Borrowers who do not own a projector should apply to the appropriate Regional Officer C?f the Central Office ofTnformatlOn (Of to thelf headquarters at 83 Baker Street, London, W.l) for advice on how the use. o( a projector can be arranged. ApplicatIOn should be made well in advance.

The Winning Men's Team.-Left to right: F. A Trott (Regional Ambulance Secretary), Adams Clarke (Railway Executive), J. Law, A. G. Binstead Lady Mountbatten W. E. Jupp (Captain), A. Hickman, and N. Worcester

The Winning Women's Team.-Broadway L.T.E.

Lt.·Gen. Sir Henry Po wnall presents the

Trophy to Mr. W. E. Jupp

The Editor's Opinion

A DRIVE to increas.e the ship of the NatIOnal HospItal Service Reserve has been launched. Eighty thousand enrolments are needed to bring the Reserve up to peace-time strength.

The Reserve has attracted 18,000 members so far, and the figures compare very well with other branches of Civil Defence. We hope that the new drive will be successful, for members will find that they are able to perform a worthwhile peacetime service as well as taking their places in defence preparations.

The work which the Reserve will do in the hospitals is valuable and important, and we feel sure that members will find their service to others a source of deep content. They are needed in the hospitals in peacetime just as much as in war, and the training is interesting and useful.

There is just one point about

recrUItmg with which we fed concerned. The age limit is 60 for -both men and women. Is this justified, in view of the fact that men and women in their sixties are nowadays encouraged to work on 7 There are plenty of arguments for recruiting the over-sixties ; doubtless people of that age are not so capable of physical effort, but surely there are many jobs of a sedentary nature which they could do and thus release younger people for the harder work.

Many older people want to take part in Civil Defence, and hospital work seems an ideal opportunity for them. Could we olease have this age limit removed 7' We feel sure recruiting will go all the better without it.

Footnote.- The age limit for the Home Guard is 65. If a man can carry a pack and rifle at 65 is he not capable of performing hospital duties 7

and Yours *

DEAR SIR,

In the last issue the' Use of Petrol for Wounds' (in the Queries and Answers section) shocked me, and as a Petroleum Chemist I would like to point out why. The term Petrol, as the layman understands it, is that for' Motor Gasoline' in the industry.

In these days this product contains Tetra Ethyl Lead as an Anti-knock' additive and spedfic instructions are given that this material is used for a Motor Fuel only. Petroleum companies and the Ethyl Corporation go to great trouble to provide protective clothing and to instil a careful handling of the T.E.L. in spirit, and great stress is laid on constant medical checks for all operators. Bearing in mind the very poisonous nature of T.E.L., it is toxic by inhalation and absorption through the skin, my decision in cases of emergency described by Dr. N. Corbet Fletcher is rather let there be a danger of Tetanus rather than a combination of poisoning from both Tetanus and T.E.L.

(1) Staff Officer Bolton is reported to have said that' he reckoned m o re than 5 per cent. of the people treated had foreign bodies in the eye.'

The total number of cases treated by Red Cross and St. John were nearly 20,000, 5 per cent. of which would be nearly 1,000. The total number of 'foreign bodies in the eye' are stated to be 709.

The actual number of cases treated by St. John members only, is given as 3,695, and 709 · happens to be nearly one-fifth of 3,695 !! Is it possible that Staff Officer Bolton said one-fifth (not 5 per cent.) of the cases were foreign bodies in the eye?

(2) It is sad to see that the casualties treated by St. John members were broken down as follows.' It is certainly not the way to give first aid!

FlRST AID & NURSTNG, NOV.IDEC. 1951

by first aid? It is unfortunately much too common to refer to people who are suffering from some complaint as 'cases.' But I was brought up as a student never to refer to a pregnant woman as a ' pregnancy.'

[t is indecent, that is, unbecoming for a doctor, a nurse, or a firstaider to use such an expression, if only out of respect for one's mother. I think the Red Cross were wise not to draw attention to the fact that 9 expectant mothers had passed by their way!

Yours faithfully, KENNETH E. LUND, NORW1CH. CSt.J., M.A., M.B.

(Slightly dazed . by Dr. Lund's broadside, First Aid makes the following reply :-)

People

*GOING back to the West Indies for a further two years' service as Matron of the Shell Group hospital at Point Fortina large oilfield and refinery centre in the south-west corner of Trinidad-is Irish-born Miss Clare Fearon, who started her training in 1930 at the Civic Hospital, Liverpool.

Miss Fearon has had the most interesting and varied nursing On leaving Liverpool Hospital, she underwent further general training at Westmorland County Hospital, Kendal, and at St. Mary's, Manchester, where she obtained her matron's housekeeping certificate and passed her midwifery examinations in 1937. After a spell at the Radcliffe Infirmary, Oxford, and the Savernake Hospital , Marlborough she specialized in industrial nursing and was responsible for the equipment and staffing of all surgeries in the Rootes' group of factories.

Just returned from a visit to Syria Jordan and Lebanon is Miss Evelyn the British Red Cross Society's International Relations and Relief Adviser. Said Mis') Bark in an interview: 'The misery of the refugees is of course evident everywhere and particularly in Jordan where the greatest number are seeking shelter. Living in one tent I saw as many as ten people, and the tent-if such it could be called-absolutely in rags, patched up with all sorts of odd bits and pieces. On the other hand the U.N.R.W.A. is making some progress with the building of houses. Tn the majority of cases the refugees themselves make the bricks out of the local stone mixed up with mud and a kind of straw called tiban.

7

There are however many products n the industry which do not contain T.E.L. but most laymen are not likely to associate these with petrol although they compare with the prewar 'non-leaded' petrol, and thus these can be generally ignored except by the specialist in industry.

Yours faithfully, LEONARD H. C. WOOD,

Associate Fellow of

the

(3) 'Some 11,000 aspirin were used' is an extraordinary expression. , Some' before any kind of number is all too common in present-day writing and is probably used for 'nearly,' 'more or less than,' 'about,' but is 'sloppy' English and not elegant. What are 11,000 aspirin? We talk of 50 sheep, 3,000 fish, 12 brace of grouse, etc., but not , 11,000 aspirin.' Presumably aspirin tablets are meant and if so why not say so 7 I am not surprised that the Princess Royal was astonished !

(1) Staff Officer Bolton was referring to the cases treated at the Red Cross Post. The figure 709 is the total of foreign bodies in the eye' treated at the St. John Post.

(2) and (3) Schoolmasters will agree with Dr. Lund, but it is submitted that the meaning is clenr even if the language is colloquial.

(4) Dr. Lund attaches to the word 'evacuated' the me a ning nearest to a doctor's under5tanding, but he is reminded that the Concise Oxford Dictionary authorizes the use of the word as meaning' removed.'

In 1943, she joined the Colonial Nursing Service and became Matron of Barbados Hospital until 1945 when she took up her present appointment with the U.B.O.T. (a subsidiary of Shell). She describes the hospital at Point Fortin as ' one of the best and most up-to-date in the West Indies.' There are 46 beds, including 15 private rooms, 2 large wards and a casualty block. The hospital runs a large out-patient department, a small physio-therapy unit , and dental treatment is available on certain days of the week. There are 3 resident British doctors and 12 locally-trained West Indian, South African and Chinese nurses, who live in a comfortable hostel adjoining the hospital, where every nurse has her own room and bathroom.

The overcrowding is terrible and the amount of sickness appalling. Although understand that the Arab. compared with the European, is not particularly disposed to T.B. , the present conditions of poverty, congestion and malnutrition are beginning to take their toll. U.N.R.W.A. has started a small pilot scheme at Anita, nOlih of Jerusalem. This aims primarily at giving custodial care to positive T.B. cases, isolating dangerous courses of infection from the communities in which they live and at the same time giving consideration to the psychological angle of T.B. patients who hate to be separated from tbeir families. 'Another very serious matter is the percentage of blindness amongst refugees, which is estimated at 1 per cent. Since there are nearly one million refugees you can appreciate the high figure to be dealt with. Many are born blind and many go blind through tracoma, a prevalent disease amongst the Arabs and especially amongst the children. If this disease is detected in time it can be eradicated in 90 days. However, even if the patients come voluntarily to the clinic it is very difficult to convince them of the necessity of following the treatment rigidly. Eye clinics are badly needed and I understand the W.H.O. is making a study of tbis question.'

of Petroleum. GRA YS,

ESSEX.

Institute

N.C.F Replies:

We are much indebted to Mr. Wood for his instructive and interesting letter and of course we have pleasure in publishing it. It is evident that he knows more about petrol than I do.

To the Editor of First Aid'& Nursing. SIR, , First Aid at South Bank' by a First Aid Reporter has several curiosities to which I would like to refer

(4) The use of the word , evacuated' of people, when one means' removed,' should be avoided like poison; otherwise it suggests that when patients are' evacuated' castor oil has been administered. The word came heavily into vogue about 1939-41, when the authorities were quite undecided which should be evacuated, the towns and cities, or the women and children!

(5) 'Normally' is not a synonym for usually' or ' ordinarily.'

, Normally the ambulance took 3t minutes to arrive' could be 'the average time for the ambulance to arrive would be minutes.'

(6) I have known cases of Meniere's disease, but never heard of Meumiere's.

(7) The most extraordinary cases listed are the 9 pregnancies. I have never heard of them as casualties. Were they accidents or infectious cases? And how are they treated

(5) Again, the Concise Oxford Dictionary gives 'typical' and , usual' as synonyms for normal.' It is therefore correct to say that 'the ambulance normally took 3l minutes to arrive' in the sense that the ambulance 'usually' took 31 minutes.

(6) A misprint for which an apology is offered.

(7) 'Pregnancies' was the word used in the St. John statement. We cannot see anything indecent in the word. but it js a matter of opinion. In regard to first aid treatment in pregnancy, the 40th edition of the S.J.A.A. Manual First Aid to the Injured has an appendix on , Emergency Birth'; and Bailliere's Handbook of First Aid has a chapter on 'First Aid in Cases' so it is assumed that first aLd is not unknown in these cases,

Miss Clare Fearon, matron of Point Fortin Hospital, with the- nursing staff

News from St. John

Penang

St. John's Day, Sunday, 24th, was a red letter day to the Penang Brigade whose members numbering approximately 500 strong attended a church parade at the Assumption Church , Farquhar Street with the Municip a Ba nd in at endance. 'After the church service the members marched through the streets of Penang with the ha nd at the he a d before returning to the sta rting point. The parade was under Corps Officer Mr. H. L. Cutter.

On the 23rd June the members of the Blj g l de had a Flag Day and managed to a sum of appro x imately S J 300 by se llIng fl a gs and car posters-a record incidentally.

The annual inspection of the Penang Brigade took place at the West lands School ground on 29th September 1951. J t was made by the Acting Commissioner Mr. q. W O.B.E. accompanied by M1SS I. RIcher, the Organizing Officer and the District Superintendent, Dr. C. H: Yeo. Thirteen ambulance divisions comprising 650 officers and men were on parade undl'r tbe command of the Acting District Ofticer, Mr. S. S. Adams.

After the inspection members of Divisions I. IV, V and XI demonstrated first aid work before the guests , among whom were Major-Gener a l E. B. de Fonblanque, C.B., C.U.E., D.S.O.; Dr. M. L. Bynoe, Chief Medic a l Officer the Hon. Dr. K. J.P.; and several other disingUIshed gentlemen.

The awards of the Order of Serving Brother and Sister of the St. John Ambulanc.e Brigade, warrants of appointment vouchers, medallions and labels were dIstrIbuted by the Acting Commissioner and in the march past he took the salute

Throughout the inspection and march past the Chung Ling High School Band was playing.

Leicester

The Lane Ambulance Division

part In a church parade with the Glp SY Ex-Servicemen Association on Armlstlce Sunday. Div. Supt. T. Hames

B.E M., was in charge of the parade, which was headed by the East Park Road C. & 1. Band, a route being taken from the GIPSY Lane W.M. Club to St. Gabriel's Church and was met by the Rector, Rev. At 11 a.m. the two minute's silence was observed, followed by the homage to the dead. Sgt. F. Hughes (late R.A.M.C.) recIted Laurence Binyan's wellknown lines' They shall not grow old.'

The Lessons were read by Div. SLIPt. T. Hames, B.E.M., and Sgt. F. Hughes' the hymns were accompanied by the band. The Rev Ingham also paid tribute to those who. fell ID the two wars. At the end of the SerVIce the parade reformed and marched back to the Gipsy Lane W.M. Club by a (;hfferent route,

TOPICAL NOTES FOR FIRST AlDERS

& NURSES

The Admission of Emergency Cases to Hospitals

The Ministry of Health has issued a Circular (R.B.H. (51) 115) asking all hospital authorities to overhaul their arrangements for the admission of emergency cases of acute illness in order to ensure that urgently requiring hospital treatment are adrllitted without delay and causing unnecessary difficultles for general practitioners. The Circular contains many suggestions for improving the present procedures, so that no request for emergency admission should ever be refused except on medical authority. It sometimes happens that patients brought to hospitals as emergencies are found to be less in need of medical treatment than of care and attention not available in their own homes. The hospital should then find the right destination for such example, in a local authorIty hostel. The Circular also suggests that, as a running check on the efficiency of an emergency service, a record should be of all requests for emergency admlsslOll, the steps taken to comply with the request and the result including the time taken for appropriate action.

As long ago as 1938, ' bed bureau' schemes were started by King Edward's Hospital Fund for London, and quickly spread throughout the country; and schemes are not yet entIrely Lncorporated into the nationalized hospital service they are of inestimable value. Records as those suggested by Mllllstry, have been kept. For example, t.hey show that at the peak of the mfluenza epidemic last January the successful placing of emergency patients into hospital fell from the usual 90 p.c. to about 60 p.c. The King's Fund Service has a warning system to be put mto operation if the demand for emergency beds agai n threatens to become intensified.

Organization of Nationa1 Health Service Reserve

Alterations in the organization of the National Health Service Reserve are set out in an appendix to the Ministry of Health Memorandum

R.B.H. (51) 87, H.M.C. (51) 80, B.G: (51) 83. In order to provide RegIOnal Boards with information concerning the kind of service that members of the Service will be able to .render, it is proposed that every tramed nurse in the Reserve and every nursing auxiliary who has completed her initial training should be asked to complete a form which will then be sent to the B<;>ard. Hospital Management Comm1ttees and Boards of Governors have all the necessary information regarding the trained nurse members enrolled by them, and it is desired that these authorities should see to it that the forms are completed and sent to the appropriate Regional Board. The St. John Ambulance Brigade and the British Red Cross Society have undertaken to secure through their local branches completion. of the forms in of the nurslllg auxiliaries who have undergone their initial training. Unless the information obtained these forms is kept up to date 1t cannot be of real value so that the question of repeatincr these returns at definite imervals bis under con-

It is also proposed that a Itst of duties which nursing should be taught and are reqUIred to perform during their hospital training should be made available to Matrons and Ward Sisters, and should be displayed in ?uty rooms and ward kitchens. It IS felt that this would promote a understanding and co-operatlOn between the hospitals and the nursing auxiliaries.

The End of the Radium Commission

The Radium Commission a Short History of its Origin' and Work, 1929-1948 was published on 19th November (price 7/6). It tells bow the Commission was set UP, in

FIRST AID & NURSING, NOV.IDEC. 1951

1929, under voluntary control and continued to operate until Mr. Bevan, when Minister of Health insisted upon its closing down 1948, and all its assets 1 including 75 grammes of radium, being handed over to the Ministry; for there was no other body to which the Commission could hand over. The members of the Commission had discussions with the Ministry, in 1946, regarding its place in a national health service, suggesting that it might act as an expert adviser; but Mr. Bevan replied that 'hospitals and their equipment would be vested in the Minister.' He said that there could be no sp('cial arrangements for the ownership of one item-radium-and that the Commission's functions of advice determining the hospitals to which the national radium should be issued, and of collecting and analysing records of cancer patients would be carried out by other agencies. And thus, to quote from the published history' The Commission has passed away on the eve of momentous developments in the radiological world, when the physicists are making available many new types of ray and a great assortment of new engines to produce them. The urgent problem is to discover what significant biological change is brought about by each of these highly specialized machines. The voluntary control exercised hitherto by the Commission has ceased to operate, and the future development of Britain's radiotherapy is now in the hands of Regional Hospital Boards and Boards of Governors. The nucleus of a cancer organization already exists in a n umber of radiotherapy centres; but in no region is there yet centralization of surgical treatment of cancer.'

New Filmstrips

Three more filmstrips presented by the National Film Board of Canada are now available in this country and can be obtained from Unicorn Head Visual Aids, Ltd., 40 Broadway, London, S.W.l. The popularity of these Canadian filmstrips is steadily growing and they are being used in schools, clinics, hospitals, first aid centres and wherever health teaching is given or the biological sciences are taught. The newly available strips are :-

Rupture oj the Spleen

A CCORDING to the British Medical Journal (3rd November 1951), rupture of the spleen is a more common accident in Encrland than is usually supposed. Inb this sense, rupture' means a variety of wound in which the organ is torn or almost burst.

The spleen is a reddish-purple gland situated in the upper part of the abdomen on the left side where it is protected by the lower ;ibs. It is well supplied with blood and its functions are to produce fresh white corpuscles and to destroy red corpuscles which have become worn out.

Rupture of the spleen can result from any accident where violence is received over the lower left ribs or upper abdomen. Examples include , run -o ver' and 'crushing' accidents being flung against the handlebars of a cycle or motor-cycle, and falls over projecting objects such as kerbs or steps. Every first-aider has already learnt of this injury as a complica-

Orphan Willie-a Filmstrip on Child H)giene

This is an amusing story, in six chapters, of the metamorphosis of a grubby, untidy orphan lad who is shunned by other children, into a well-groomed, pleasant-mannered boy who becomes a scout and a member of the rugby team, and who is successful in all his social contacts.

Orphan Willie lives with his gentle, dreamy, but totally unpractical Uncle Joe whose main interest in life is collecting butterflies; and whose three sons are in the Army, Navy and Air Force respectively. These boys come home and take Willie in hand. The script is in doggerel rhyme, in the 'Cyril Fletcher' manner. All children and young people will enjoy this filmstrip, and doubtless will remember and quote couplets from the script.

Introducing Baby

This is a technicolor filmstrip on post-natal care of both mother and child from the moment of birth until the second year of life. All aspects of feeding, bathing, special toilet procedures, clothing, sunbathing

tion of broken ribs.

The symptoms and signs are those of haemorrhage from an internal organ. In milder cases however temporarily' stop and the first-aider may be mIsled mto thinking that his patient has solely suffered from shock from which he is There is, however, conSiderable danger that the blood-clots may be disturbed as the patient recovers from shock or if he is unnecessarily handled 0; moved.

It would appear that \vhene\/er the history suggests the possibility of a ruptured spleen, treatment for internal haemorrh age should be adopted even in the absence of characteristic symptoms. Careful observation must be m aintained and it is most important to keep a record of the pulse, taken at frequent intervals.

Surgical treatment consists in removal of the organ which is not essential to life.

and playing are shown and explained. Immunization to such diseases as smallpox, diphtheria and whooping cough are discussed, and so also are the difficulties that may arise \\'ith teething, weaning and the taking of more solid food than can be supplied by the breast or the bottle. The development of the baby's personality and his emotional needs are indicated in a natural and commonsense manner. The accompanying script is well written and is as informative as it could be , considering its length and scope. Not only parents, but all 'Nho have the care of babies and young children will appreciate this filmstrip.

Feminine H ygiene

This is also in techrucolor and is very suitable for use in senior girls' schools and clubs: and in the preliminary schools of hospitals. A most informative script is supplied with it. From the point of view of sex teaching this film and its associated script should meet the needs of those whose duty it is to give such teaching in an adequate and acceptable manner.

British Railways

Southern Region Centre

Congratulations are extended to the following doctors who have rendered valuable service to the Soutbern Region Ambulance Centre, by lecturing and adjudicating competitions on their being appointed Honorary Life Members of tbe St. John Ambulance Association, in recognition of the services they have rendered: Dr. Sheila M. Niall , Dr. F. M. Pole, Dr. W. J. Walter, Dr. B. A. R Pitt.

Tbe MaunseLI ' Cup Competition wa s held at A shford Works recently, when six tea ms took part. The s andard of the work was very high and once again Mr. Morse's team was announced the winner. Mrs. H. C. Lang presented the trophies and prizes. Competitions and friends were entertained to tea by the Works Manager, Mr. Sa unders.

Woking Class held their Annual Presenta tion of Award s in the Railway Athletic C lub , Woking recentl y when the awards were p res ented by Mr. S. Winnifrith , St ation M as ter. M r. Hatch is to be congratulated 00 the a rra ngemen ts he made for the soci al event and for undertaking the duties of Cl a ss Secretary in this newly fo rmed Cla ss

Western Region Centre

Pr ese ntation of A wards at Padding/on

The p res entation of two Class 1 awards (clock with an appropriate engraved silver plate and framed ce r tificate) and eighteen Class 2 a wa r d s (framed certificates) , was recently m a de by Mr. K. W. C. G r and Chief Regional Officer.

Mr. H. Adams Clarke, Chief Officer (Staff and E stabli shment) and Dr. H. H. Cavendish

Fuller Chi ef Medical Officer , Railway Executi ve, were present together with a number of Chief Officers of the Western Region.

Swindon

Mr. W. H. Bodman, Staff Assistant to the Mechanical and Carriage and Wagon Engineers, who is President of the Class , presided at the concert and presentation of trophies, prizes and awards. The presentations were made by Mr. H. R. Webb , Stores Superintendent, assisted by Mrs. Webb

The Mayor and Mayoress (Alderman and Mrs. A. Leonard) Mrs. Bodman, Mr. P. Anstey, Regional Secretary , and Mr. J. A. Martin, his assistant, together with a large number of local officials were also present.

Cardiff

Mr. T. R. HalJ, District Motive Power Superintendent, presided at the supper and presentation of awards to the Cardiff Ladies' Class a Porthcawl. Mr. C. E. Shaw District Commercial Superintendent presented the a ward s and congratulated the Class on their achievement during the past year , especiallv the members of the ladies' team who competed in the All Line Competition at Paddington.

Newport Goods

Mr. B. J. Protheroe, Goods Agent, presided at the presentation of awards, which were distributed by Mr. N. D. Jenkins, District Commercial Superintendent. Mr. Jenkins emphasized the importance of the movement, and stated that the Newport Goods Glass was one of the most progressive in the district, the results being being due to the interest taken by Dr. R. J. S. Doherty, lecturer, and Mr. G. Dando , class instructor.

Ystalyfera

The presentation of class awards was made by Mr. C. E. Watkins, Chairman of the Class , who spoke of the early days when the Clas s commenced and appealed to the younger men and women to become

interested in the Movement. Mr. W. H. Crawford presented Mr. Watkins with his label for 27 years' ambulance service, and congratulated the Ystalyfera team which had won the Henry Folland Shield five times with the London Midland Region, and had this year won the Swansea District Competition and had also qualified for the Western Region Final Competition.

North-Eastern Region

At the B.T.C. Police Club , Leeds, on 22nd November , Mrs H. A. Short. wife of the Chief Regional Officer Region, British Railways, York, made presentations to 87 members of the Leeds District of British Railways' North-Eastern Region Ambulance Movement. Awards included two Serving Brother Diploma s , five IS-year efficiency medals , two 20-year bars , one 30-year bar, 20 certificates, 11 vouchers , seven medallions, and 39 l a bel s

Dr. L. Brill, of Leeds, who has so long been associated with the Railway Ambulance Movement as a lecturer and examiner , received a memento from Mrs. Short, acting on behalf of the Class members, in appreciation of his services.

The presentation s were made during an interval of a mu sical evening arranged for members and relatives and f riend s

Amongst pre sent, in addition to Mr. and Mrs. Short, were Mr. E. W. Arkle (Commerci a l Superintendent) Mr. A. De a n (Civil En g ineer), M r. H. S Cole (Chief of Police, Northern Area) a nd Mrs Cole, Mr. T. W. Polding (Di s tric Passenger Superintendent, Leeds) and Mr. T. R. Heaton (District Goods Superintendent, Leeds) Mr. W. J. Thomas, the Sta t ion Ma s ter a H a rrogate, was Chairman

LONDON TRANSPORT

THE Final First Aid Comp e tition for the Probyn Shield took place at the Avondale Hall, Clapham, S.W 9, on Saturday, 24th November , 1951. Twentysix teams had pre viou s ly t a ken part in elimination contes ts, nine leading teams meeting in the final competition The winners were Lot s Road (leader, F. Edward s) with 427 marks out of a possible 500 Other team members were: H. Godfrey, W. Butler S. Gosling, F. Golding. Second place was obtained by Charlton (leader, c. Cherry), with 393 t marks, team members were: O. Lidgard , W. Maxted, .T. Knowle, S. Billings , followed by Baker Street, 3rd, with 378 marks (leader, J. Warden), team members : J. Watts A. Smith P. Dowling, A. Young.

Other teams taking part were Baker Street (Women), Dorking, Camberwell (Women), Camberwell 'B ,' Sutton 'A,' and Fulwell.

The Shield and prizes were presented by Mr. J. R. Garwood, Divisional Superintendent (South-East) Central Road Services who was introduced by the Chairman:

Mr. Alex J. Webb, General Superintendent (Staff and Training) Railways. The judges were Dr. D. D. Towle, District Staff Officer S.J.A.B., Dr. G. Bousfield, Area Surgeon S.J.A.B.. and Dr. J. Fairlee of London and S.J A.B. Mr. T. T. Shephard, Rollmg Stock Engineer, Road Services and Yice-Chairman of the Centre, thanked the Judges for their help in making the competition such a successful one ,

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Stomach, Duodenum BEAUTY TREATMENT

Teeth , the Muscles how to bring out your best points

Child Wel fare SELF DEFENCE

The Lungs, Pleurisy

Hygiene, Anatomy, Pharmacy

Fevers, Bladder, Kidneys

Pregnancy, Childbirth

Home Remedies, Diet

MOVABLE MODELS OF

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Homceopathy, Arthritis what to do if attac ked Neurasthenia

Rheumatism , Poisoning COMPLETE INDEX

Patent Medicines enables you to find Glossary, etc., etc. instantly what you require THE HUMAN BODY-hundreds of illustrations and Female

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Types of Bandages Splints

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Presentations by M rs. H. A Short to Mr, J. O Hansell and Mr. C E. Addison. (See North-Eastern Region)

Bed Cross NEWS

Battersea Park Festival Gardens

British Red Cross Society manned the Festival Gardens First Aid Post from its opening until its closure on 3rd November.

During the whole period the 348 men and women from all parts of British Isles who were on duty treated 8, I 03 casualties. Some 450 old and infirm persons took advantage of the special Red Cross Wheel Chair Service and thus saw the Gardens in comfort.

Many Red Cross members gave up their holiday to render first aid at Battersea. Casualties were: minor injuries 4,] 65 major injuries 2, faints 180, digestive 643, nervous attacks ] ,01 8, ear 56, heart 8, immersion 37, child-birth 6, infectious I, malaria 1, epilepsy 6, diabetes 25, nose bleeds 51, others ],925.

They Won the Competition, Too

Five members of the East Yorks 129 Detachment, B .R.C.S. , were travelling to Newcastle recently by bus to take part in a competition when they came upon a road accident. The coach was stopped and the casualties were treated and sent to hospital. The team went on to Newcastle and won the competition. The Chief Constable of Darlington complimented the team on their prompt action.

First Aid Cycle Squad

A Lambeth D.etachment, London / 83, has formed a Cycling Squad of first-aiders. It consists of up to four men. Each man carries a haversack and the leader has a and a ring-keeping gear with Irons and cord. The box-trailer was homemade and caused a stir when doing first aid duty in the Festival Borough procession

The trailer was u sed to transfer Red first aid equipment to a post at the Archbish<?p's Servi ce at Lambeth Palace during Festlval week, and the ring-keeping gear has been used by the Lambeth Cadets to protect their tent during a sports day.

Lady Limerick's Report

Rep orting .on her Australian tour Lady Llmenck, Vice-Chairman, said she had travelled some 30,000 mlles in thirty days had had the most wonderfully interesting tune. The Austrahan Red Cross had given her a warm welcome and had made her an Ho.norary Life Governor of their Society, which she regarded as a tribute to the work of the B.R:C.S. went on to say that the Austrahan Society had a wide programme of work and gave some details of their outstanding services :-

B.lood Transfusion.-Responsible for the natl?nal. service. The annual cost of the servIce IS about £100,000 to which the State G,?vernments contribute. Blood costs the Society about £1 per pint. In some where it is necessary to charter a to carry the blood to a transfUSion case It may well cost over £100,

Recruiting Drive for Hospital Reserve

A NEW recruiting campaign to treble the membership of the National Hospital Service Reserve has been launched. Every member of the Reserve is urged to enrol two friends during the winter. Press and poster publicity, aided by special exhibitions, etc., will appeal to the public to join this essential service. The Sr. John Ambulance Brigade and the British Red Cross Society are playing an important part, for they are responsible for training recruits.

In a special message to regional committees and local area committees, Miss Hornsby-Smith, Parliamentary Secretary to the Ministry of Health, says that 80,000 enrolments for the peacetime strength of the Reserve are required. At the moment there are 18,000 members. 'There are many aspects of war that are unhappily wasteful,' she goes on, 'but here is a service and training upon which time spent is never wasted, and which will always be an asset to the individual member as well as the nation. The wife and mother, the sister and aunt, the worker in office, factory or farm: anyone of these who takes the skilled training in first aid and home nursing given by the N.H.S.R. is thereafter a more useful citizen.'

The Reserve is open to men and women, the age limits being women In-60, men 30-60. In the event of war, the National Hospital Service Reserve will help to man not. only the expanded regular hospital serVIce but all the first aid posts and the mobile first aid units who will go out from hospitals to the areas of enemy attack.

In war, the hospitals would be divided into three different categories. Hospitals

T.E. Sanatoria.-Extensive work is being ar:nongst T.B. patients, and the Society mallltams three excellent sanatoria in New Soutb Wales.

Convalescent Homes for Ex-Servicemen.Lady Limer:ick mentioned how impressed she was wlth these homes. Diversional therapy is encouraged, both in and out of hospital, classes being arranged at Red Cross Centres, and there is a special correscourse for persons in outlying dlstncts. The completed handicrafts which are of a high standard, are sold in Red Cross shops Insulin Service.-in some cities a daily round is organized giving injections to diabetic patients.

Immigrants.-Ex tensive welfare work is being done for immigrants. Red Cross Transport Services.-Run on ,imilar lines to the Hospital Car Service.

Training.-In the Australian Red Cross is on much the same lines as our own. target of £750,000 per annum, l.e. 2/- per head of population. A novel .form ?f appeal is being exploredthe object ?erng to raise one penny on every beast sold m Australia, which it is estimated bring in £300,000 per annum for the SocIety.

Other Voluntary Organizations.-Whilst

II! Australia Lady Limerick met representaof many voluntary organizations, mcludmg the St. John Ambulance Brigade

in the most vulnerable target areas would be evacuated, though in some a few beds would be retained to deal with accident and emergency cases. These would be called 'casualty transit centres.' Outside these most vulnerable areas, 'cushion hospitals' would deal with the main volume of casualties from the target areas. In the safer rural areas there would be 'base hospitals' to which long-stay cases would be moved.

The N.H.S.R. would not only help to man these hospitals but would be responsible for the war-time first aid services. These would consist of static first aid posts at or near hospitals, and mobile first aid umts based on hospitals. Static first aid posts :would be at most sizable general hospitals m all three areas. Mobile first aid units would be based on cushion and base hospitals. In practice, each unit will be under the charge of a doctor and will of about N.H.S.R. nursing aUXilIarIes. The umts will be motorized with two light cars for the staff a light van for their equipment, and The drivers of the cars and van and the motorcyclist are members of the special 'M' (or motorized) section of the Reserve composed of auxiliaries who are car or motor-cycle riders.

The r.nain .function of the first aid posts umts will. be to deal with the lightly mJured casualtIes, leaving the hospitals free to deal with the seriously injured.

Trained nurse members of the N.H.S.R. will serve in the hospital wards and static first aid posts. They are asked to do only a paid annual refresher course of 48 hours when they join the Reserve.

and she visited some of their first aid posts.

City of Coventry Division

The second Presentation Ceremony of certificates to N.H.S.R. personnel took place at the Forum Cinema on 13th October the. Mayor of Coventry, linking Society wlth the Reserve proudly showed the audience the Red badge he wore on his lapel. In his speech he referred to the urgent need for recruits and to the grand work done by the Red Cross in his connection. Coventry, he went on to say, had recrUIted 166. At the first ceremony in 1950, some 40 people received certificates. On this occasion the number had to be limited to 40 because there were so many certificates and badges to be presented !

After the ceremony a recruit stepped forward and told the audience of the training she had received and urged more to corne forward and join the Service.

West Riding of Yorkshire

113 and 312 have manned the Millhouses First Aid Post for some 7721 hours during the period January I st to 7th October. Between the period 24th March and 7th October 439 casualties were of .which 28 were hospital cases.

It IS to note that one patient was suffenng from sunstroke but it would be still more interesting to' know when this occurred. It must have been the ONE day of summer!

PATENT "PORTLAND" AMBULANCE GEAR

The Gear Iliustrated(A.B.C.D.) carries two stretchers on one side of Ambulance, leaving other side clear for sitting patie nts.

The UP AND DOWN action is quick and easy for loading or unloading.

A. Shows the two stretchers in position.

B. Shows the top stretcher lowered ready for loading.

C. lilustratr-s the same Gear w th the top stretcher frame hinged down for use when only one stretcher case is carried.

D Shows the same position as in "C' only with cushions and back rest fitted for convalescent cases.

Where Ambulances are required to carry four beds two Gears are fitted, one on EITHER SIDE. and the same advantages apply as described above.

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Queries and Answers to Corl·espondents

The Textbook to reJerence ma; be made in this column is the 40th (1950) Edition of the S.J.A.A. Manual of First Aid to the Injured. Correspondents are requested to write on one side oj the paper only.

Thanks to the Doctor

In the last issue, under the heading 'Thanks to the Doctor' we stated that Dr. T Corbet Fletcher had been conducting the Queries and Answers column for 30 years. Actually, he has been doing so for 36 years. Vie regret the mistake, and gladly publish this correction.

Paralysis of Muscles

, W. G.' (Stoke). - We at our class would appreciate y our ruling as to whether it is possible to recognize paralys is when the patient is unconscious. It has been suggested that the limb, if lifted a little, lVould Jail more lifeless than would a normal limb We should be pleased to have y our opinion.

To the doctor this sign of lifelessness' in a limb to which you refer is important, but to the first-aider it is likely to be of little use as the difference in the rate of movement may be so small as not to be observable.

The reason for this sign is in the fact that when a limb is raised and then allowed to fall the patient will, either consciously or subconsciously, use his muscular power to prevent the limb striking the g round with too much force. If, however, the patient is insensible this control is absent and the first-aider would pro bably see no difference in the rate of fall.-N.C.F.

Examination Howler , P. B.' (Hounslow).-In a recent examination a candidate was asked how he JIIould treat a patient who had had his Jorearm severed below the elbow joint. We wer e much amused when he rep lied- ' I would first dres s the wound and then support the limb in a St. John arm sling.'

Good! Next please! !-N.C.F.

Dilatation of Pupils

'W. G.' (Stoke).-As a regular r z ader oj First Aid, I find that the queries and answers are very instrllctil'e ; and I should be pleased if the follolVing could be answered Jor me :-

According to the Textbook the pupils oj the ey es in Nerve Shock are usually dilated and yet, il1 Haemorrhagic Shock (which is more severe) it is stated that the pupils may be normal or dilated. As this is a problem which puzzles our chaps during their diagnosis, we should be pleased to have YOllr views on this matter.

The dilatation of the pupils arises from loss of control of the eye muscles by the higher centres of the brain. The greater the shock, the wider is the dilatation. In Nerve Shock the effect on the pupils is rapid but in Shock due to Haemorrhage the dilatation usually comes on gradually and in proportion to the extent of the haemorrhage. At first the loss of blood will not be sufficiently severe to produce any gffect but with continued bleeding the shock increases.-N.C.F.

Barrel Bandage for . F. D.' (Dunston) .-I Irish to draw attention to Figs. 182 and 184 071 page 246 of the Textbook ll'izic/z has inadvert ently been primed in error. Being an old seam all , J knOll' that it is imposs ible to secure the bandag e as illustrated. Fig. 82 011 page 120 is oj course correct but both illustratiol1s certainlr differ.

Except for the use of the roller bandage in Figs. 182 to 18.+ on page 246 of Textbook both the wording in the text, the method of application and of securing are identical with those on page 120. It follows, therefore, tha t if you can secure the triangular bandage you should be able to secure the roller bandage. -l .C.F.

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Twelfth Edition, revised by Margaret E. Hitch, S.R.N., late Sister Tutor, Saint Bartholomew's Hospital, with a Foreword by Sir Cecil Wakeley, P.R.C.S . A complete encyclopredic and pronouncing dictionary of the medical terms in common use-in a pocket-sized volume. T\venty-one appendixes cover a variety of important subjects, S'pli nts and Bandage s, Abbreviations, Diets, Blood TransfuSIOn, Antl-bIOtlCS, etc. There are 496 pages and over 200 illustrations.

, This dictionary keeps its place in the front rank of such publications can be unreservedly recommended to all members of the British Red Cross, and the Saint John Ambulance.' British Red Cross Quarterly Review.

MEDICAL DICTIONA y

DALE, REYNOLDS & CO. LTD. 32 Finsbury Square OR London Eel

BAILLIERE, TINDALL & COX 7·8 Henrietta Street London WC2

Please send me copy/ ies of Bailliere's Nurses' Medical Dictionary, for which I enclose remittance of..

Name

Address AI252

1. W. (Leicester) writes :-

In a recent First Aid Competition

Dual Practical T es t we were required to treat a patient who had a slight injury to the forehead and a fractured patella. At the completion of the tr eatment we left the patient lying more or less where he had fallen, but wit h blankets under and over him, with head and shoulders raised and feet tied together and raised, awaiting the arrival of the ambulance, which had been summoned. We found that we had lost a possible 21 marks because we had not attempted to move him to shelter. The method of transport expected to be adopted was the three-handed seat. Do y ou agree with this?

We have since attempted to do this in practice, but find that (1) we have not been able to lift the patient from the ground by two first-alders unassisted, and (2) the splint under the buttock cutting into the firstaiders' hands is and would make it impos sib le to carry the patient an y distance.

Another team we saw do the same test adopt ed the blanket nft, which appeared to us a much more satisfactory method.

An important principle in first aid for a fractured patella is to relax the muscles of the front of the thigh. This is why the head and shoulders are raised and the feet supported well off the ground. This position should be maintained as far as possible during transport hence the reason for the three-handed seat despite the difficulties you mention.

There would be no objection to using a shorter splint as a temporary measure to prevent it cutting into the first-aider's hands.

R. F. (Twickenham) writes :(1) 111 the new 40th (1950) edition of the S.J.A .A. Manual, page 257, under the heading 'Resuscitation Apparatus,' th e use is advocated of the' Novita' Oxygen apparatus.

No mention is made of the use of carbon-dioxide as a stimulant to respiration, as !Vas formerly stated in the 39th edition (1938), Appendix 1, page 245.

queries

Has the us e of carbon-dioxide, administered by the 'Sparklet,' or other portable resuscitators, now been discontinued?

If so, what are the reasons for this?

Are there an y circumstances under lvhich ca ...bon-dioxide can be used as al/ aid to resuscitatioll ?

(2) Is it possible to bring forward an eye from its socket and lie it on the cheek, for surgical or other treatment, then replace it without damage to the eye ?

(1) Carbon-dioxide is, of course, a powerful respiratory stimulant but its use as a routine measure in asphyxia is neither advisable nor necessary, since in most cases there is already an excess of carbondioxide in the blood. Moreover, there is evidence that inhalations of carbon-dioxide can further embarrass the heart and circulation. If used at all, e.g. in a case of coal gas poisoning, only a few whiffs should be given and administration should be stopped directly the breathing becomes deeper.

(2) By means of a special eye instrument called a speculum, which draws the eye-lids upwards and downwards to their maximum, the eye-ball can certainly be made to budge forwards but only a limited extent. But to lie it on the cheek is not possible since it is held in posi tion by no less than six muscles, and also by the optic nerve which if cut results in permanent blindness.

S. W. (Spondon) writes :-

We have been discussing poisons, and the treatment for corrosive acids on page 176 of the 40th edition, S.J.A.A. M anual- two tablespoons of magnesia powder in a pin t of water. If magnesia is not available powdered chalk may be substituted, or a pint of soapy water. But if soapy water is used surely the patient will vomit and the corrosive acid burn and stain the lips.

Most patients who have taken a corrosive acid vomit in any case and the object of giving the antidote is to limit the harmful effects of the poison as far as possible. The pint

of soapy water will help in neutralizing in the stomach the acid that has been swallowed, hence if vomiting occurs afterwards, the vomit will not cause further harm to the patient. Giving soapy water is an accepted treatment in the medical profession in an emergency. Moreover, poisoni ng by a corrosive acid is a very serious condition and first aid cannot be delayed by a consideration as stated.

E. A. (Huddersfield) writes ;-

Discussing imaginary and possible cases at a recent class meeting we could not decide what ll oufd be the correct treatment of a scald of the left leg, l1'ith blister formation, a simple fracture of the right tibia, and slight concussion. The query is that of treatment of both legs, and the use or other' I ise of S[lliiltS for the fracture.

First treat the scalded limb being liberal with the pads of cotton wool. Do not forget to instruct an assistant to support the fracture in the usual manner throughout. Complete by applying first aid for the fracture with or without splints according to general rules. Adequate padding should prevent the blisters from bursting but even if they do, they will alreadj have been covered with sterile dressings.

Book Review

'Black's Medical Dictionary' by J. D. Comrie, M.D., F.R.C.P.Edin., and William A. R. Thomson, M.D. A. & A. Black Ltd., 30 /-.

This is the twentieth edition of a wellknown dictionary; its popularity and worth can be gauged from the fact that twenty editions have been called for since first published in 1906, and that even in these days of costly printing and publishing four editions have been necessary since the war.

The first edition set out to give' information in simple language upon medical subjects of imporlance and general interest,' but with the passage of time this dictionary has become rather more than a Doctor's Book' with which, at one time every home was equipped. It stands somewhere between a technical dictionary of medicine and a guide to the domestic treatment of the commoner ailments. As such, it will be of considerable use in first aid and home nursing training.

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•.. Then you will follow this point-by-point argument a nd reach the same conclusions as so many doctors, nurses , hospitals and clinics have done.

DO YOU AGREE ... that the causes of most skin infections are the common s trains of STAPHYLOCOCCI, STREPTOCOCCI and B PYOCYANEUS ?

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KING GEORGE VI

First Aid mourns with the whole country and Commonwealth the passing of a great King.

In all our history there has been no Sovereign who devoted himself so completely to the good of his country and the welfare of his people as did King George VI, whose reign spread over some of the most difficult and dreadful days suffered by the British people.

In the dark days his late Majesty was the leader of his people; his conduct and bearing were of the noblest; his personal life amidst the happiness of the family circle was a model to all his subjects.

The late King was Sovereign Head of the Order of St. John; his devotion to duty and selfless service to others were qualities which ever gave an inspiring lead to all first aid workers.

'''e mourn not only a beloved Monarch, but one whose close association with the ambulance movement was ever an inspiration.

If you are a logical person ...

MEDICO·B OLOGICAL

Fractures 'of Individual Bones

by A. D. Belilios , M.B. , B.S. (Lond.) , D.P.H. (Eng.)

I N tbe last issue, the symptoms and signs caused by fractures were discussed in general but the reader was warned not to expect to find all tbese features present in each and every case. Moreover, some bones when they are broken provide a characteristic picture whicb is ea ily recognizable if the first-aider knows what to look for. This article, therefore, calls attention to the special symptoms and signs of fractures of individual bones in the body apart from those given last time.

Fractured Lower Jaw

In addition to severe pain, tbe patient has difficulty in speaking or swallowing. Frequently he leans forward and supports his chin with the palm of his hand. Examination of the inside of his mouth may reveal irregularity of the teeth and a wound of the gum. There may be profuse flow of blood-stained saliva from the lips. Some of the blood may be swallowed and subsequently vomited in which event it may be brown and like coffee-grounds Jn appearance.

Sometimes there 1S partial asphyxia caused by the tongue slipping backwards into the throat. This will be recognized by hearing obviously obstructed breathing accompanied by a gurgling sound in the throat.

Fractured Ribs

The patient complains of a sbarp stabbing pain if he attempts to take a deep breath, cough or sneeze. The breathing is restricted and shallow ; any attempt to take a deeper breath results in a sudden 'catch' in the breathing and increased pain.

Tn a complicated fracture accompanied by injury to the lung, bright red, frothy blood may be coughed up and shock is more obviously present than in a simple case. Sometimes air escapes into the fat under the skin over the broken rib. This is called' surgical emphysema'

and produces a soft swelling which gives a crackling feeling' if the first -aider touches it. It is produced by the first-aider's fingers compresing bubbles of air which have found their \\'ay into the fat. In severe cases, surgical emphysema may extend rapidly involving a great deal of the patient's chest, his neck or arm.

Severe sbortness of breath and difficulty in breathing will result if air from tbe injured lung escapes into the pleural cavity and gradually fills it up ; in this even the lung may partially collapse.

Sometimes the characteri tics of a complicated fracture may be delayed, hence observation should always be kept on the patient particularly in regard to the rate of his pulse and the condition of his breathing.

Injury to the liver and spleen produces the symptoms and signs of haemorrhage from an internal organ.

F r actures of t h e S t ernum and Sca pula

These are uncommon injuries but not difficult to diagnose if the firstaider remembers thei r possibility and examines his patient thoroughly.

Fra ctured C la yicl e

The history supplies an important clue, for example, having fallen on the hand or shoulder. Frequently the patient supports his injured elbow with his sound hand and keeps his head slightly inclined to the injured side This position is adopted with the object of relaxing the muscles which are attached to the collar - bone and hence easing the pain. Otherwise the fracture is diagnosed on general principles.

Fractur ed H um eru s

(a) Near the Shoulder.-This can be very difficult to diagnose and is usually an impacted f r acture. Examination of the bone is a l most impossible owing to the amount of muscle round the shoulder and the swelling which follow. Pain, shock

and inability to mo\e the arm are the chief cha r acteri tic.

(b) Middle and Lower Third of the Humerus together l\'itII Fractures of tile Olecranon (bony knob behind the eJbow).- These injurie together with fracture of one or both bone of the forearm must be diagnosed on general princi pie

CoU es F r a ctur e

This is a fracture of the lower end of the radius ometime combined with that of the ulna. Caused usually by indirect violence, a for example, falling on the hand. it is usuall .. rnpacted. A similar kind of fracture. the chauffeur's fracture, results when , cranking up , a car which backfire. Obvious and marked deformity u ually makes the diagno is of this injury easy.

Bones of t h e H an d

A fracture mu , t be u pecled whenever the hi tory suggests that a bone could have been broken. Swelling and tenderne s may be the only physical signs although if one or more of the matacarpals are broken, there is often an appearance of ' sinking' in of the fir t row of the knuckles. A fracture of one of the carpals may be difficult to diagnose even by an X-ray: often a second picture after an interval of several days i required before a positive diagnosi can be made even by a doctor. It is, however, essential to make an accurate diagnosis since failure to treat the fracture adeq uately may cau e farreaching discomfort for the patient.

F ractur ed P el vis

Severe hock usually accompanies the injury. The patient feels as if he is fall i ng to pieces and is unable to stand. There is severe pain in the region of the hips, made worse if he attempts to move his lower lim b s.

T he feet may be ro ll ed outwards and lie powerle s i n this po ition.

rf the fir t-ailier p lace his on the opposite sides of the

and attempts to pre s the bone inwards towards each other the patient complain of severe internal pain. Thi ign is described as tendernes on conjoined pres ure.' The test should be undertaken gentl) and only performed in the ab ence of other ign of a fracture.

Complication may affect the bladder or the urethra which latter i the little channel along \\-hich urine i con eyed from the bladder until it leaves the body. The patient may feel that he desire to pa water but often finds that he is unable to do o. or only succeed in passing a little blood. Extrava ation of urine, de cribed in a previou article, may occur. The patient should be kept under ob ervation for the ymptorn and igns of haemorrhage from an internal organ.

F r actur ed Fe mur

A fracture of the upper end, particularly the neck. of this bone is very common in the elderly and occa ionaliy result from trivial violence. part from pain and limitation of use, the foot on the injured ide i frequently rolled outward (' everted ') and lies powerIe _ in thi po ition. Shortening of the limb i generally ob\'iou. 0 further examination is u ually necesary but if in doubt the fir t-aider will quickly find tendernes on feeling over tbe neck of the bone. Formerly an extremely eriou and often falal accident. particularly in the elderly, improved method of urgical treatmem now give a mazingly good results. When the patient has recovered from the hock of the accident. an operation is performed and a metal object rather like a nail but called a pin i put th.rough the bone in order to hold the head to the neck. Thi enables the patient to move about in bed or even to get up and thu prevent the dangerous complication -broncbo pneumonia - from which formerly 0 many patient died.

P atella

There i obviou swelling and deformity of the knee caused ....partly by blood and fluid in the joint. Following an injury which a-ffect this joint, a fracture hou ld be diagnosed.

F racture d F ibula

Thi the commonest Injury in tile region of the ankle and i cal led

Chit-kelt P ox

A U I BER of cases of Chicken Po).. have been occurring recently in many part of the country. Although. without doubt. one of the milder infectiou disea es. it cau e inconvenience in the household. particularly if one or both of the parents catch it from . their children.

The di ea e i - cau ed b\ a \ Jru _ and is pread from one per on to another by the breath and by the droplet ' method. patient beinQ mo t infectiou during the stages of the complaint, often before it ha been diagnosed. There i al 0 evidence that ailment can be pread by mean of the hands tind clothing of tho e in attendance on case. and by infected article. but the e ri k are mall. \\ell-kno\\ 11 method of catchinQ Chicken Po"\ is by contact with a patient uffering from a variet of hingle. The di ease u uall -begin about 1-+ days after exposure infection but the official incubation period i from 10-23 day The fir - t - ymptoms

a Pott' - fracture. ]t aA'ect · the bone about 1.\ in. abO\e it lower end. Frequentl) in addition there i al 0 a mall fracture of the lower end of the tibia. There i u ually obvious deformit), the foot being -di.::placed outward - although occasionally it i di placed im\ ard .

A fis ured fracture of the 10\\ er end of the fibula i, al 0 very common and its po ibilit) hould never be forgotten by any first -aider who i called upon to examine a prained ankle. There i no characteri tic feature but the -lightest amount of tenderne along the course of the bone ri Qht do\\ n to the tip of the bony on the outer ide of the joint is ufficient to justify a diagnosi

F ractured T ib ia

Since the urface of this bone is -0 obvious, being ju t under the kin. it is u ually pos ible to diagnose a fracture by sight alone. Fis -ured fractures, ho\\evec are nOI uncommon particularly in the region of the ankle.

are los of appetite. J. feeling of fatigue. a light cough and ally vomiting. There i a moderate degree of fever and a furred tongue. The ra h appears \\ ithin 2-+ and consi t of red lumpy - pot on the kin: the e turn into mall blister on the follo\\ ing da\ and finall) inro scab. Fre -h of pot. each pa !:-ing through the - arne staQe occur on the follO\ving day - -

There i - quick. reco\er) in the average case and complications are \ery ra re: if. ho\\ eyer. tbe pot are cratched ep i may result and permanent car ma) form. The patient i not usually con idered free from infection until the la t cab ha fallen off and the s kin ha completely healed

One attack of Chid,en Po\. u UJllv give life-long protection again cntchinQ the di ease <lQain but there is no loubt that om'e unfortunate individual do indeed have the complaint twice although thi occurrence is e\tremeIy rare.

lIo.ee X IlleSeS. bUI HOSIJital Sho.-tuge COlltiulles

of Health annual report for the year ended t-.farch 1950 ays tha nursing and mid\\ ifer) -taffs impro\ed In strength. and there were more lUden nur es in training than at any previou s time.

Unfortunatel)'- he goe on iln O\erall increa e in the number of nur es only relie\ed the - hortage in uch field - a the sanatoria. the chronic sick and mental hospital and only lightly lessened the number of bed - closed for la ck: of fitaff. mo t of \\ h ich were to be found in the e hospital .nurses repre -enred one in four of all trained nur es in ho pital On 31st March 1950. there were 13-+.019 fulltime and 2-+.593 part-time nurse, and mid\\ive in ho pital - increa -es of appro\imatelv 9.000 full-time and 2.000 part-time stafr In the vear. Domestic staff increased io 10-+.272 i'ull-time :.1nd 2c .530 part-time \\orker - \\hich meant that' the critiei m that nurse were occupied in domestic dutie \\ as no t so genera I.'

F1R;;r I D & VR'i[ 3. J FE B. 1952

5

The Tragedy of Korea

Bed Cross Team Experie"ces

Mr. Peter Driscoll, leader of the British Red Cross team in Korea, recently arrived back in this country, and has given a graphic description of conditions in that tragic country.

'In our preoccupation with the ebb and flow of the warring armies across the 38th parallel,' he said, , we are apt to forget the plight of the civilian population over whose homes and paddy fields the battle has surged back and forth . After 18 months' fighting it is estimated that 470,000 civilians are either dead or mIssmg. At least 6,000,000 Koreans have lost their homes and have had to abandon their small farms which in most cases their families have tilled for many generations. Many fell victims to illnesses springing from undernourishment and exposure, while others were wounded by bombing and shelling . Not even the children were spared the horrors of war, and many were orphaned or became separated from their parents. All these became our care when they were brought down to Taegu.'

Mr. Driscoll explained that the part the British team were called upon to play was that of advisers to the Provincial Government in the establishment and administration of camps, in the distribution of United Nations relief supplies of food and clothing, and in the planning of a medical programme for the treatment of sickness and injuries and the prevention of disease. Typical of all this was the story of the refugees from Chorwon, just north of the 38th parallel. He went on :-

'They arrived in Kwangju after a long and tiring journey in railway box cars. Of the 4,000 who arrived 331 were either sick or wounded 142 of them were not to Tired, ill-clad and under-no'Jrished eyen those who were not all SIgns of the ordeal through which they had passed. Food was prepared 1-

Mr. Peter Driscoll (right) when he left for Korea a year ago and served to them, and during the next few days all were immunized against smallpox, typhus and typhoid and dusted with DDT. The sick and wounded were segregated and treated by a team of Korean doctors and nurses under the direction of the Public Health Officer. Special feeding centres and milk kitchens were set up to provide extra nourishment, and distributions of clothing and blankets were made. The orphans and children who had become separated from their families were placed in either one or other of the two orphanages in K wangju.

'It was not the intention that should remain permanently In camps. Only too often the stultifying effects of long periods of camp life in other countries ' had been seen, and in Korea it was

endeavoured as far as possible to keep the refugees in camp only as long as it was necessary for them to pass a period of quarantine away from the local population. During this time they could be registered immunized, fed and built up ih body and mind to enable them to face life afresh. The time came when they were all fully recovered and ready to pick up the threads of life again in new surroundings. They were all settled in the safety and security of the countryside in the south of the province, where I visited them from time to time. I found them happy in their new homes, and always generous in their expressions of gratitude to the United Nations and to those Red Cross officers who had helped them in their distress.'

T.D.

The Third Commonwealth and Empire Health and Tuberculosis Conference organized by the National Association fo; the Prevention of Tuberculosis, is to be held at the Central Hall, London, from 8th to 13th July 1952.

Similar conferences held in July 1947 and July 1949 each attracted over a thousand delegates from fifty countries.

The occasion offers a fine opportunity for those interested in tuberculosis and other problems of preventive medicine to meet workers in similar fields, and to explore sanatoria, hospitals and clinics in Great Britain.

Details may be obtained from the Secretary-General, N.A.P.T., Tavistock House North, Tavistock Square, London, W.C.I.

Bed C,. o ss NE W S

Stanley Shield Competitions

Forty-three Branches have entered Women's teams. The Eliminating Round will be held on 15th March and will take place simultaneously at the following Centres-County of London, City of London, Gloucester. Sussex, North Lincolnshire, Denbigh and Durham. Thirty-eight Branches have entered Men's teams. The Eliminating Round will be held on 29th March, and will take place simultaneously at the following Centres-City of London, Surrey, Wiltshire, Leicester, East Riding of Yorkshire. Scotland have also entered both Men's and Women's teams for the competition. The winning teams in these Eliminating Rounds will take part in the Finals of the competition in London, on Saturday, 10th May.

A New Cadet Unit

Eight lads, wearing dark forage caps and dark coloured belts marched smartly to a table in Globe Road School Hall, Bethnal Green, on 29th November and received arm bands, certificates and badges. The Mayor who was present at the ceremony congratulated the boys on getting down to what he described 'as a serious job of work in your spare time.' He went on to say, ' We know in this Borough, not only during the war years, but also six years after, what great comfort this Society is to the sick and suffering. Your time will not be wasted , but will be devoted to the cause of humanity- and what better service could people do for their fellow men?, The strength of the unit is now 19.

Blood Transfusion in Isleham

Members of Cambs / 68 have had an uphill struggle to organize the Blood Transfusion service in Isleham, a small village with a popuLation of 1,490. They were told in 1940 that a Mobile Blood Transfusion Unit would visit the village provided 12/1 5 donors were available. In 1942, after unavoidabLe delays, the Unit arrived and 39 donors gave their bLood. Owing to war restrictions, however, the Mobile Unit ceased to function and donors were taken to Newmarket in an A.R.P. ambulance. The journeys were uncomfortable but everyone not only survived but actually enjoyed them. This state of affairs continued until 1945 when sessions started in Isleham again, and ever since some 30 people have each given two donations annually. By April last year seven donors, who had given at least ten donations (some had given 16) received and five others have now qualified for the award. The village has reason to be proud of its fine spirit which has resulted in a contribution of nearly 600 pints of blood and earned for it the honour of being the only village in the Eastern Region with s\lCh an impressive In fact tbe

record of twelve badges in one village has not been challenged by anyone in the country.

North Riding of Yorkshire Branch organized Competition TraInmg Days on two Sundays in Novemat Scarborough and the other at Mlddlesbrough, when neighbouring detachments were invited to send up to six representatives. Eight detachments attended the training at Scarborough and nine at Middlesbrough. The course which consisted of talks on ' Training with the Use of Models' , First Aid Test Exercises on Paper> Casualty Ulllon Demonstrations and a Men's and Women's Team was organized by Mrs. Scott Divisional President. Helpful criticism given by the County Medical Officer the County Nursing Superintendent and and all who attended the training felt it was well worth while and that the hints given would be helpful in coaching teams fot competition work.

Arrangements have been made for four programmes to take place on 17th January and fortnightly thereafter in the programme entitled 'About the Home': 3-4 p.m. These show practical demonstrations of first aid in the home, presided over by a Red Cross County Medical Officer, and have been very success ful.

Examination

Successes

The following candidates passed the Examinations of the Institute of Certified Ambulance Personnel , held in October , 1951.

Final Examination

Barnes, James, Lytham St. Annes, Lancs. Bramley, Horace, Belper, Derbyshire. Dobson, Leonard , Weymouth, Dorset. Gardner, Henry Howard, Weymouth, Dorset.

Meagher, Dennis , St. Annes-on-Sea, Lanes. Robinson, Miss Elsie , Hull.

Thompson, Stanley Unsworth, Potters Bar, Middlesex.

Thomson, Miss Phyllis , Derby.

Mr. S. U. Thompson won first place in the Examination and Miss P. Thomson Second.

Preliminary Examination

Ailmore, William, Ripley, Derbyshire.

Atkinson, Thomas, Nelson, Lancs. Banks, Joseph Edward, Leek, Staffs. Boucher, John Lemuel, Croydon, Surrey .

Mercer, Miss Phoebe Lizzie, Nottingham.

Nash, Robert Edward, Weymouth, Dorset.

Price, Archibald Wilfred, Lydbrook, GJ05.

Pye, Joseph, Stoke-on-Trent, Staffs.

Rogers, Mrs. Gladys Mary, Mansfield, Notts.

Smith, William Henry Askew, Nottingham.

Spanton, Ralph Horace, Dagenham, Essex.

Turnley, William, Nottingham.

Wilson, Raymond, Folkestone, Kent.

Woolhouse, John William, London.

Mr. W. H. A. Smith won first place in the Examination &nd Miss P. L. Mercer second,

PeopleDriyer Edward Pearson and Fireman

Maunce British Railways NorthEastern RegIOn , have received a letter of f:om British Railways for prompt actIOn III stopping a train and first aid when a plane crashed on the hne near Beverley, Yorkshire, recently.

The made by Mr. A. Udell , the Dlstnct Motive Power Superintendent Hull.

Driver Pearson brought his train to a standstill within 30 yards of the crashed plane, and Fireman Baker, who was a passenger on the train, treated the injured men for shock and ensured that limbs which appeared to be broken were not moved.

V(hen Mr. G S'. formerl y ASSistant to the Dlstnct Commercial at Bristol , British Railways Western Reglon, retired from the raiL way service last year the Ambulance Mo vement lost one of its most ardent workers. He was appointed Divisional Ambulance Secretary for the Bristol B ' Division when it was first formed in 1917 and continued in that capacity until division was amalgamated with the Bristol 'A ' Division in 1950-a period of 33 years. Mr. Hodder , therefore, has the distinction of having served throughout thi s long period as the first and last Secretary of an Ambulance I?ivision. No twithstanding this amalga matIOn he contInued ambulance work until his a few months ago, and hi s qualitles were recognized by the InvItatlOn extended to him to continue during the remainder of his active service his membership of the District Secretaries' Conference, on which body he was deservedly popular. He was admitted to the Order of St. John in the Grade of Serving Brother in 1932 and promoted to the Grade of Officer (Brother) in 1939. It was unfortunate that owing to an accident, from which he is now happily recovering, Mr. Hodder was unable to attend a meeting of the District Ambulance Secretaries' Conference on 5th December, when he was to receive expressions of goodwill and a parting gift from his colleagues , but the presentation was made to him privately at a later date.

* * *

At a General Meeting of the Worcester Class, British Railways Western Region, a presentation of a wristlet watch subscribed for by nearly 50 members of the Class, was made to Mr. W. T. Smith, who has relinquished the office of Class Secretary after 31 years' service. The presentation was made by Mr. J. W. Daniel, who has worked with Mr. Smith in the Ambulance Movement for over 40 years, and he spoke of many incidents in their long association which illustrated the zeal that Mr. Smith had always displayed in ambulance work.

FIRST AID & NURSrNG, JAN. / FEB. 1952

The Opinion

THE First Aid Movement has lost a great personality in the death at the age of 74 of Dr. Nigel Corbet Fletcher, and this Journal has lost a valued contributor. For 36 years he had conducted the' Queries and Answers' column, and through it gave instruction and advice to first-aiders all over the world. His work for the St. John Ambulance Brigade, culminating in his appointment as Surgeon-in-Chief, will be long remembered; all his scanty leisure time was devoted to it until the time of his death.

N.C.f. graduated B.A. (Honours Class Tripos) at Queens College, Cambridge, in 1898, and qualified M.R.C.S., L.R.C.P. (London) in ] 904. He was given an appointment to University

British Railways

So uthe rn Region

Mr. and Mrs. H. C. Lang were guests of honour at the Horsham Class party recently, when Mrs. H. C. Lang presented the Class awards, in so doing she gave each a few words of encouragement which made the presentation very personal. Mr. W. E. Jupp, Class Secretary, proposed a vote of thanks to Mr. and Mrs. Lang and visitor for their support, which did much to stimulate the Class members. Mr. Lang in replying paid tribute to the Class generally on their achievements in the Ambulance World.

Other guests included the Chairman of Horsham U.D. Council and wife, Councillor and Mrs. J. Holmes, Police Superintendent Miller and Dr. K. Dawson.

Western Region Oxford

A Tribute to

College, London, where he remained until 1908, qualifying in that period B.Chir. (1905), M.A. (Cantab.), 1906. It was during his University days that he became so widely known in Rugby football, obtaining five caps playing for England, and seven caps playing for his University.

In 1908 he started in general practice, and it was then that he took up his work for the St. John Ambulance Brigade, as Surgeo n Instructor. Later, he became Divisional Surgeon at Hampstead, and in ] 924 he was appointed Assistant Commissioner, No. ] (Prince of Wales's) District. He was Surgeon-in-Chief from 1936 to 1950.

Dr. Corbet Fletcher was admitted to the Order in 1918 and promoted to the grade of Knight in 1937. It was through his writing, however, that he became widely known. He was the author of Aids to First Aid, Why and Wherefore in First Aid, The HiS/DIY of the St. John Ambulance Association, and other textbooks. In 1915 he first began answering queries in our columns, and later performed a

similar service to the Order of Sr. John Review. As the Hon. Medical Adviser to these two journals he made contact in print with thousands of first-aiders, and became the recognized expert on the practice of first aid. His advice and guidance were sought on every kind of problem connected with first aid, and he was never at a loss to supply the right answer. In this his grea t ability as a teacher, as well as his long experience and wisdom, particularly suited him to the work. In time he evolved a style of his and to the point, yet kmdly and sympathetic, even though he never suffered a fool gladly. He liked to leaven his column with a dash of humour, and would pass on to his readers with relish, and the time-honoured formula 'Good!

Next please! ! " every howler and odd remark that came his way. He had a great following, and llis death will be felt as a personal loss.

We on this Journal remember with gratitude N.C. F's fine services over so many years, and will not easily forget the great help he gave to us and our readers.

A first aid demonstration to the Oxford Ambulance Class by members of the Casualty Union, under the guidance of Mr. Skidmore, Reading, was held on a recent Sunday at the Motive Power Depot. The scene represented was an engine running into the side of a coach, and assistance was summoned from the station, who phoned for the local Brigade ambulance which was manned by railwaymen. The demonstration took one hour, after which Dr. Darcus gave his comments on the work performed.

Among the officers and others who witnessed the event were Mr. G. S. Halliday, Road Motor Engineer ; Mr. N. H. Briant, District Operating Superintendent; Mr. E. C. Bourne, District Motive Power Superintendent; Mr. A. E. Flaxman, District Commercial Superintendent; Mr. Miller, Station Master; Mr. Fisher, Goods Agent; Mr. Jones, Locomotive Foreman, Oxford; and J. W. Sutton , Ambulance Inspector , SWlndon.

Cheltenham Spa

The Cheltenham Spa Ambulance Class awards were presented at a Smoking Concert held at the Great Western Hotel, under the chairmanship of Mr W. M. Short, Station Master. Mr. A. W. Sheppey, Assistant District Commercial Superintendent, presenting the awards, spoke of the continued progress of the Cheltenham Clas , its success in obtaining new members , and the number of long-service awards gained by the members. Also presenl were Mr. E. G. Powell, Assistant District Operating Superintendent; Mr. K. H. G. Parkinson District Road Motor Engineer; Major: E. McIver, County Secretary of the Order ofS!. John; Dr. A. Bruce Wallace, Surgeon Instructor; Mr. G. R. Bonavia, Goods Agent; Mr. W. E. J. Perks, District Ambulance Secretary; and Mr. J. L. Jones. A first-class variety entertainment was provided, the event having been arranged by the Class Secretary, Mr. G. Walker.

Reading Mr. A. W Woodbndge, SIgnal and Telegraph Engineer, presided at the annual presentation of awards, and was supported by Mr. Gilbert Matthews, Operating Superintendent; Mr. C. W. Powell, Assistant Operating Superintendent; Mr. N. H. Briant. District Operating Superintendent; Mr. E. C. Bourne, District Motive Power Superintendent; Mr. A. E. Flaxman, District Commercial Superintendent; Mr. J. F. Bickerton, Assistant District Engineer; Mr. P. Anstey, Regional Ambulance Secretary; Mr. J. A. Martin, Assistant Regional Ambulance Secretary; Mr. A. F. Wigram, Assistant Signal and Telegraph Engineer; Mr. W. H. Holmes, Station Master; and Mr. E. J. Hamblin. District Ambulance Secretary. The awards, which included a number of long-service medals and bars, were presented by Mrs. Gilbert Matthews, Mr. Gilbert Matthews and Mr. Briant.

London Transport Ambulance Centre

The fifth presentation of first aid awards was held at the Porchester HaU, Bayswater , W.2, on Wednesday, 19th December, and was accompanied by a dance, social and cabaret.

The presentation was made by Mr. J. B. Burnell, Operating Manager (Central Road Services) and Mrs. Burnell, who were introduced by the Centre Chairman Mr. Alex. J. Webb) C. St. J., General Superintendent (Staff and Training), Railways. Some 300 out of 700 awards gained during the first half of 1951 were presented to members and were followed by special awards and Joogservice medals to the undermentioned :Long Service Medal

Mr. W. Edwards , 30 years.

Team Plaque

Probyn Shield Competition: Lots Road.

CliP Webb Trophy: Miss B. Frampton, Staff Office, Broadway. Meritoriolls A ward Certificates

Miss E. M. Bristor in recognition of her efficient rendering of first aid at a railway accident at Rickmansworth.

Mr. L. Dean in recognition of his efficient rendering of first aid at a railway accident at Golders Green Depot.

In addition, framed DipLomas granted by the Order of St. John on their admission as Serving Brothers of the Order were presented to:-

Mr. J. Warden, Motorman, Neasden.

Mr. S. W. Harden, Ambulance Centre Secretary.

The excellent dance, social and cabaret, under the direction of Mr. E. H. Knee, Depot Inspector, Riverside Garage, assisted by Mr. H. Williams, was thoroughly enjoyed by a gathering of some 700.

Dr. L. G. Norman, Order of St. John, Chief Medical Officer, and a Vice-President of the Centre, thanked Mr. and Mrs. Burnell for their interest in the Centre and for so kindly coming along to make the presentation. He also praised the work done by the Centre Secretary, Mr. S. W. Harden, in expanding the Centre during recent years. Mr. J. B. Burnell, in replying, stated how pleased he was to find a growing interest in first aid amongst the Road Service staff, and stressed the need for a knowledge of first aid in view of the alarming number of accidents that occurred, not only on the road. but in one's own home.

T OP I CAL NOTES FOR FIRST AIDERS & NURSES

P ractical Problems of the Health Services

In March 1951, a conference organized by the Institute of Public Administration took place at Church House, Westminster, at which many of these problems were discussed. The conference papers, revised and amplified in the light of discussions and subsequent developmenls, have now been published in book form for the Institute of Public Administration by George Allen & Unwin Ltd., under the title of The Health Services. Some of their Practical Problems, price 7/ 6. It is a book that should be possessed by all who take part in the work of their health services.

An introduction has been written by Henry Lesser, C.B.E., Chairman of the London Executive Council. The twelve papers that follow are all written by well-informed and experienced experts in the particular fields, and they consider the points of view of patients, doctors, consultants, psychiatrists, medico-social services, administrators and regional hospitals boards. Financial problems, the role of local health authorities and the necessity for improvements in general planning and co-ordination, are also discussed.

A State Medical Service is not a new idea in this country. It has been in operation in a limited manner since 1911. A National Health Service was planned in the years immediately preceding the second world war and it was inevitable that such a service should be established soon after peace was declared. It appears to be a general view, however, that the somewhat ruthless nationalization of all our health services overnight, instead of a more gradual evolution, · multiplied the difficulties and the risks; and that much of the success of the legislation has been due to the quality of the people in the various services who are implementing its provisions. Nevertheless, many anomalies still exist, some of which are due to omissions in the Act or to divisions

of function between the central and local authorities. Material shortages add to the difficulties. Health Centres, which formed an essential part of the whole scheme, cannot yet be started, and housing shortage vitally affects health at every turn. The realization that all of these factors are understood and are being faced by the people who are responsible for the various services augers an eventual re-orientation so that, at all levels, success may be achieved.

The New Charges for Health Services

The proposed charge of 1/ - on each prescription is no surprise, for the necessary legislation for this was passed by the last Parliament. The majority of people are well able to pay such a charge, and it is in line with the basic idea of the Welfare State that the cost of the drugs prescribed should not be taken into account, for this might create hardship , especially when rather expensive substances-such as insulin for diabetes or pethidine for those with inoperable carcinoma or other painful condition-are required over a long period. The Chancellor's assurance that help will be given in meeting both these and other charges in cases of hardship should dispel apprehension; and so also should the statement that no charges are to be made in the case of children and expectant or ·nursing mothers. The charge for dental treatment should relieve congestion in the admittedly understaffed dental service, whereas the exemption of children from these charges . should improve their chances of getting treatment without the delay that has so often occurred. With regard to the proposed levy on surgical appliances, hearing aids and wigs supplied through the hospital services it is well to remember that each in which hardship is claimed will be investigated by the almoner-as has always been doneand that help will be given when necessary. It would appear, therefore, that the new charges may

make for a generally improved service, as well as an annual saving of £40 million in the national budget.

New Filmstrips , Meals for the Million '

The Department of National Health and Welfare of the Film Board of Canada has made four filmstrips exemplifying the presentday campaign for cleaner food.

Part I-called Keep the Germs Out -first shows how food in a restaurant could become contaminated and gives some shots of the bacteriological laboratory at the hospital, and also of germs in culture tubes and under the microscope. Then all the modern methods of keeping germs out of a restaurant or food shop are depicted-windowscreening, self-closing doors, the stopping of plaster cracks in walls or ceilings, the sealing of plumbing inlets, covering of garbage containers, and so on. The choice of food, the detection of contamination, cleanliness in all aspects of food handling and the training of staff are all shown, sometimes in a very amusing manner. Part Two is called Keep the Germs Down. Realizing that with all the care that can be taken to keep germs out, some will succeed in getting in ; the next step is to destroy them or stop their growth. Their rate of multiplication - not only in food and food 'utensils, but on light switches, on the adding machine, on shelves and even door knobs- is demonstrated to be amazingly rapid. Then all the means of keeping them in check are shown on the strip cartoons. Part Three is called Serve Them Right, and especially shows the right ways of handling and serving food and of dealing with used plates and other utensils. An interesting story emerges in the cartoons which includes a birthday party.

Part Four -"Watch Your Health -deals much more with the personal aspect-the manager rejecting an applicant for a waitress'sjob because she does not measure up to the standards of personal cleanliness he requires, and engaging one who does. Then we follow Ethel-the successful applicant-in her work and in her private life, and are shown the care that she takes with her own health and cleanliness so that she forms a very admirable member of the team

that is always fighting possible food infection, and therefore protecting the public from diseases that can be carried by food. "

The scripts supplied with these films are interesting, amusing and excellently compiled, so that the maximum amount of information is given in the fewest possible words. The numbers of the films are CAl to C.44, and they are distributed by the Unicorn Head Visual Aids, Ltd., Broadway Chambers, 40 Broadway, Westminster, S.W.l, price 12/6 each.

'St. John' Course in Food Handling

The st. John Ambulance Association has arranged a course of nine classes in hygienic food handling, followed by an examination and the award of a certificate to those who satisfy the examiners. This is specially intended for shop assistants. The Association has also published a small manual which explains all the possible causes of food con-

tamination and the simple means that can be adopted to avoid or overcome such contamination. The filmstrips mentioned above could be used to demonstrate and amplify the instruction given. It now remains for local interest in this important subject to be aroused, so that classes may soon be organized throughout the country. If a food shop could display certificates showing that all its assistants had taken this course and had passed the examination more customers would be attracted and an incentive would be provided for other food shops in the district to attain the same standard. Legislation and bye-laws concerning the production, preservation and handling of food supplies cannot, of themselves, prevent the outbreaks of food poisoning that occur with disturbing regularity. It is necessary also that the individual citizen should understand the danger and help in the campaign for cleaner food.

Your Opinion

DEAR SIR,

The same day on which I read my copy of your December issue, including the answer to 'R.F.', Twickenham, in Readers' Queries, I had a letter from a Naval Officer on board a ship at sea. He writes to tell me tbat he is now on full duty, although he was presumed dead a year ago; he heard that I had dealt with him only during a subsequent enquiry.

When I arrived at the scene of an accident-a plane which had crashed - I was told that one man was not breathing and appeared dead, but the other was in great agony.

I naturally tackled the 'dead' man first, and a few whiffs of concentrated carbon-dioxide induced into the lungs by artificial respiration made him gasp for breath, and he was safely removed to hospital, with an occasional dose given whenever the breathing got shallow.

I feel that the real value of CO2 as an urgent first aid measure is not yet fully appreciated. I have never

seen or heard of any case of its bad effect on the heart-unlike oxygen which in many of the experimental cases in an R.A.F. hospital last year was seen to cause collapse.

I realize that there are two schools amongst doctors on this subjectone mad on oxygen and the other CO 2-but from my large experience of CO 2 as an urgent first-aid help, I consider that its immediate use should be advocated, rather than wait the arrival of any sort of apparatus.

Artificial respiration must, of course, be carried out continuously, and every effort made to stimulate normal respiration; oxygen will not do this, but carbon-dioxide will.

I enclose my card.

Yours, etc., URGENT FJRST·AIDER.' (T n view of the controversy aroused by this subject, readers will find the article by Dr. Gilbert Burnet, on the opposite page of special interest.)

Carbon Dioxide and Asphyxia

DURING normal quiet breathiIlg, air containing roughly 80 p.c. nitrogen and 20 p.c. oxygen is inspired by each breath into the lungs. Here the red blood corpuscles of the circulating blood stream absorb oxygen, and carry it to the cells of the body for their life and activity. The living cells take up the oxygen, and as a by-product of consumption, return carbon-dioxide into the blood stream, which returns to the lungs through the veins. Into the air-spaces of the lungs the carbon-dioxide escapes, and the corpuscles take up another load of oxygen.

The result of this circuit of blood is shown by the difference between the inspired air and the expired air, which now contains only 16 p.c. of oxygen, but has 4 p.c. carbondioxide (the 80 p.c. nitrogen remains constant-an inert carrier).

Naturally, if the tissues have to do more work, more oxygen is used and more carbon-dioxide developed. This relatively increased percentage of carbon-dioxide to oxygen in the blood presented to the cells, automatically controls the supply of further oxygen in as much as it stimulates the cells of the special respiratory centre in the brain, and causes an immediate increased action of tbe respiratory muscles, with a consequent increase in the supply of oxygen. The first sign of the increased ratio of carbon-dioxide to oxygep in the blood is increased rate and depth of breathing. This is easily demonstrated by breathing into and out of a closed bag; the first inspiration will get 20 p.c. oxygen but subsequent breaths will get a gradually increasing dose of carbon·dioxide which will make YOLl gasp for breath and remove the bag.

Suppose the bag is not removed, in other words, suppose there is no more oxygen admitted to the lungs, either through lack of oxygen or cessation of breathing, the heart would be pumping blood which is short of oxygen (almost venous blood) to the cells and tissues; the lips and ears would become cyanosed; but worse still, the brain cells would be devitalized and

By Dr. Gilbert Burnet, M.e.

insensitive even to the large increased ratio of carbon-dioxide in the blood presented to them; respirations would cease- suffocation. Even after breathing has ceased, tbe heart may go on beating and circulating the blood until death occurs, when the blood will be almost devoid of oxygen and full of carbon-dioxide. The heart may continue to beat for 20 minutes or more after all breathing has ceased ; in such a case the postmortem examination would show almost complete absence of oxygen in the blood, and of course much carbondioxide.

Such a condition of extreme asphyxia must be anticipated by the first-aider in all cases of suspended or deficient breathing. His prime duty is artificial respiration , at once and continuously, in an atmosphere containing at least 20 p.c. of oxygen. The essential of greatest urgency is to restore oxygen to the brain cells before they become too insensitive to their normal stimulant-C02

Now, if the heart is still going, there will be red blood corpuscles in the blood around the empty air spaces of the lungs; and if these can be filled with air, there would be enough oxygen to load them to full capacity (for the air contains 20 p.c. of oxygen, and only 4 p.c. of this is used in normal breathing). It was found during the first world war that oxygen under pressure did not succeed in restoring the breathing, as it does not stimulate respiration.

A few years ago , Professor Yandell Henderson, studying methods of resuscitation in America, suggested

that we could not estimate the amount of desensitization of the respiratory centre, and with astonishing success used a concentration of 30 p.c. carbon-dioxide. To-day many lives are saved by an occasional whiff or even one dose of the almost pure gas. The first symptom of carbon-dioxide poisoning is a gasp for breath, and provided that the atmosphere contains as much oxygen as ordinary fresh air, there will soon be relief a nd no necessity for further artificial respiration . One word of warning must be given: after all asphyxias there is a tendency to relapse; artificial respiration may not be necessary if an occasional dose of carbon-dioxide is added to the inspired air .

Suffocation of the slow type is not the only asphyxia likely to be met by the first-aider; the commonest causes of the cessation of breathing are accidents. In fact , anything tha t will interfere with the automatic working of the respiratory centre may lead to it. In other words , all cases of shock must be watched ; a condition of extreme asphyxia must be anticipated in all cases which show deficient breathing. Sometimes a smack on the face, a shouted command may cause the patient to ga sp into his lungs enough oxygen to save the serious desensitization of the respiratory centre, and s ubsequent necessity for ar ti fici a l respiration . In all cases of doubt , artificial respiration must be done at onceSchafer's method- but in all cases it must be continuous, and not i nterrupted by even questions by doctor or police, until an automatic breathing returns. It may be required for a long period a n d rocking stretcher or iron lung called in; but in all case s an occasional dose of CO2 wjU help recovery of automatic breathing.

FIRST AID HANDBOOKS

H. K. LEWIS & Co. Ltd., 136 Gower Street, London, W.C./ £USton 4282 (7 lines)

Development of Child in Britain

By Agnes E. Pa\ 'ey, S.R.N., Diploma in Nursing (Uni versity of London)

IN these days of humane social services it is somewhat difficult to gain a true perspective upon the whole subject of child care unless one reviews, hriefly, the changes and developments that have occurred during the past two centuries.

During the eighteenth and first part of the nineteenth century there was an appalling degree of poverty and destitution among manual workers, and the plight of children who came under the of the Poor Law was pitiable beyond all conception. They were freq uently apprenticed to cotton mills at a very early age, where they worked for twelve to sixteen hours a day and even during the night. Or they were employed by chimney sweeps and were made to climb long, narrow chimneys. 'Parish children' of five and six years of age worked underground in coal mines for twelve to sixteen hours a day where, naked and crawling, they dragged buckets through narrow tunnels or lay on their backs wielding picks in seams that were too small for a grown man to enter. None of these children ever saw daylight except on Sundays, and the only education they received was from Sunday schools that were first established in the latter part of the eighteenth century.

Most respectable citizens appeared to be quite unaware of the hardships and cruelties that were the lot of the unwanted or orphaned child of parents wi thout means, nor of the brutality towards them of adults with whom they were boardedout or under whom they worked.

Nineteenth Century Legislation

Concerning Child Workers

A review of the legislation that attempted to better the conditions for child workers reveals how terrible those conditions were. In 1767, an Act introduced by Jonas

Hanway, and subsequently known as 'Hamvay's Act,' stated that all Parish children were to be boarded; out in the country, at least three miles from a city. Hitherto, many such children had been herded wi th demoralized and even insane persons in workhouses, and had been made to work for very long hours. The provisions of this Act were, however, not widely enforced, in fact, they are not completely implemented even at the present time, mainly due to a lack of suitable foster parents, although aU children in public institutions are now treated with an understanding kindness. Hanway's Act also provided that Parish children should not be bound as apprentices for more than seven years, or after reaching the age of twenty-one. Hitherto, children could be made the virtual slaves of their employers for as long as seventeen years.

In 1819, an Act was passed that reduced the hours of work for children in cotton factories to twelve a day and prohibited night work and the employment of children under nine years of age; but it was not until the passing of the Factory Art of 1834 that any inspectors were appointed to ensure thaL its provisions were carried out, and, in any case, there were many loopholes and a very inadequate number of inspectors. This Act limited the wprking hours of children in factories to nine hours a day, and insisted upon two hours' schooling, in addition to the nine hours of work. It forbade the employment of , Parish' apprentices under ten as chimney sweeps, but the prohibition applied only to children under the Poor Law.

Another of its provisions was the segregation of children in workhouses from adults and from the sick and insane. In 1838, a survey showed that there were 42,767 children in the workhouses of England; and until 1865 there were

no paid llurses ill \\ orkhousc infirmaries, the sick being tended L:ntirely hy otller inmate, including children from seven years of age. However, orders had been issued as early as 1847 forbidding the employment of little !!irls in men's wards.

Lord Ashley's Mines and Collieries Re!!ulations Act of 1840 allowed only men and boys over ten years of age to be employed underground; but many of the mines were in isolated districts and although inspectors, with limited powers, were employed the Act was often ignored. In the same year Lord Ashley secured a Royal Commission to investigate conditions in industries that were not covered by the Factories Act. Its Report was published in 1843 and it showed that children as young as four years of age were working for sixteen hours a day in potteries, calico-printing, nail and needle factories and in the hosiery and tobacco trades. In 1844, a Bill was passed limiting the working day to twelve hours for adults and six and a half hours for children. In 1887, the minimum age for boys working underground was raised to twelve years.

Lord Ashley, who was afterwards the seventh Earl of Shaftesbury, worked incessantly to arouse the public conscience and to bring about some improvements in the terrible conditions among the very poor.

The Influence of Victorian Novels

Charles Dickens' 'Oliver Twist,' published in 1838, drew attention to the ill-treatment and general demoralization of children in workhouses, where no love or kindness was ever shown them. The book proved to be much more effective as propaganda than the Reports of Commissions. In 1850 it was estimated that, in London alone, there were 30,000 filthy, destitute and lawless children. Many of them died of starvation, exposure or tuberculosis, whilst tl-:iose who survived became criminals or prostitutes. Following the closing of mines and certain factories Lo child employees many more small children were apprenticed to chimney sweeps. The climbing of chimneysoften hot and containing pockets of smouldering soot-involved terrible burns and other injuries. Charles Kingsley's Water Bahies , which

Tw-e1fth Edition, revised by Margaret E. Hitch, S .R.N., late Sister Tutor, Saint Bartholomew's Hospital, with a Foreword by Sir Cecil Wakeley. P.R.C.S. A complete encycl0PlEdic and pronouncing dictionary of the medical terms in common use-in a pocket-sized volume. T\renty-one appendixes cover a variety of important subjects, including Poisons, Splint and Bandages, Abbreviations, Diets, Blood Transfusion, Anti-biotic , etc There are 496 pages and over 200 illustrations. ,

was published in 1863, produced a furore of indignation amongst the good Victorians who, hit.herto, had had no idea of tbe suffenngs of the child slaves in chimney sweeping and various other industries. In the following year an Act was passed for the protection of these children ; but it proved to be almost a dead letter and it was not until Lord Shaftesbury succeeded, in 1875, in getting his Chimney Sweepers Bill passed that effective legislation compelled all master sweeps to. be licensed, the licence to be wIthdrawn if climbing boys were employed.

In ] 881, the Society for the Prevention of Cruelty to Children was founded in Liverpool by Thomas Agnew , and three years later its London branch was established by Baroness Burdett-Coutts and Miss Hesba Stretton. The investigations and reports of this Society were instrumental in ensuring the passing of the Prevention of Cruel ty to Children Act in 1889. Meanwhile, many individuals had inaugurated schemes for the protection of infant and child life, one of the earliest being the Foundling Hospital, which was established by Captain Thomas Coram in 1741. Later in the eighteenth century Sunday Schools were started in order to teach reading, writing, simple arithmetic and the Christian way of life to children from slum areas who were working all the week. The development of Ragged Schools was a movement that extended from about 1839 until 1870, when the passing of the Education Act and the establishment of Board Schools rendered them no longer necessary.

During the nineteenth century countless Refuges , Asylums, Societies and Missions were established to deal with destitute children and young people and to help them to live honest and useful lives. Many of these ceased to exist when the evils they were designed to remedy had - been overcome. Others developed with the times, changing their outlook and often their nameg, and they constitute very powerful factors in present-day social services, although still under voluntary control and receiving no financial support from the State. It is hoped to give some account of the most important of these in subsequent articles.

News from St. John

Guildford

'

On behalf of the Guildford Borough Corps , I accept this ambulance into our keeping for the aid of the disabled and the sick.'

With these words, spoken by CorpsSupt. A. J. Stockwell at the Guildford Sports Ground, a new Bedford ambulance passed into the service of the Guildford Corps of the St. John Ambulance Brigade Occasion was a service of dedication for the new ambulance recently conducted by the Corps Chaplain, the Rev. R. B. S. Gillman.

The new ambulance, which joins two others of the same type delivered last year, has a special adaptment fitting for four stretchers for use in civil defence or other emergency work. Another will be added early in the new year. The local corps hope to build up a fleet of them, replacing the old ones, some of which are 20 years old.

The Rev R. B. S. Gillman dedicated the ambulance in the service of God and for the relief of human suffering.' Then he passed it to Major-Gen. C. W. Toovey, County Commissioner, from whom it was accepted by Supt. Stockwell. Drawn up on three sides of the ambulance were ambulance men, representatives of nursing Divisions , ambulance and nursing Cadets from Guildford, Haslemere, Farnham, CranIeigh, Horsley and Cobham. The Dorking Cadet band was also present.

Salute at the march-past after the ceremony was taken by Major-Gen. Toovey. With him on the raised dais in Woodbridge Road were the Mayor and Mayoress of Guildford (Ald. and Mrs. A. J. Puttock ). Units marched back to the Leas Road Ambulance Station , which was open to the public for inspection .

East London

The annual dinner of the No 30 (East London) Ambulance and No. 76 (East London) Nursing Di visions was held at the Savoy Hotel, London , on Saturday, 12th January. Mr. Leo de Rothschild , VicePresident of o. 30 Division , was in the chair and, assisted by his mother, Mrs. Lionel de Rothschild , President of o. 76 Division and Superintendent of No. 146 (Bethnal Green) Division, welcomed members and their guests on arrival.

Divisional Superintendent Alfred Goldstein, in proposing the toast of the Guests, welcomed, amongst others, Lieut.-Gen. Sir Otto Lund, K.e.B., D.S.O., Chief Commissioner of the St. John Ambulance Brigade, and the Mayor and Mayoress of Stepney (Councillor W. G. Humphries, J.P. , and Mrs. Humphries) Dr. F. R. O 'Shiel, M.O.H. Stepney, and Divisional Surgeon J. M. Raphael's daughter, Olga , who had qualified as a doctor a week previous.

Sir OttQ said that he was glad to learn that there was such a close liaison between the two Divisions and the municipal authorities in the Borough of Stepney; s uggestions from councils and organizations were always welcome and the Brigade must

FIRST AID & NURSING, JAN. / FEB. 1952

pres on with its work, even if, as he hinted, Civil Defence would not be so necessary half-way through this year. He read a message from Lady Mountbatten, the Brigade's Superintendent-in-Chief, and City of London Supervisor, who had been summoned to Sandringham. Her message read: 'The efforts of the St. John Ambulance Brigade are ever growing. The increase in the demand for our services are more and more pronounced.'

A special cheer was raised when Supt. Goldstein congratulated District Officer T McBride on celebrating his 72nd birthday on the day of the dinner.

The Mayor complimented the two D ivisions on their work for his Borough.

Other speakers included Mrs. Lionel de Rothschild , Mr. Leo de Rothschild, Div. Off. E. M. Stitcher, M.B.E. (Treasurer o. 30), Col. G. F. Page, D.S .O. (Commissioner o. 1 District), Major A. e. WhiteKnox, O.B.E. M.C. (Surgeon -in-Chief), Di v. Supt. Mrs. F. A. Robinson and Di v. Off. Capt. R. Parks.

The dinner was followed by a dance and cabaret.

Charlton

The annual report for 1951 of C.112 (Chariton) Cadet Ambulance Division states that dUJ:ies have once again played a very big part in the lives of the Cadets. During 1951, the total number of duty hours put in by boys of the Di vision was ] ,936 a very notable achievement.

The Division also hold the record for the most hours put in by one boy in one year.

In June, the Area Commissioner, Dr. W W. King-Brown, presented Cadet David Waller with a Special Service Shield for performing no less than 534 t hours in hospital and public duty. On the same occasIon, Special Service Shields were presented to Cpl. D. Stevens and Cadet E. Craig, whose combined total was almost 700 hours At the close of the year, duties were being performed at St. Nicholas Hospital, Plumstead, St. Alfege and the Miller Hospi tals, Greenwich, and Cadets were acting as messengers with most of the Adult Division s in the Borough of Greenwich.

The numerical strength of the Di vision rose very sharply during the latter part of 1951. Although only five new Cadets were enrolled into the Di vision during the year, there are at present 36 boys under training, and who will take their examinations early in 1952. There are also eleven St. John Juniors, bringing actual strength up to 79 officers, student members and Cadets, student members being senior Cadets (over 16 years) who are in posse sion of an Adult First Aid Certificate.

Watford

The Watford Ambulance and Nursing Di visions concluded their Jubilee celebrations by a dinner held at Cawdells Restaurant , Watford. More than 150 members, their families, friends and guests attended under the chairmanship of Mr. A. Staveley Gough (Se nior Divisional Surgeon).

Col. Page (Commissioner London District) proposed the toast of 'The Watford Divisions,' and presented the Jubilee Certificate. Mr. A. Staveley Gough responded.

Councillor L. D. White (Divisional Superintendent) gave the toast of 'Our Guests.' The Mayor of Watford (Councillor L. E. Haines, J.P.), in responding, expressed

FIRST AID & NURSING, JAN. /FEB. 1952

the gratitude of the Borough of Watford for the immense amount of voluntary work performed during the years. Mr. G. A. Forbes (Divisional Officer) proposed the toast of the Chairman , and Mr. A. Staveley

Gough re ponded in a \ ery happy speech. Excellent entertainment was provided throughout the evening by local artistes and all present agreed that it had been a memorable and enjoyable event.

Competition News

Correction

We regret that in our report of the General Post Office National First Aid Competition (page 5, last is ue) we did not correctly name the members of the winning team (Barrow-in-Furness H.P.O.). The name should be: L. Tonkiss (Capt.), S. G. Cooper, J. L. Rowland son, D. Price; E. McSweeney, Reser ve. Webb Trophy First Aid Compeition

The Annual First Aid Competition for the Webb Trophy (London Transport Ambulance Centre) took place at the Ambulance Hall. Baker Street Station, on Monday , 10th December, 1951. This is an individual competition for women members of the Centre and consists of a practical and oral test The practical test was that of a man who on coming out of a shop slips on some orange peel and in falling to the ground suffers a Colles fracture of the right arm, concussion and a slight wound on the bead. Competitor were required to render efficient first aid within the 10 minutes allowed for the te t.

An inovation wa made thi year in that 1st year (Certificate) and 2nd year (Voucher) members were granted 8 p.C. and 5 p.c. additional marks respectively. The winner was a 1st year member, Miss B. Frampton. of the Staff Office , Broadway, who obtained marks out of a possible 150, being closely followed by Miss A. Middleton of the Drawing Office , Chis\\'ick Works , with 90 marks. Miss M. Thurlow of the Publicity Office, Pett y France, was third with 85 marks, and Mi s V. Davies of the Ticket Office, Clli wick Work. fourth with 83J mark.

The Team Test wa judged by Miss E. M Bristor. Divi ional Superintendent, 125 2 ( ) Division, London Transport Corp S.J.A.B., whilst Mis M. Curd, Divisional Superintendent, 125 1 ( nDivision , London Transport Corps, S.J.A.B., officiated at the Oral Test.

Mr. S. W. Harden , Centre Secretary, congratulated the winner and passed a vote of thanks to the judges and stewards for the kind help and a istance in making this yel another successful competition. He al 0 thanked the competitors, for their keen interest in taking part in this event. Miss Bristol' and Miss Curd replied and gave some useful remarks to the competitors.

Welwyn Garden City and Hatfield Inter-factory Competition

The first Welwyn City. Hatfield inter-factory first aId competltJon, organized by the St. John Ambulance Brigade under Div. Supt. E. A. Ru ch, Welwyn Garden City D ivision, was held on 24th ovember 1951. The result was :-

1. Roche Product; 00' 00. 27

2. I.e.I. Ltd. 252

3. Murphy Radio " B .,

4. Murphy Radio' A' 00' 224

5. orton Grinding Wheel 207

Mr. K. H. Holley , Per onnel Manager, LeT. Plastics Divi ion, pre ented the LC.I. cup to the winning team, and Mr. W L. Greenwood, Murphy Radio , presented the Murphy cup for the individual competition. and congratulated the winner. Mr. John Bell of the I.c.I. , on a very creditable effort.

In hi umming-up of the afternoon's work, Dr. Hardy Kinmont. Deputy County Commissioner, said that, on the whole it was very good indeed. He \\ a very plea ed with the quality of the actual work and he hoped that interest would be timulated for future competitions

• De "ere Shortt' Cup

Six railway team. London Midland Region, competed for the De Vere Shol1t Ambulance Cup on 7th January.

Edge Hill Pas enger Station team were the winners with marks out of a possible 220. Huskisson (e.LC.) being econd with 139,1. Edge Hill Goods, Bank Hall M.P., Edge Hill Loco and Park Lane followed in that order.

Dr. William Kulke and Dr. D. O. Hughes were the judges, and prizes were provided from local funds of all the Ambulance Centres in Li\'erpool.

Morecambe District Cup

Seven teams from British Railway, London Midland Reg ion. competed in the Morecambe and District' Re sidential Cup' Competition on January 12th. Re ults

were :-

'vfax. 210

I. Hey ham Harbour ].+3

2. Clapham' B 142

3. Lancaster G.A.. . 141

4. Lancaster G. ..' B 12

S. Clapham' A . 125

6. Morecambe Prom. 105

7 Morecambe Police 101 Reserl'es \fa x. ,\Jarks 50

I. E. Bennett, Clapham' B . 46

2. H. Law, Heysham Harbour 42

3. J. Lennon, Lancaster G.A. 38

4. F. Price. Clapham' A .00 34

5. Brook. Morecambe Police

1st Year Competirion Afax •"fark 50

I. S. Price, Clapham 4

2. G. Craig, Lancaster G.A. .+7

3. H. Seacy Lanca tel' G.A. 40

4. e. Stokes Lancaster G.A. 38

5. J. Robin on, Lancaster G.A. 36

6. S. Shepherd, Lancaster G.A. 00' 33

W. H. Best District Engineer, Lancaster. presided at the. pre entations. Mr. Be t presented the pnzes.

The arrangements \\ ere III the hands of a committee of representati\'es from Classes in the o. 1 Area, No. 22 DI tnct of the London, Midland Railway Ambulance Centre, \\'ith J. B. Winder. Morecambe, as Secretary.

'Aids to Medical Nursing.' 4th Edition, by Margaret Hitch, S.R.N. Bailliere, Tindall & Cox, 6 -.

A new edition of this useful book will be welcomed. The student nurse will profit much by it, and it provides a handy reference book for the qualified nur e.

The wide field of medical nursing is covered comprehen ively yet conci ely in twelve chapter, and the text is illustrated with a number of excellent diagram and photographs. This new edi tion has been revised with care, and brought up to date. Although pocket size, it i a complete textbook, and very good value for the low price of 6s. 'Warwick and Tunstall's First Aid to the Injured and Sick,' 19th Edition. Edited by A. P. Gorham, M.B.. Ch.B. M.R.e.S., L.R.C.P., D.A. John Wright & Sons Ltd. (Bristol), 6 6.

Thi is a well-knO\\ n first-aid manual edited by a prominent officer of St. John in Bristol who, a a former Corps Surgeon S.J.A.B. and Police Surgeon, City and County of Bristol, Medical Officer to the Bri tol Fire Brigade, a well a a teacher in fir t aid at Bristol University, i well qualified to prepare such a work.

The manual will be useful for industrial u e, and for in tructors in fir t aid. It follows tandard firstaid practice, and avoids dogmatic and contro\'ersial methods. A reliable guide which we can recommend.

, Civil Defence and You' by J. O. Baker. Jordon & Sons, Ltd., 6.

This handbook surveys the field of civil defence. and give a clear, picture of the hazards <?f war to the population, and the way lD which protectlOn can best be organized.

The author who is Civil Defence Officer. South-East Sub-division, County of Kent deals with modern weapons un.der four 'heads: Incendiary, High Exploslve, Chemical, and Atomic. He goes to give, under the heading Agamst the Hazards of War, a rehab.le assessment of the factors whlch can be rntroduced to minimize and neutralize these dangers. Concisely written, and haying drawing and diagram, this WIU be very useful in training CJ\ II defence personnel.

Beaders!J Queries

Answered by Dr. A. D. Belilios, M.B., B.S. (Lond.), D.P.H. (Eng.)

A NEW EDITION THE 1NSTITUTE OF CERTIFIED AMBULANCE PERSONNEL

WARWICK & TUNSTALL'S PROFESSIONAL EXAMINATION

FIRST AID

TOT H E I NJ U RED AND SIC K

*D. L. G. (MiddJesbrougb) writes :-

I 11'ould like to get your ruling 011 the following point:

Presuming that all appliances are available. A patient has a fracture 0/ one thigh and has to be carried a long distance over uneven ground. On page 145 of the Handbook it states , immobilization may be necessary.'

One of our class strongly maintains that a splint on the fractured thigh, reaching from the waist to just below the knee, with a broad bandage over 'he hips and the other four as in illustration No. 100, and using the knee bandage to hold the lOlVer end 0/ the sp lint, would be sufficient.

I contend that the spUnt should extend from the armpit to just beloll' the/oot with the use of eight bandages, as in the 39th Edition of the Handbook.

Would yo u please be so kind as to say which of the methods is right or most suitable.

The answer is governed by the last paragraph on page 17 of the 40th edition of First Aid to the Injured (S.J.A.A.), if the students are working to this course. This means in fact that we no longer work according to the' word of the book' and that an examiner should accept any reasonable method .

Under these circumstances both opinions could be considered correct, although the standard method is in accordance with the student's view, and is summarized on page ] 45 of the Textbook, Rules 1, 2 and 3 which relate to the first paragraph on this page.

I must confess that 1 personally would prefer the old method from the 39th edition of the Manual but it is no longer a s tandard method or the S.J.A.A.

As many of our readers will know, Dr. N. Corbet Fletcher, who for 36 years has been conducting our' Queries and Answers' column, died in Hampstead General Hospital on 21st December last, after eight days' illness. He had suffered from chest trouble for some months but had continued with his general practice and his questions and answers until the date of his admission into hospital. Even then he took pains to see that the few remaining questions were put in order for the press.

Because of this, some readers who have sent queries lately may not have received replies as speedily as is usually the case. However, we are glad to announce that Dr. A. D. Belilios, M.B., B.S.(Lond.), D.P.H.(Eng.), whose regular articles in this journal have been so much appreciated by readers, is taking over the' Queries and Answers' feature. To our readers he writes ;-

, It is with mixed feelings that I introduce myself to you on taking over" Questions and Answers." The occasion, of course, is one of sorrow since we have lost that great teacher of First Aid- Dr. Corbet Fletcher-whose tireless efforts and keen enthusiasm shown in these columns will live in the memories of first-aiders the world over for many years to come. Moreover, the careful, studied and tactful answers which he supplied to many astute questions make it exceedingly difficult for anyone to follow in his footsteps. Since I cannot hope to run these columns in quite the same manner as formerly, they will not be confined solely to first aid but questions on Elementary Nursing, Medicine and similar subjects will be welcomed.'

Readers are reminded that queries should be addressed to the Editor, and that a stamped addressed envelope should be enclosed if a reply by post is required.

AN ADVANCED AMBULANCE HANDBOOK

Edited by

A. p, GORHAM, M.B., (H.B., M.R.C.S., L.R.C.P., D.A.

Corps Surgeon, St. John Ambulance Brigade Police Surgeon, City and County of Bristol

At last this well-known First Aid manual is again available-in a completely revised edition with over 280 illustrations, a large number of them in colours.

An indispensable handbook for all engaged in nursing and fi rst aid, Ove r 250,000 cop ies have al ready bee n sold in previous editions Order your copy to-day through your bookseller or direct from the publishers

Nineteenth Edition 286 pages 6s. 6d ., postage 4d

The, next examinations of the Institute will be held in

April 1952

PRELIMINARY-Saturday , 5th April, London. The examinations will also be held in one or more otller centres according to applications received. Written paper on Anatomy, Physiology and Hygiene. Or al.

FINAL-Saturday, J9th April, London. Written paper on Principles of First Aid, Transport of the Injured; and chojce of Emergency Obstetrics, or First Aid in Coal Mines, or First Aid in Industry. Oral and Practical.

CLOSING DATE for entry, on form provided, I st March.

For particulars, Syllabus (.:' 6), Previous Test Papers (1 6/or 3) appZl' to JOHN WRIGHT & SONS

THE SECRETARY, I.C.A.P., BRISTOL 61, Cheapside

PATENT "PORTLAND"

AMBULANCE GEAR

The Gear Illustrated(A.B.C.D.) carries two stretchers on one side of Ambulance, leaving other side clear for sitting patients.

C. D. (Guildford) writes :-

1 would be much obliged J 'ou are able to give me information regarding disinfection of ambulances after transporting the following cases: lvhooping cough, diphtheria, measles, dysentery, typhoid fevers, acute poliomyelitis, puerperal pyrexia and smallpox.

So far as the ambulance itself is concerned the usual method is to spray the interjor thoroughly and systematically with a formalin solution. The spray used must be capable of delivering the antiseptic in a finely divided state. After it has been sprayed, the ambulance hould be kept closed for at least six hours

and then thoroughly flushed ouL with air before being used again.

Articles within the ambulance such as sheets, etc., should be removed prior to the spraying process and treated in a steam disinfector or by other methods jf they are harmed by steam.

H. H. J. (Chesterfield) writes :-

In the 40th edition of the S.J.A. II. Manual of First Aid to the Injured, and with reference to compound fractures of the leg and thigh, these lvould appear to be treated exactly the same as a simple fracture. 11/ other lI 'o rds, The book does 1101 sa)' that (l the broken bone protrudes,

The UP AND DOWN action is quick and easy for loading or unloading

A. Shows the two stretchers in position.

B. Shows the top stretcher lowered ready for loading.

C. Illustratf"s the same Gear With the top stretcher frame hinged down use when only one stretcher case IS carried.

O. Shows the same position as in "c' only with cushions and back rest fitted for convalescent cases.

Where Ambulances are required to carry four beds two Gears are fitted, one on EITHER SIDE. and the same advantages apply as described above.

Fun cotaloeue af Ambulance Equipment No. 7A will be sent on request.

Queries (continued/rom page 4)

extension must not be applied. Is this a mistake or a deliberate omission?

Since the advent of Penicillin and similar drugs, some authorities no longer attach the arne importance as formerly to the difference in treatment of simple and compound fractures. In any case, nowadays, the type of fracture to which you refer will soon be under the care of a Surgeon who possesses his own methods of preventing sepsis. Other authorities, however, prefer to adhere to the rule that extension should not be applied if the broken bone protrudes.

H. C. (London) writes ;-

I fook after the First Aid Room of a small factory. Recently one of my mates asked me to recommend him something to get rid of a wart on his finger. I told him to go to his doctor

but was surprised to hear later that all the doctor had done was to buy his wart off Mm for a penny and had given no treatment. I have now told my friend to go to the skin hospital. Have I done right?

No. I am afraid you have been very naughty. You were quite right in referring the patient to the doctor in the first place but quite wrong in questioning by word or deed the advice the patient received. There are more things in Heaven and Earth than are dreamt of in your philosopby and warts do in fact sometimes disappear by the method wbich the doctor adopted and also incidently by other methods of wart-charming.

J B. (Hendon) writes ;-

The doctor, lecturing to our class has questioned the S.J.A.A treatment

of haemorrhage from an internal organ and advises that patients suffering from haemorrhage from the lungs, stomach and other regions should not be removed to hospital at the earliest possible moment as stated except in cases when a doctor cannot readi(v be obtained. Whose opinion are we to believe?

Both opinions are covered in the 40th edition by the last paragraph on page 17, and the doubt would not have arisen if this important teaching had been appreciated. In the instances which your lecturer mentions, it is often wiser not to remove the patient to hospital until he has received preliminary treatment given by a doctor but naturally the decision must depend on circumstances (environment). If the illness occurs in the streets, or similar place where there are no facilities for temporary nursing, the Textbook advice must be followed.

HOUSEHOLD PHYSICIAN

Describes in simple language, with helpful coloured plates and diagrams

The COMPLAINTS OF MEN, WOMEN AND CHILDREN

Their Cause, Treatment and Cure

A few of the Subjects treated:

First Aid Principles of NurSing PRESCRIPTIONS

What to Do in Emergencies Eye, Ear, Nose 375 proved remedies

Influenza, Colds, etc. Throat, Liver · MOTHER AND CHILD

Measles, Mumps, Catarrh Chest th H , e ear teaching pictures

Corns and Warts Stomach, Duodenum

Physical Culture, Self Defence Teeth, the Muscles BEAUTY TREATMENT

Treatment for all Skin Diseases Child Welfare how to bring out your best pojnts

FIRST AID:-

General Rules

Examination

Fractures

Dislocations

Sprains

Wounds

Ha:morrhage

Types of Bandages

Splints

Shock

Artificial Respiration

lifting

Transporting, etc., etc.

The Lungs, Pleurjsy Homceopathy, Arthritis SELF DEFENCE

Hygiene, Anatomy, Pharmacy Neurasthenia what to do if attacked

Fevers, Bladder, Kidneys Rheumatism, Poisoning COMPLETE INDEX

Pregnancy, Childbirth Patent Medicines enables you to find Home Remedies, Diet GI I h ossary, etc., etc. instant y w at you require MOVABLE MODELS OF THE HUMAN BODY-hundreds of illustrations

HUNDREDS OF TESTIMONiA"LS ··

" I am delighted

Male and Female

COUPON FOR FREE BOOKLET or write

To VIRTUE & Co., Ltd., (F.A. Dept.) 9/ 11 Gray's Inn Road, London, W.C.I

Ple ase send me Prospectus on THE HOUSEHOLD PHYSICIAN without any obligation to purchase

NAME

AD DRESS

Send this form in unsealed envelope, stamped

with' The Household PhYSician,' and as I am an Ambulance man, I can appreciate them to their fullest extent_"

"Being a Nurse it is of great help to me."

Q4 A 'ta\ f i nter-hoSP' ted or 4 t\y construe dation for Recen ommo rt haying aCC 'with at tentranspo, 8 ittiflg cases \ d t) stretcher afld . S es (With at ten an. . ) r sittIng cas Fitted wIth dant , 0 mnartrnent.

\ aaae co r Separate Ugb bwire\es s d mbu\anc.es eda\\Se a of many sp .' and conThis IS one \\y desIgnIng ",Ie are contInUa and yoU are that Y' u rposes, f variouS P equirestructing Of d details ot your r d d sen h e abroa . invite to y or anyW er • n this co untr rnen ts \\.

ST AID Be ' NURSING

Headaclle

No matter how obscure the cause of a headache, palliative relief IS an e.ssential of treatment. When the pain is removed, undivided attention can be gIVen to causative factors.

In all types of headache, 'ANADIN' Tablets provide a safe analgesic. Rapid zn action and particularly well-tolerated, their anodyne action lS unattended by depression or nau sea.

First Aid & Nursing

If you are logical person .•.

Then you will follow this point-by-point argument and reach the same conclusions as so many doctors, nurses, hospitals and clinics have done.

DO YOU AGREE .. . that the causes of most skin infections are the common strains of STAPHYLOCOCCI, STREPTOCOCCI and B. PYOCYANEUS ?

IN THAT CASE . a treatment which is effective against all three will be indicated for cuts, abrasions, burns, scalds, boils and most inflammatory skin infections?

THIS IS THE TREATMENT

ANTIPEOL Cutaneous Vaccine Ointment contains the sterile vaccine filtrates of the three micro-organisms mentioned. The filtrates destroy the actual micro-organisms and at the same time act as a local immuniser against re-infection. This is a

purely biological action and there is no damage to delicate tissues.

RAPID HEALING is further expedited by the ointment base of proved efficiency. For burns and scalds, ANTIPEOL has special advantages. It is microbicide and non-adhesive. Therefore dressings do not have to be changed every day.

AND HERE IS THE PROOF.

Antipeol Ointment is proving and reproving itself every day in dozens of surgeries, clinics, hospitals and homes. Letters from the medical and nursing profession bear convincing testimony to its effectiveness.

THERE is the logical argument for including ANTIPEOL Ointment in every First Aid kit. As a logical person, why not send for full details and a clinical sample ?

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Marchi April 1952

Methods of Artifieial Respil

By 'I/irst Llider!

FROM recent writings in this country, it appears that we are being subjected to another wave of opposition to the Schafer's method of artificial respiration.

In the Lancet of 15th March, a chapter, detailing concise theoretical experiments on the efficiency of various methods, puts Schafer into third place, behind its modificationNielsen, and its predecessorSilvester. Finally, it suggests that Schafer's method should no longer be officially recommended.

to have lost elasticity of the chest muscles, and to counteract this he has instructed a helper to kneel, facing the patient's head, to lift and depress the shoulders at the appropriate times of his Schafer action. Moreover, this action with the shoulders, perhaps borrowed from ielsen, has been frequently used with success whilst artificial respiration was in progress on a rocking stretcher, which depends so much for its success on the diaphragm.

Methods of Artificial Respiration

Asphyxia by A. D. Belilios, M.B., B.S. (Lond.) 2

Editor's Opinion 3

News from St. John 4 Burns and Scalds among Children by D. MacG. Jackson 5 Red Cross News 8 .

British Railways 8

Competitions 8

Topical Notes for First Aiders and Nurses 9

World Health D ay 10

Development of Child Care in Britain-2 by Agnes Pavey, S.R.N. 11

Books for First Aiders & Nurses 12

Readers' Queries 14

Without dealing with the theoretical figures presented in the Lancet, which depend so largely on artificial patients, many first-aiders, who have experienced the value of Schafer in actual cases of emergency, will insist that the success of Schafer depends not only on the elasticity of the chest muscles, but on the action of the diaphragm, which is not seriously called into play in either Nielsen or Silvester. This diaphragm action, produced by Schafer's method, is recognized by experienced first -aiders as the greatest factor in the expansion and contraction of the chest cavity. So much so, that when the efficient first-aider finds an apparently dead man lying on his back, he will force up the diaphragm by one push of abdominal pressure as he prepares to turn him rapidly into the prone position for the recognized Schafer action The effect is seen in the frothy mucus extruded from the mouth and nose.

There has been an occasion when a Schafer performer has noticed that the patient was so far gone as

On another occasion, perhaps, the Girl Guide, trained in Schafer, finds that her light weight is not sufficient to compress the heavy abdominal muscles of the heavy man under her care. She would immediately carry out the shoulder lift method until such time as a heavier first-aider comes along to carry out a full diaphragmatic action.

Surely, when a method such as Schafer's has been taught and accepted in this country by so many thousands who have been trained to carry it out efficiently, it is wrong to attempt to institute a diversion.

As a matter of fact, many teachers of first-aid, after training pupils in Schafer, are accustomed to indicate the rare occasions when Nielsen or Silvester may be required. Moreover, the teacher of a young class in first aid realizes this, and of course indicates that a second helper should be utilized if the full action of the diaphragm cannot be brought out, and this helper carries out the shoulder lift.

In other word, Schafer's method of artificial respiration should be the foundation of the training.

a

Asphyxia

CASES of a'Sphyxia are only too common and are always extremely urgent demanding treatment without delay. This article, the!efore, deals with a su bject of whIch every first-aider must possess a perfect knowledge.

Asphyxia occurs wheD there is insufficient oxygen in tbe blood. It results in failure of breatbing which may by partial or complete, and often leads quickly to unconsciousness and death. As an introduction is desirable to give a brief hon of tbe anatomy aod physiology of respiration.

Respiration is the process by whIch oxygen obtained from fresh air is drawn into the blood stream while carbon dioxide, a waste product produced by tissue action, IS removed from the blood and expelled into air which is then exhaled.

The essential organs of respiration are the lungs; these are two in number situated one on eitber side the chest. Each lung is rather lIke. a sponge in texture and consists of minute pockets of lung tissue WhICh are called alveoli. Throug.h their thin walls, oxygen passes 111tO the blood stream while carbon dioxide and water vapour leave it.

Blood is carried to the alveoli

tbe right ventricle of the heart

Via the main branches of the pulmonary artery which after entering the lungs divide into capillaries .to form a network round the alveolI. These capillaries become trib\ltaries of the pulmonary vell1S which eventually pass back to left auricle of the heart carrying lL1 them purified blood.

Air reaches the alveoli of the through the organs of the respiratory tract. These include the nose and mouth, the throat or pharynx, the larynx or voice box the trachea. or windpipe, and' the broochI. These organs are too well

By A. D. Belilios, M.B., B.S. (Lond.), D.P.H. (Eng.)

to merit a special description

1I1 a short article of this kind but the student will recollect that when the trachea enters the chest it divides into two large branches wbich are called the bronchi. These enter the lungs and then divide into smaller and smaller tubes like the branches of a tree. The final branches, wbich are very minute, are called the bronchioles and these convey air to the alveoli.

Each lung is closely covered by a lining called the pleura. ThLs I?-embrane is in two layers one of whIch covers the lung while the other lines the inner wall of the chest. The layers are continuous with each other at the root of tbe lung and thus form a closed cavity called the pleural cavity.

Respiratory Mechanism

term refers to the method by whtch the act of breathing takes

The muscle of respiraIS the dIaphragm but it is a.ssisted by other muscles which are situated between the ribs.

Inspiration results from enlargement of the cavity ofthe chest caused by the action (contraction) of the diaphragm. For this purpose the muscle changes its shape' and lower in to the abdomen.

The Increased size of the chest causes the to expand owing to their elastICIty., and air is drawn through the tract until they are filled. WIth expiration the move!llents of the diaphragm are reversed' It now rises to its original and bence the lungs become smaller forcing air out of the body.

The no.rmal rate of breathing for adult IS from 12 to 18 breaths a mtnute.

Respiratory Centre

This term refers to the part of the system which controls breathmg. The medulla oblongata

is the la st part of the brain and joins the spinal cord. It is situated in the base of the skull just above tIle large opening which leads to the spi nal canal. In the medulla oblongata are situated small masses of grey matter called vital centres because they control the essential activities of life. Of these the respiratory centre is of great importance since it controls the respiratory mechanism.

Causes of Asphyxia

There are many causes of asphyxia a nd they provide for the keen an excellent example of the Importance of classification jf he wants to remember them all satisfactorily. The first essential is to appreciate that the causes can be divided into three, namely :-

(1) Those that affect the respiratory tract.

(2) Those which affect the respiratory mechanism.

(3) Those that affect the respiratory centre.

(1) Those affect the respiratory tract can .be. divided into (a) actlllg mSIde, (b) ca uses 111 the walls and (c) causes actmg from without as follows :-

(a) Inside (i) Foreign gases, e.g. coal gas, sewer gas, motor exhaust fumes, etc.

(ii) Foreign fluid, e.g. water as in drowning.

(iii) Foreign matter, e.g. choking, vomit, blood, artificial teeth.

(b) Walls Swelling of the tissues of the air-passages caused by stings, corrosive pOlsons, etc.

(c) Outside (i) Compression of tracbea from hanging, strangling, throttling, etc.

Oi) Smothering.

(2) which affect the respiratory mechamsm can be divided up as follows :-

FIRST AID & NURS1NG, MARCH APRIL 1952

(a) Mechanical- pressure on the chest

(b) Spasm of respiratory musclestetanus, strychnine poisoning. (c) of respiratory musclesdtseases such as poliomyelitis.

(3) Tho.se which. the respiratory centre lllclude 1I1Jury the effects of electricity (electric' shock and lightning) and certai n poisons.

Degrees of Severity

Two. degrees of severity of asphYXia are usually described partial and complete, but it must be remembered that the two merge easily into each other and very often only a short stage of the partial vanety. precedes

PartIal asphYXIa occurs when a patiel:t can still succeed in obtaining sufficlent to support life although madequately. Breathing becomes rapid, difficult and possibly jerky and irregular. It may be by coughing, spluttermg and fighting for breath. The patient's colour usually changes his lips becoming cyanosed and 'also his cheeks, ears and finger nails. The pulse is quick and feeble and if conscious the patient complains of pain over his heart, giddiness and general weakness. But it must l?e forgotten that in coal gas pOlsomng the colour if anything becomes pin ker than normal.

Complete asphyxia occurs when the supply of oxygen becomes insufficient to support life. There is complete loss of consciousness and the breathing ceases. Soon the heart stops beating and the patient dies.

General Rules for Treatment

The first step in treatment is obviously to remove the cause as far as possible. In many cases once this has been done, the patient will begin to breath normally once again as for example in choking, hanging, strangling, etc.

Sometimes, of course, the patient has to be removed from the cause, for example, in cases of drowning, inhalation of a poisonous gas and electric shock. Moreover, even when he has been removed, the cause may continue to act and cannot be removed. Thus in coal gas poisoning, carbon monoxide forms a firm combination with the contents of the red blood corpuscles

which is only slowly resolved.

Artificial respiration must be immediately if the b!"eathmg has ceased and may be alded by giving inhalations of oxygen but not as a rule combined with carb<;>n dioxide. Although the latter gas IS a powerful stimulant to respiration, its use in first aid has been largely discarded since it is appreciated that in many instances there is already an excess of carbon dioxide in the blood. To give more only tends to embarrass the heart in .its action. Occasionally a few whlffs of carbon dioxide may be of value as for example in poisoning

with narcotic poison and with coal gas. Once however the patient has a few deep breaths, the carbon dlOxlde should be discontinued, but can be repeated if the breathing becomes shallow.

All the general principles of first aId 11!ust be applied, for example, is a free passage of aIr, undolllg 11ght clothing, and the treatment for shock, which latter should be applied as far as posslble during artificial respiration. Administrative procedure, for example, sending for a doctor or ambulance, arranging for removal to shelter, etc., must not be forgotten.

Opinion

EVERYONE who has given any thought to the problem of accidents in the home will welcome the recently introduced Private Member's Bill in Parliament which seeks. to ensure the adequate guardmg of all gas and electric fires. In another part of this issue we reproduce a most interesting lecture by Dr. D. MacG. Jackson given to the Royal Institute of Public Health and Hygiene, on burns and scalds among children. The lectLlfer made the point that every year about 600 people die from the effects of burns, and about 2,400 serious burns occur in England and Wales from domestic heating appliances. Just over half are due to coal fires and the remainder to gas and electric fires. The chief cause of these injuries in.the home is the unguarded fire.

An Act of Parliament passed in 1908 makes it an offence for a householder to be without a guard on an open fire if children under seven years of age are in the house, but the existence of this Act is practically unknown to the majority of the population. If the purpose of this measure had been carried out in recent years many deaths could have been prevented, and especially the tragic loss of young lives, for Dr. Jackson tells us that 71 per cent. of domestic burns occur in children under 14 years of age Will the new meaSLlfe which makes an unguarded electric or gas fire an offence suffer the same fate as the 1908 Act (which relates only

to coal fires)? We think not, for there has been an encouraglllg response from the manufacturer s of gas and electric fires. In fact some makers of these have been making guards for their fires for many years, even though there has been little call for them from householders.

The fact is, that tbis simple precaution of guarding young children from naked flame in the home is an adult responsibility which has been ignored in the past. As Dr. Jackson says, it is no use expecting children to be careful; they have no beat sense.' It is the responsibility of their parents , and if the adults do not accept that responsibility they will have to be made to do so

It is the same with the prevention of scalds. The number of serious scalds sustained in the home is equal to the number of burns, and fourfifths occur in children under 14. Unfortunately, in this case there is no simple precaution such as a fireguard which provides an easy solution. Most cases are due to thoughtlessness, such as carelessly leaving saucepans, teapots, etc., within the reach of children.

Much good has been done by home visitors pointing out these dangers to parents. With this problem, no Act of Parliament can provide an answer. The solution lies in educating the householder to the dangers that lurk, especially for the young, in every home.

Leicester

Fifty-two years' service in the Brigade is the grand record of Mr. John Walkins, who has recently retired from office as Superintendent, Leicester Working Men's College Division.

To mark his retirement and transfer to the Brigade's reserve I ist, the Leiceste,r Corps paid tribute to him at a celebration dinner at the Victoria Grill, Leicester.

On behalf of Leicester Corps members, Corps Supt. R. Flowers presented him with a fireside chair.

Mrs. Watkins was given a handbag.

During the dinner, Corps Supt. Flowers pinned a seventh bar-representing a total of 50 years' service to the Brigade-to Supt. Watkins' service medal.

It was in 1914 that he first became associated with the Working Men's College Division.

Corps Supf. Flowers said Supf. Watkins had re-passed bis annual first aid examination every year since 1898.

He had attended 863 drills-a yearly average of J 7.5 out of a possible 20.

Harlesden

Tbe 135 (Harlesden) Division has lost one of its most efficient members by the recent death of Pte. R. G. Nottingham.

Bob,' as he was known to his Brigade colleagues, had served with the Division for 12 years during which period be had given some 2,600 hours of his evenings and weekends in service to the public. He was always smart, cheerful and courteous, an example to all, and one of tbe best-liked men in the Brigade. His loss is keenly felt by bis colleagues and he will be hard to replace. He was a real credit to the Order of Sf. John of Jerusalem and exemplified to the full the motto of the Order-' For the Faith; For the Service of Mankind.'

Mo]esey

Among the guests of the No. J 51 (Molesey) Division at its first Annual Dinner at the Carnarvon Castle Hotel, East Molesey, on 8th March. were the S.W. Area Commissioner, Dr. D. A. B. Hopkin, his wife, and Area Superintendent C. W. Hipkins. Major W. H. Smith, the Division's president, occupied the chair.

Mr. J. Foord Whitaker, J.P., Hon. Auditor to the Division, proposed 'The Brigade,' tracing briefly the history of the first aid movement and quoting some examples of the service rendered by the Brigade. Over 20,000 cases of accident or sudden illness had been treated by members of the Brigade at the Festival of Britain during the five months it was open.

In his response, Dr. Hopkin welcomed the opportunity of meeting the men of the Division, and reminded them that it was the men in the many divisions upon whom the work of the Brigade depended. He congratulated his hosts on their initiative.

The National Hospital Reserve, he told them, V:'ould look to members of the Brigade for asslstance should the emergency arise.

Proposing the toast of' No. 15J Division,' Area Superintendent Hipkins referred to the work done by Corps Officer F. A. Bowman whose promotion had detached him from the Division, and to Divisional

St. John

Superintendent Walsh who, for health reasons, had transferred to the Brigade Reserve. Molesey Division, he said, was only small but had a good record of service -1,234 hours of duly during the past year in addition to the 51 weekly drill sessions. He paid tribute, too, to the large amount of time and enthusiasm devoted to his Division by Divi sional Surgeon B. A. Rodger, whose name he coupled with the toast.

Replying Dr. Rodger expressed pleasure at the presence of representatives from Headquarters, indicating that Molesey was not forgotten. He thanked them for their encouragement. The Division'<j work had already endeared it to the neighbourhood.

The toast to the guests was proposed by Divi sional Officer Witch, who spoke with appreciation of the services of Mr. Whitaker, Mr. Walsh and the Divisional Surgeon.

A former Divisional Secretary, Mr. A. H. Palmer, responded for the guests. He had followed the progress of the Division with pride and had seen them more than holding their own in the competition room with larger and older divisions who could select teams from veteran competitors. He complimented them on the success of their first dinner.

Mrs. Hopkin thell presented trophies and awards: the Moss Efficiency Cup to Hon. Sgt. Davidson, the Major Smith Cup to Ptes Herring and Whiting, and the Pocock Cup to H !Sgt. Davidson, with Ptes. Beer, Pocock and Whiting. St. John Ambulance Association Medallions were received by Ptes J. Beer and F. voh, while Labels were gained by H , Sgt. David son and Pte s. Peeks , Clements, Edwards, Fennemore, Gunner, Herring and Pocock.

Then came a surprise item, tbe presentation,_ from the Di vision, of a fountain pen, to Div. Off. Walsh, their former Officer-inCharge, as a token of regard. Mr. Walsh was obviously touched by this tribute and after he had thanked his colleagues the more formal part of the evening's programme terminated with the presentation of bouquets to Mesdames Hopkin and Rodger. The hall was then cleared for dancing.

Folkestone

The Annual General Meeting of the Folkestone Corps was held on 16th FebrLiary when Corps Officer L. Easton, O.SU., presided, supported by Corps OfAcer R. Moat, O.SU. , and Corps Officer Miss M. Davis. Also present were Officers of all Divisions within the Corps, and members of the adult Ambulance and Nursing Divisions.

The meeting commenced with a minute's silence in memory of our late Sovereign

Head, His Majesty King George VI, and of members of tbe Brigade who had passed away.

Reports of each Divis ion were given showing a membership to date of 62 Ambulance and Nursing members and 95 Cadets, who between them had carried out well over 3,000 hours of voluntary public duty. Tbe Ambulance Cadets had done well in competition work, having gained second place in the County and third in the Regional Competitions.

Tbe Social Committee had arranged many outings including a day trip to London and a visiL to Rye on Bonfire Night. A vote of thanks for the good work was carried.

Corps Officer Easton congratulated members on their work in the year, and especially thanked Corps Officer Moat and Corps Officer Miss Davis. He continued, saying that during the past two years a certain amount of re-organization of the Corps had taken place, much of the administrative side having passed from the Corps Staff to the Officers of Divisions. Both Corps Officer Easton and Corps Officer Moat proposed to retire at the end of J 952 or transfer to the Reserve, having completed over 40 years' service in the Brigade. It was a hard decision to make but they felt now was the time to give a warning.

All expressed their regret at this decision, but assured Corps Officer Easton that all would endeavour to continue in the same principle upheld by Corps Officers Easton and Moat and thanked them for all their help in the past.

Corps Officer Miss Davis asked that a vote of thanks and appreciation to Divisional Officer Mrs. Williams be recorded, on her transfer to the Reser ve.

BURNS AND SCALDS AMONG CHILDREN

By D. MacG. Jackson, lVI.A , M.D., F .R. C.S.

RECENTLY a five-year-old girl, held back from school through a cold, was standing before a gas fire in her nightdress. Her mother had left the room for a few moments to fetch her clothes. During this time the nightdress caught fire and the mother, returning, attempted to beat out the flames. Her little daughter died from burns.

On Christmas Eve a mother was upstairs hiding the toys intended for her seven-year-old daughter. The cbild in her nightclothes was downstairs where an open fire and a sma1l gas griller were burning, the latter placed on the floor. The mother heard the child scream, and rushing downstairs she found the child running out of the house in flames. The child reached a neighbour's house and a coat was wrapped round her, but she died in hospital from her burns.

Ashford Ultened

On Thursday, 20th March, Mr. C. P. Hopkins, Chief Regional Officer, Southern Region, opened a new Medical Centre at Ashford Works. It was in 1946 that the Directors of the Southern Railway decided to develop an Jndustrial Medical Service at Ashford, and in the following year Dr. A. E. Ginn was appointed as full-time Divi sional Medical Officer.

Suitable accommodation was very difficult to find owing to shortage of labour and materials, but to-day a modern welJequipped Medical Centre has been provided in the works It consists of a consulting room, special eyesight examination room, waiting room and first aid treatment room, togetber with accessory ofAces and stores.

Mr. T. J. Henniker, who has been Ambulance Attendant at the works for over 20 years and Ambulance Class Secretary responsible for first aid matters, will now have an up-to-date treatment room, and t h e advantage of a doctor on the spot for consultation.

The parents of a large family heard screams, and entered one of their rooms to find that the nightdress of their three-year-old girl had caught fire while she was standing on a four-inch curb before an open grate, reaching for some toys which were on the mantelpiece. Later the child died from her burns.

These are only three of the 600 deaths that occur each year from burning in England and Wales . The magnitude of the social problem presented by burns is still not generally appreciated in spite of the detailed study given to the subject by D r. Leonard Colebrook during the past ten years. He, more than any other person, has laboured ceaselessly to prevent the wastage of human lives resulting from burns and scalds. In placing the social problem of burns before you I have borrowed freely from his work, and am glad to acknowledge my indebtedness to him.

First, I should like to make clear where people receive their burns,

who it is that runs the greatest risk of being burned, and how they receive their injuries. After that I wish to deal briefly with the prevention and treatment of burns.

In the Medical Research Council Burns Unit at the Birmingham Accident Hospital over 400 serious burns are admitted every year , and in addition about 2 ,000 less severe burns are treated as out-patients. Although this Unit is placed in the centre of a heavily industrialized area, an analysis of the place of injury shows that two-thirds of the serious burns occur in the home. One may presume that in a nonindustrial area an even larger proportion of the burns would be domestic.

Of these domestic burns, 71 p.c. occur in children under 14 years of age, and 50 p.c. in children under five. Children, therefore, are the principal sufferers from this type of accident. Another important feature of the analysis of domestic burns is that severe burns are sustained more frequently by women than by men; in fact this is, I the only type of accident which affects women more than men. Not only is the incidence greater in women, but the mortality also is higher, ten times as many women over 65 years of age receiving fatal burns as men. A third group of people who are especially likely to be burned are epileptics; 25 p.c. of adults burned at home are burned in an epileptic fit. In answer then to the question 'Who gets burned?' you will appreciate that there are three groups: the young, who have not yet learned the dangers of heat; the elderly in whom alertness is perhaps beginning to become impaired, and epileptics who are the victims of periodic helplessness due to unconsciousness.

Each year it is estimated that 2,400 serious burns occur in England and Wales from domestic heating

report of a lecture delivered to the Royal Institute of Public Health and Hygiene is reproduced from the Institute's Journal, February 1952, by special permission.

5 appliances; just over half are due to coal fires and the remainder to gas and electric fires: 400 of these patients die from their burns. The chief cause of these injuries by burning in the home is the unguarded fire.

The second important cause of severe domestic burns is the inflammability of the clothing used by most children and women, especially for their night attire. One-third of the home burns had their clothes alight. Again this was most often seen in children under 14, two-thirds of whom bad their clothes alight. But burns are not the only cause of thermal injury. The number of serious scalds sustained in the home is equal to the number of burns, and an even larger proportion, four-fifths, occur in children under 14, the commonest cause being upsetting teapots, teacups and saucepans which have been left carelessly on the edge of a table or on an unguarded fire. Unprotected baths and buckets of hot water carelessly left on the floor or in the passage are another frequent cause.

The Prevention of Burns

As a result of his analysis of the cases treated in the Medical Research Council Burns Unit in Birmingham, Dr. Colebrook considered that onehalf to two-thirds of the domestic burns could have been prevented by taking reasonable precautions. While children are sometimes part authors of their own misfortune, they are, on the other hand, often merely the innocent victims of adult failings, and are often guiltless in their own destruction. It is no use expecting the children to be careful : children are not aware of the dangers of heat, they have no heat sense ' It is the responsibility of adults to make it impossible for them to burn themselves. Serious

This

burning accidents usually take the form of clothes catching fire, and this usually occurs due to momentary contact by a cotton fabric, which is highly inflammable, with the naked flame of a coal fire or the heating elements of gas and electric fires. Children may play near the fire, often the only available space in a small crowded living-room, and a girl's frock swings too close to the element. A not-too-alert girl in her teens stoops to switch off an electric fire and her dressing gown falls across it. An old lady with failing sight, living alone, peers up at the clock on the mantelpiece and allows her ski rt to touch the open fire. These are the accidents that fill our wards with seriously inj ured patients.

How can these accidents be prevented?

Although the Children's Charter of 1908 made it an offence for a householder to be without a guard on an open fire if there were children under seven years of age in the house, there is little evidence that this law has made any appreciable difference to the yearly total of deaths, and it is quite certain that to-day, 43 years later, the very existence of the Act is unknown to the majority of the population, and very many homes are witho ut any fireguard. Moreover, the law does not apply to gas and electric fires which are so widely used to-day, and these are especially dangerous since many of them are portable and

The Modern Treatment of Burns

There are three chief enemies which every extensively burned patient has to meet and overcome if he is to live and avoid deformity. These are, shock, infection, and contractures.

Shock is still the commonest cause of deaths in burns ; infection, especially in the form of bronchopneumonia, is the second commonest cause of death; and scar contractures are responsible for the major part of the disability and deformity following this type of inj ury. Each one of these complications can be prevented to a large extent by correct and energetic treatment, and each one is much easier to prevent than it is to cure. The problems raised by these three complications of burning will now be briefly considered.

FIRST AID & NURSING, MARCH/APRIL 1952

the patient becoming seriously ill or even losing his life.

stand in the middle of a room. There is more reason to press for adequate guarding of these fires because it can be provided so easily, with little extra cost or spoiling of design.

A standard of safety has recently been fixed for all gas and electric heating appliances, and arrangements are being made by Dr. Colebrook to bring a Private Member's Bill before the House of Commons at the opening of the New Parliament to ensure the future adequate guarding of all gas and electric fires before they are offered for sale. It is with the greatest satisfaction that those of us who spend our time treating burned children and adults view this vital preventive measure. It will clearly be the greatest single step forward yet made in the protection of children from burning accidents.

To sum up then, the problem of reducing the number of serious burning accidents in the home is chiefly one of guarding the fires, but there is also need for continual education and propaganda to develop 'heat sense' in both children and their parents. The development of substitutes for dangerously inflammable clothing materials is perhaps a measure we cannot all do much about at present, but an awareness of the dangers of cotton and rayon materials will do something to prevent these mutilating injuries.

When the skin is burned the capillaries in the skin are damaged, and they become permeable to plasma which leaks out of the circulation on to the surface of the body to form blisters, or leaks into the tissues causing them to become water-logged. In extensive burns this leak may be so great that insufficient plasma is left in the circulation to supply the needs of the body, and as a result the patient becomes dangerously ill due to shock. If shock is to be prevented, the plasma that is lost from the circulation through the burn must be replaced by a plasma transfusion without delay, and rapid transfer to hospital is usually necessary to effect this. The leak continues for about 24 hours so that it is necessary to continue the plasma transfusion for this period of time. Provided plasma is given sufficiently early and in adequate amounts sheck can be prevented or controlled, and the first enemy overcome.

Whether the patient becomes shocked or not depends on the extent of the burn. In practice, the child with a burn of a larger surface area of the body than one arm is likely to become shocked unless the plasma loss is made up, but if the area burned is less than this, shock will not occur. It will be apparent that this is one of the circumstances in medical practice where prompt treatment is of real val ue s ince delay in transfusion may re sult in

The second enemy of the burned patient is infection. When a burn is inflicted, the heat that destroys the skin also destroys the usual skin organisms on the burned area. A burn is, therefore, initially, a clean wound. The local treatment of a burn should be directed to keeping it clean and securing healing of the skin as quickly as possible. Accordingly, the correct first-aid treatment for a burn is to cover it immediately with a sterile or freshly laundered cloth; this is usually a handkerchief, towel or sheet for domestic burns. This protects it from contamination with organisms which can occur so easily by the direct contact of fingers and clothes, and by airborne infection from the mouths and noses of the patient himself or his friends. This first aid dressing ensures that the burn will be as clean as possible when the patient arrives in hospital to have the proper dressing applied, or in the case of a more severe burn to have a skin grafting operation carried out.

In a properly organized Unit for the treatment of burns great care is taken to prevent the burn becoming infected after the patient's admission to hospital. Special rooms are set apart for the treatment of recent uninfected burns, and the burn is covered with a dressing which is as bacteria-proof as possible. Provided the dressing is efficient in this respect cross-infection from the burns of other patients and from the respiratory tracts of patients and attendants is unlikely to occur. Whenever the burn is re-dressed, which is infrequently, the dressing is carried out in an air-conditioned room; in this room, the air which is contaminated with micro organisms as the old soiled dressings are removed, is continually replaced by fresh, clean air from the outside. The rate of change of the air is in the region of twenty complete changes of the air in the room in each hour. Until the burn is completely healed there is always a chance that it may become serious ly infected, so that skin grafting for deep burns is carried out as early as possible as one way of eliminating this risk.

In the past gross infection of burned surfaces was a common cause of fatality. but now with better first

aid treatment, greater attention to protective dressings, and with the help of antibiotic drugs this is rarely seen. From time to time, however, especially in patients with extensive burns, death still occurs from septicaemia and bronchopneumonia.

The third enemy of the burned patient is the scarring that follows burns which destroy the full thickness of the skin. This results in gross deformities and limitation of movement at the joints. The principal feature of treatment directed towards preventing this complication is the early skin grafting of areas where the full thickness of the skin has been destroyed. By this means rapid healing is obtained with as little contracture of the burn as possible. Sometimes it is possible to tell on the day of injury that a burn penetrates the full thickness of the skin. In this case the burn can be cut out and replaced with a skin graft on the same day and this shortens the healing time by two or three weeks. On the other hand, however, it is often difficult to tell which areas of a burn penetrate the full thickness of the skin, and a period of up to three weeks is then necessary before the depth of the burn is unmistakable and grafting can be completed.

The usual type of skin graft which is used for covering raw areas is a thin sheet consisting of the superficial one-quarter or one-half of the thickness of the skin taken from the thigh. If this is applied to the raw area and kept in place for four or five days it becomes attached to its new site and forms satisfactory skin, the donor area from which it is taken healing in ten days, and after some months leaving no scar. This is the simplest type of skin graft, and it has a wide use in healing large raw areas rapidly and permanently.

Sometimes, however, skin of better texture is required for exposed areas such as the face, and in these cases it is better to transplant the fun thickness of the skin, the site from which the full thickness graft is taken being grafted in turn with a split skin graft.

A third type of graft consists of skin together with the underlying fat. This type, because of its thickness, cannot be cut from the body

7

completely and be expected to grow when applied to a raw surface. If this amount of tissue is to be transferred to another site it must only be partially separated from the body in the form of a flap, retai ning enough blood supply to maintain its life. It is then applied to a raw area securely, and only when it has become firmly attached to it in three weeks or more can the base of the flap be separated and inset. Sometimes if a skin flap is to be moved in several stages it is convenient to convert it into a tube, but this type of graft which is called a tube pedicle is essentially the same as a flap of skin with its underlying fat

Children often suffer from extensive deep burns so that large raw areas result, and through these areas they lose much exudate and blood so that they become very wasted and anaemic. Many people look upon skin as the brown paper round a parcel; the contents are important, but the paper is of little value This is far from the truth. The skin is a most important organ of the body, and although one ca n live without a stomach , without one lung or without one kidney, no one can live without adequate skin co ver. Patients frequen-tly die due to too little skin, and they may die if its replacement by grafting after burns is delayed too long.

Sometimes skin from another person can be used to provide temporary skin cover for an extensive burn, but this type of graft ha s the disadvantage of lasting for only three weeks and then disintegrating so that a raw area is left once more. It may however, a fford a very valuable breathing space during which the areas from which skin has been taken on the patient himself can heal and recover sufficiently to provide a second crop of skin two to three weeks later. The grafting of extensive raw areas in burned patients is a life saving measure and it frequently calls for careful planning, thoroughness a nd skill if the life of the patient is to be saved.

To conclude, let me re-emphasize that the person who will prevent a child from being burned has done an inestimably greater service than the one who only repairs the damage done-much of which, both mental and physical, is often irreparable.

Guards on gas and electric fire') can save lives, and it is likely thal lhis vital pre venti ve measure will shortly be compulsory

Bed Cross NEWS

The following letter had been received from the Secretary of State :-

'I have it in command from The Queen to convey to you, and through you to the officers and members of the Headquarters of the British Red Cross Society, and of the City of London, County of London, Essex, Hertfordshire, Kent, Middlesex, Surrey and Berkshire Branches of the Society, and of the Scottish Central Council Branch, Her Majesty's sincere appreciation of the manner in which they carried out their duties towards the masses of their fellow subjects assembled in the streets of London and Windsor on the occasion of the funeral of His late Majesty King George VI. Her Majesty wishes her grateful thanks to be conveyed to the officers and members of the Society who were on duty for the public service which they rendered.'

A unique report has appeared in the Romford Times under this title, 'Enough to Rattle Anybody,' which reads:' Members of the B.R.C.S. were at Brooklands in force on Saturday. They were ready to treat any members of the 13,602 crowd. But they had only one casualty all afternoon. He was one of their own members-and he was hit on the head with a rattle.' We are glad to report that the accident was not serious, though the poor casualty lost a brand new raincoat in the excitement.

Yorkshire, West Riding

Miss Kingdom of West Riding / 284 has received a letter of commendation from the Nottinghamshire Police for action taken in a nasty accident. Whilst on a business trip she came across a child run over and pinned down by a bus. The driver, overcome by shock, was unable to help, and it was not until a lorry arrived loaded with workmen that the child could be released. Miss Kingdom carried her to the roadside, and did what she could until the police and ambulance arrived. It was a severe ordeal but the child survived.

Gloucestershire

Miss Silk of Cheltenham was on meals on wheels duty.' She knocked repeatedly on the door of an old lady who was crippled with arthritis but there was no reply. Finally she forced an entry and found the woman had upset her paraffin lamp and was on fire. Miss Silk hastily extinguished the flames with a blanket. Fortunately there was no injury and so after making sure the old lady was comfortable, she notified the nearby ambulance station, who promised to an eye on the patient. This prompt actIOn undoubtedly saved a life and prevented a serious fire.

Carnarvonshire

Following the Aer Lingus disaster in the Aldwark-Myton district, Caroarvon Branch went into action. On the night of the crash there was a blinding snow storm, but immediately it was reported the County Director and an associate member, Mr. John Roberts, went to the scene of the accident, a bog, some way from the road. There were no survivors, but they assisted in the search for bodies. Eventually six were recovered. The County Director left at 11.30 p.m., but Mr. Roberts remained to help the police and firemen to remove the bodies, and did not finish duty until 2.30 a.m.

*Co mpetition s

Police National Competition

The Metropolitan Police (L Division) won the Police National First Aid Competition, held at the Central Hall, London, on 29th February, by a margin of 31 votes over the City of London Police, the runnersup. The winners gain the Pim Challenge Trophy, and the Police Review Challenge Cup goes to the second team. Placings were as follows :-

1. Metropolitan Police (L Div.) 355

2. City of London Police... 324

3. West Sussex Constabulary 322

4. Glamorgan Constabulary" B" 314

5. Birmingham City Police No.1 309

6. West Riding Constabulary" B" 294}

7. Devon Constabulary 285

8. Grimsby Borough Police 281

9. Stockport County Borough Police 280 }

10. Royal Ulster Constabulary 278

11. Edinburgh City Police

The Lord Prior of the Order of St. John (Lord Wakehurst) presided at the distribution ceremony; the challenge trophies and individual plaques awarded to the first three teams were presented by Sir Hugh LucaS-Tooth, M.P. (Parliamentary UnderSecretary of State).

Women's Competition, B.R. (Western Region)

The result of the Women's First Aid Competition, British Railways, Western Region, held in London on 11th March, was as follows :-

I. Newton Abbot (Florence M. Lean Cup and prizes) 303!

2. Paddington (Mabel A. Potter Cup and prizes) 301

3. Swindon (prizes) 272i

4. Bristol

5. Swansea 250}

6. Cardiff 239 Dr. E. J. Selby was the adjudicator in the team test, and Dr. C. T. Newnham in the individual tests. The subsequent proceedings were presided over by Mr. R. Burgoyne, Regional Staff Officer, and the presentation of trophies and prizes made by Mrs. Burgoyne.

The Newton Abbot team will represent the Western Region in the British Railways and London Transport (Railways) Competition for Women which is being arranged by the St. John Ambulance Association at Central Hall, Westminster, on Friday, 16th May,

.British Railways

London Midland Reg on : Crewe

During the recent session of Ambulance lectures of the Crewe Class, the Chairman, Mr. E. R. Brown, Assistant Works Manager, received a Silver Cup given by Mr. S. Wilkinson, to be competed for annually by the First Year Students. Mr. Wilkinson, himself a member of the Class, said he hoped this trophy would be the means of encouraging and maintaining the interest of the First Year Students. They were the Ambulance men of tbe future.

Mr. E. R. Brown said how pleased he was to accept the Cup on behalf of the Class. The Crewe Class were fortunate in having members like Mr. Wilkinson who took such a keen interest in the Ambulance Movement. The com pet ition was introduced to further the interest in Ambulance work of the new members, and he was sure the additional stimulus of holding this trophy would promote the keenest competition.

Mr. E. R. Brown also said he had great pleasure in presenting to Mr. T. W. Evans, Vice-Chairman of the Class Committee, a framed Diploma of the Serving Brother of the Venerable Order of the Hospital of St. John of Jerusalem, and he was sure Mr. Evans, by virtue of his long and untiring efforts on behalf of the Ambulance Movement, was fully deserving of this honour.

Southern Region

Portsmouth Class held their Annual Dinner and Presentation of Awards recently, when Mrs. King, wife of the Assistant Traffic Superintendent, presented the awards. The entertainment provided following the dinner concluded a most successful event.

Mrs. Matson, wife of the Works Manager, Concrete Department, Exmouth Junction, presented prizes on the occasion of the Exmouth Junction Carriage & Wagon Class Annual Dinner, which was its first social venture and a very successful one.

Lewes Class held a special meeting recently to re-organize its Class activities, with a view to extending its numbers and introducing social events. The following Officers were appointed: President.' Mr. J. Dance, Station Master, Lewes. VicePresidents: Mr. L. West, Station Master, Plumpton; Mr. S. Larkin, Permanent Way Inspector, Lewes. Chairman.' Mr. G. Turner. Treasurer.' Mr D. Colwell. Class Secretary.' Mr. A. Harvey. Committeemen.' Mr. F. Haggar; Mr. F. Styles. Class Instructor.' Mr. P. J. Oliver.

Basingstoke Class Annual Competition was held at the Great Western Hotel recently, when J. Powill and H. Neale received silver medals for gaining first and second place respectively. Dr. J. White, of

FIRST AID & NURSING, MARCH/APRIL 1952

Haslemere, adjudicated the competltlon and Dr. Audrey Carey presented the medals and pr izes.

Maidstone held its first Class Dinner recently, when Mr. H. S. Burrows, Station Master, presided. Mrs. Nunn, wife of the former District Traffic Superi ntendent, presented the awards, and Mr. F. A. Trott, Regional Ambulance Secretary, in his remarks, paid tribute to the Class Lecturer, Dr. Halfpenny and the Class Secretary, Mr. Callaghan, for their untiring efforts at Maidstone and for furthering the Ambulance Movement in general.

Western Region

Mr. G. N. Bullock, Clerk, Hereford Barrs Court has, on the recommendation of the St. John Ambulance Brigade, been promoted in the Order of St. John of Jerusalem to the Grade of Knight of Grace. Mr. Bullock formed the Brigade in Hereford in 1930 and was the first Divisional Superintendent of the Hereford City Division. He has passed through many subsequent offices and is now County Commissioner for Herefordshire.

Bala Ambulance Class held its Annual Dinner and Presentation of Awards, presided over by Mr. Gordon Price, and the awards were presented by Mr. J. Roberts, Assistant District Operating Superintendent. Other guests included Dr. Robert Jones, Colonel Price, Captain J. Williams and Mr. H. Jones, District Ambulance Secretary. A programme of light music and variety entertainment was provided.

Wellington Ambulance Class organized an enjoyable smoking concert in connection with its presen tation of class and long service awards to members of both Wellington and Shifnal Classes. Mr. P. Griffiths, District Tnspector, presided, and Mr. J. Roberts, Assistant District Operating Superintendent, presented the awards. Special tribute was paid to the Class Secretary, Mr. C. C. Russell, for his untiring efforts to further the interests of the Movement.

Hereford Barton held a supper and social evening in connection with its annual distribution of awards. The Chairman was Mr. C. Perry. The awards, which ranged from first-year certificates to 35-year efficiency awards, were presented by Mr. R. H. B.. Nicholls, District Operating Superintendent, who spoke in high terms of the activities and achievements of the Class and urged the members to encourage their colleagues to join the Ambulance Movement, particularly the younger men.

TOP ICA L NOTES FOR FIRST AIDER,S & NURSES

Can We Afford an Unlimited Health Service?

When Lord Beveridge compiled his Report he estimated tbe cost of a National Health Service would be in the region of £170 million for the first few years and that, as the population became healthier ) productive power would increase; so that, although the Service would develop as research extended, the extra cost would be cancelled out by the lessened individual demands made upon it. How wide of the mark this prediction has proved to be! The cost rose by leaps and bounds to £400 million and the estimates for the coming year, despite the proposed cuts, have exceeded this figure by £2t million and have only been prevented from rising still higher by imposing an arbitrary ceiling. A remarkable but somewhat disturbing book by Dr. Ffrangcon Roberts, called The Cost of Health, was published on 19th March and has already given rise to discussion among all groups of thinking people.

as the treatment of chronic diseases improves, but does not cure, more people exist in what Dr. Roberts calls 'medicated survival'; and therefore require medical care, drugs and treatment for progressively longer periods. Thus, medical advances continually outstrip the means to pay for them.

One of the conclusions Dr. Roberts arrives at is that' The idea that the full resources of medicine can be put to the service of the nation in perpetuity, without any regard to economic limitations, must be modified. Indeed, as the years go by, what is practically possible will fall further and further short of what is theoretically possible.' Readers will find this book amazingly informative, dispassionate and completely free from political bias.

International Conference on Blood Transfusion

100,000,000 medicine bottles are lIsed every year for National Health Service prescriptions, and the President of the Pharmaceutical Society estimates that there are at least 50,000,000 empty medicine bottles cluttering up British households!

If everyone returned their empty medicine bottles it would help us all by keeping down the cost of the National Health Service; and it would help our country in this difficult time of financial strain: so the Ministry of Health is asking people to wash their empty medicine bottles well in hot soapy water and retlll'l1 them promptly fo (heir chemist,

Dr. Roberts shows the underestimate to be due, not primarily to the rise in the cost of living, extravagant administration and wholesale abuse of the Service, but to the complete failure of the State to realize the dynRmic force of medical science and progress, and to have regarded them as something of a much more static nature. The victories that have been, and are being, won over incapacitation and death by the development of new antibiotics and drugs such as cortisone and anticoagulants, the application of nuclear physics to medicine, improvements in anaesthesia and extensions in diagnostic investigations and in surgery have been, and will continue to be, most costly. More people survive the acute diseases of young life and therefore reach the age at which chronic disease may develop; and

Medical and other authorities concerned with blood transfusion held a conference in London from ] st-Sth March, with the object of effecting an international standardiztion of blood transfusion equipment. Hitherto, many nations had developed their own procedure, and differences in the equipment used have prevented blood supplies from one country being quickly and easily used in another. By the end of its sessions the conference had agreed on important points, such as the overall sizes of glass containers, including sizes of the necks of bottles, the type and properties of stoppers, the dimensions of the mounts of piercing needles and flexible tubing, identification of the piercing positions in the stoppers bot h for collecting and transfusion, and the minimum rate of filters and drip chambers. This of apparatus is designed to an interchangeability of the eqUlpment required for obtaining blood

FIRST AID & NURSING, MARCH/APRIL 1952

from donors as well as in giving transfusions to patients. In compliance with the rules the International Orgamzatwn for Standardization, these agreements are now being referred to the Standards Associations of the member countries for incorporation in their national standards; whilst other proposals appear to need further investigatIOn wIll be considered again at the next meeting of the International Committee in the light of correspondence and discussion in the meantime. At the present time 33 countries are members of the In terna tional Standardiza tion Organization.

The National Blood Transfusion Service

The Report of this that gifts of blood to hospltals 1ll England and Wales during 1951 reached the high figure of 593,8] 8 ; which is 70,000 more than in 1950 and in fact, higher than in any year with the exception of 1944, when there were 669,000 donations. The number of new donors enrolled last year was 114,384, which brings the total to a post-war record of 465,137. These figures must not, however, induce a feeling of complacency upon a high achievement, for if a reasonable reserve of blood plasma and whole blood is to be maintained the Service still needs 170,000 more donors in order to avoid calling upon existing donors more than twice in anyone year, and to replace those reaching retiring age of 65.

Helping the Blind to See

One of the most dramatic developments of twentieth century surgery is the replacement of a cornea that has become opaque through disease by a healthy transparent one removed from another person's eye; but the present inadequate supply of corneas for grafting places a definite limitation upon the ophthalmic surgeons of this country. To ensure success, a cornea used for replacement must have been removed from an eye within two hours of death, and the law does not allow this to be done. A movement to obtain an alteration in the law has been started. It will probably be concerned with the bequest of eyes and with the use of eyes of people who have died in hospital when no

World Health Day

WORLD Health D ay was celebrated on 7th April. It has been observed annually since 1949 and is an increasingly important occaswn.

Dr. Brock Chisholm, D irectorGeneral of the World Health Organization, has stated that , Healthy Surroundings Make Healthy People '-the theme suaaested for the observance of Health Day in 1952-points to a goal shared by all nations, and it shows where some of the problems lie which must be solved if efforts to improve health throughout the world are to succeed

, D espite the magnificent made by medical science,' he saId, , three out of every four men, women and children in the world still suffer from diseases spread by unsafe water supplies, unsanitary excreta disposal, uncontrolled insects rodents, and inadequate protectIOn of milk and other foods. The responsibility for this tragic of human life and energy rests WIth each of us, individually, in our three-fold capacity as members of

objection is known to exist and when relatives have given their consent.

'Eye banks' ha ve been established in France since 1947, and ophthalmic surgeons in that country have been enabled to make great progress in corneal grafting . In England, it is important that public opinion should be enlisted in support of the proposed legal amendment, and to this end nurses and others who have some understanding of the problem could help to give a fair and reasonable idea of what is involved, and so to counteract some common misconceptions rega r d i ng the establishment of eye banks.

New Drugs for T ub er culos is

Once again, announcements have been made that new drugs have been produced that offer the h ope of cure of tubercu losis, particularly of the throat, intestines, bones and meninges. Press reports f r om America give the results obtained in 190 cases; but in view of p ast. disappointments it would be well to await further investigation befo re

the family and of the local community and as citizens of a shrunken world.

, Each of us needs to realize that sanitation is, after all, a way of life. Whether we live in a " developed" or an " under -developed" country, it is our duty both to ourselves an d to our neighbours to practice certain elementary principles of hygiene which can be with little, if any, expense by IndIvIduals and families. By keeping a clean home, a clean shop, a clean factory and a clean neighbourhood, we are meeting one of the first requirements for our own health and for a healthy community . . 'But we must go beyond thIS ; we must also support fully the establishment and development of local and national programmes in community sanitation. They deserve our support because they aim at providing services designed to p r otect us against the many dangers that may threaten health and life if conditions in our physical environment are unsatisfactory.'

becoming too optimistic. The new substances are derivatives of the vitamin B complex, particularly isonicotinic acid hydrazide. Under the auspices of the Medical Research Council, laboratory tests of this and related substances have already begun in this country. Tuberculosis of the structures mentioned in connection with the reported cures is very often an extension of a primary lung lesion and, so far, no reports of the effect of the new drugs in lung tuberc ulosis have been received.

R e gi s tration N umb er s in th e H ealth S er vi ce

The abolition of Identity Cards has created a minor prob l em for the Hea l th Service . Tt wou ld be costly in both money and l abour to i ntroduce any new system for the w h o le service, so the numbers already in use will be known as National Health Service numbers, a n d arrangements are being made to provide num b ers for b abies an d other perso n s who do not possess the former reg istration numbers.

Development of Child Care in

B y Agnes E. Pa\Tey, S.R.N., Diploma in Nursing (UniYersity of London)

T HE Foundling Hospital is the oldest of the large voluntary oraanizations for the care of children in b this country, for it was established in 1741 by Thomas Coram. He was a seafaring man who, after a successful career as a ship-bui lder in Massachusetts, returned to England in 1720 and settled,. with his wife Eunice, at Rotherhlthe; from he made daily journeys to London. He was then a kindly, childless man of 52 years of age, and he was frequently shocked and distressed at seeing a deserted baby lying by the roadside. On investigation he found that the mothers of these babies were often unfortunate airls who were totally unable to provide for an illegitimate child.

Foundling Hospitals had been esta blished in various countries, for example, in Paris by de Paul in 1649; but Captam Coram found that there were prejudice against such a plan in England. Nevertheless, be began to agitate for some such provision and he worked for 17 years to enlist sympathy and to secure support. He drew up a , Petition' signed by 21 ladies of rank another signed by noblemen and' gentlemen, and a third by Justices of the Peace and other , persons of distinction.' A personal petition from him came before the King in July 1737,;. but he tried to present a sImtlar petItIOn to P rincess Amalia a few months later he met with a serious rebuff. He formed a committee of ' governors and cruardia ns' of the proposed hospital and at last, in October 1739, a Charter was obtained for the establishment of a Hospital for the Maintenance and Education of Exposed and.

Children '-whIch IS the ongmal and correct name of the Foundling Hospital. He rented a house in

Hatton Garden and on the opening day, in 1741, the hospital received 20 ba bies under the age of two months, no questions whatever being asked of the person bringing the child; but it was requested that some writing or other mark or token should be affixed to the child so that he or she could be identified later, if necessary. Each child was inspected for any disease whereby the health of other children might be affected, and was baptized on the following Sunday evening.

As far as possible the children were to be sent to country foster parents till the age of three They were then to be 'brought up to labour fit for their age and sex.' When old enough to leave the hospital they were to be apprenticed, their apprenticeship remain.ing under the supervision of the hospItal; aI?-d at its conclusion, or on a gLrl marrying, each was t? be given clothin a and other artIcles to the b value of £ 10. ThIS programme underwent considerable modification as time passed. Plans we.re. up for the historic bll1ldmg 111 Bloomsbury Fields, which was completed in 1747, and then the Hatton Garden house was given up. A areat difficulty was that the number babies brought to the hospital was always far greater than be admitted, although about tWIce the number originally planned for were taken in. There was little knowledge at that time of the danger of infection when large number of babies were grouped together. Many of th.en?- had been neglected prior to so that it was hardly surpnslOg that about 40 p.c. died. It was .that the decision to send babIes mto the country to be nursed by foster parents was really put into effect.

Gove rnm en t Aid

As a result of a petition for aid, Parliament granted the ho pital , in 1756, an annual subsidy of £10,000 on condition that all children brought to the ho pitat under a certain age should be accepted. The age was at fir t fixed at two months, then six months and finally at one year. A basket was hung outside the gate into which a baby could be deposited, and then the bell was rung. On the first day of the new plan 117 babie were left at the gate. In 1he first four year under the Government subsidy 1-+.93-+ were admitted, many of them in a pitiable state of neglect, and over 10,000 died-rather more than t\\'othirds. During the period of Government support the children had to be employed as soon as possible and at five years of age worked at winding silk and makmg hemp and nets. Between five and eight years of age Parliament directed that they should make cloth. At eight or nine the children who were received under the Parliamentary grant were apprenticed: la!"ge groups being sent to factone. Before and after the Parliamentary grant no child was apprenticed under the age of twelve. In 1761 , Parliament withdrew its support, but this experiment in State had resulted in a great reductIOn of voluntary subscriptions .

Reorganization

When the Governors had exhausted their finances they decided to accept only those babies who were accompanied by a fee of This system was, of course. not m keeping with the founder's wishes, and when it was abolished the children were chosen on the merits of each case. The chief conditions were, and still are, that they should be illegitimate and under one year of acre and that the mother should borne a good character previous to her misfortune . .or delivery. This necessitated enqumes into parentage and thus the secrecy that was at first observed was no longer possible. All babies young children were boarded out ]11 the and later returned to Bloomsbury to be educated earn their living as respectable They were all taught and singing, and Handel himself

presented an organ to the chapel and personally superintended an annual performance of his , Messiah'; all the proceeds going to the funds of the hospital. It was proposed that the hospital should become a public school of music, but many supporters objected to this proposal, saying that ' music was an art of luxury and by no means requisite to life or necessary to morality.'

Present Work of the Foundling Hospital

In spite of its many viscissitudes the Foundling Hospital has continued its work for destitute children for over two centuries and its present comparatively secure financial position is, in a great measure, due to the wise development of the Bloomsbury estate and its tremendou s rise in value. In 1926, the Foundling Hospital originally opened in 1747 was demolished and a primary and a secondary co-education school was established at Berkhampstead.

At first these were called the Foundling Hospital Schaols , but this name was thought to confer a stigma upon its scholars and it was changed to the Thomas Coram School. In 1946, the primary school was discontinued because it was decided that the children should stay with their foster parents until the age of eleven and attend schools in thejr own district. The redundant accommodation at Berkhampstead was then taken over by Hertford County Council which now has 300 places for day boarders who live in their own homes, whilst about 100 resident boarders are from the Foundling Hospital; but these children return to their foster parents for all holidays. They are, therefore provided with as normal family conditions as possible. Like other children they can enter for scholarships for further education which will enable them to qualify for any profession for which they are fitted. still plays. an unusually promlllent part m the school curriculum and the choir gives a carol service at St. Pancras Church every year. Since January 1951, the school, which is still co-educational has been known as the Herts County Secondary School.

offices of the Foundling HospLtal are now in a new building

FIRST AID & NURSING, MARCH/APRIL 1952

in Brunswick Square, Bloomsbury and, nearby, are' The Cross Roads Club' and' The Coram Nursery,' with which is associated a Child Welfare Centre. Only the first child of an unmarried mother is eligible for admission to the Foundling Hospital, and he or she must be under one year of age. The Cross Roads Club is a hostel for mothers and babies. It receives mothers-to-be one month before the termination of pregnancy. They go inlo a maternity hospital for twelve days for the birth of their

babies and then they return to the hostel. The mother may be advised and helped to obtain a resident post so that she can have her baby with her, or non-resident employment when the baby may go to the Day Nursery; but if the mother wishes to give up the child entirely the Foundllng Hospital may arrange for its adoption or may place it with foster parents. In the latter case the child's life and education are supervised by the hospital until he assumes adult responsibilities for himself.

Books for First Aiders & Nurses

'A Handbook of Elementary Nursing' by Arthur D. Belilios, M.B., B.S.(Lond.), D.P.H.(Eng.) and Dorothea DuncanJohnstone, S.R.N. Bailliere, Tindall & Cox, price 7/ 6.

There is so much that is good in this book that one hopes that a reprint or a second edition might be improved by the correction of a few minor inaccuracies. do not agree that 'washing hair in bed is inevitably a strenuous procedure and the patient is exposed to a certain amount of cold' ; for much depends upon the development of a good technique; nor that after the application of lethane ' for a week the hair is neither brushed nor combed.' It certainly should not be washed-one hopes that washing is done before the application -but it can be combed as often as is necessary. The use of D.D.T. emulsion is not mentioned although this avoids the disadvantages of lethane for a verminous head.

The Higginson syringe is rather a dangerous instrument when used for the of an enema by an unskilled person; and IS glucose ever ordered as an addition to a rectal saline nowadays? or the nummular sputum of advanced tuberculosis ever seen from a patient who is under treatment for this disease? There is a want of clarity in some descriptions. For example an improvized ring pad for the elbow 0: heel is said to be 'made with a flarulel bandage and covered with cotton wool.' The instructions regarding a turpentine stupe are too vague to ensure that an reaction is obtained and blistering IS prevented; and in tepid sponging the patIent IS placed between blankets with a hot water bottle and the sponging is followed by the giving of a hot drink.

The second section of the book which gives a brief description of the more diseases and their treatment, prefaced by a short account of the anatomy and physiology of the organs concerned, is entirely sound and is adequate for the purposes of the book which, according to the authors' preface is designed to help those who, with-

out special training , are called upon to nurse a of their own household; and also as a help to members of the National Hospitals Service Reserve and the British Red Cross and St. John organizations. It could also become a valuable textbook for Assistant Nurses and thus fulfil a very real need . In its present attitude it might prove unacceptable to this great group of nurses becau se it so ignores their presence. M a y I suggest that an outline of the training of an assistant nurse, comparable to that given of a student nurse's training , should be i ncluded in a reprint.-A.E.P., S.R.N., Diploma in Nursing (University of London).

Aids to Practical Nursing,' Seventh Edition, by Marjorie Houghton, M.B.E., S.R.N., S.C.M., D.N.(London). Bailliere, Tindall & Cox, price 5 -.

The fact that this book is now in its seventh edition speaks for its usefulness and the soundness of the information it gives. Basic nursing prooedures do not change, but Miss Houghton has revised the text making slight alterations where she deemed them desirable and including an additional note. and there-for example, on the provlslOns of the Nurses' Act, 1949, as they affect the training and status of nurses the relation of the hospital to the and to the individual patient, and the newer antibiotics. With regard to the last mentioned, the nurse is reminded of her duty to keep herself informed as to new products, their modes of administration and the precautions to be observed in their use. The scope of the book is comprehensive enough for the average student nurse for it covers the syllabus of the General Council in practical nursing it is conveniently small in size in spite of its 370 pages, and its price is still only 5/ -.-A.E.P., S.R.N., Diploma in Nursing (University of London).

(continued on page 16)

A NEW EDITION

WARWICK & TUNSTALL'S FIRST AID TO THE INJURED AND SICK AN ADVANCED AMBULANCE HANDBOOK

Ed iced by A. P. GORHAM, M.B., CH.B., M.R.C.S., L.R.C.P., D.A. Corps Surgeon, St. John Ambulance Brigade Surgeon, City and County of Bristol

At last this well-known First Aid manual is again available-in a completely revised edition with over 280 illustrations, a large number of them in colours. An indispensable handbook for all engaged in nursing and first aid, Over 250,000 copies have already been sold in previous editions. Order your copy to-day through your bookseller or direct from the publishers

A NEW FIRST AID FILM

'HELP' is a brilliantly produced film des igned to introduce children to F irst Aid.

Here is an interesting and often exciting les s on in pictu r es that young people can easily understand and remember.

FOR YOUTH

Junior Red Cro ss and all you t h o r ga nizat ion s It is a 16mm. sound film th at l as s 13 minu tes. 'He lp' h as been seen and app r o ved by lea ding a u tho ri ties a nd can be ob tain ed from :

The Film Librarian, Sound-Services Ltd., Nineteenth Edition 286 pages

JOHN WRIGHT & SONS

A Handbook post this form

6s. 6d , postoge 4d. 269 King ,ton Rd., London, S W 9

BRISTOL

, Help' teaches them the principles of Fir s t Aid in a way that they will enjoy and leaves them with a re a l enthusiasm for it s s ubjec t

Help' can be obtained on free loan by schools, the

•

The Public Relations Dept.• T.}. Smith & Nephew Ltd., Neptune Street, Hull

T. J. S mith & Nephew Limit ed /11C11ll1facfll rers of E lastoplast alld ElaslOcrepe

of Elementary

by Arthur D. Belilios, M.B. , B S. , D.P.H., Phys ician a nd Lectur er to Studen t Nmses, Wimbledon General Ho spital ; Lecturer Battersea Pol y technic a nd Dorothea Duncan-Johnstone, S R. N With 314 pages and 57 drawings.

This handbook h as been de s igned to pro v ide , in s imple la nguage and without el a bora te technicalities , an introduction to the general principles and ba sic procedures which unde rlie the whole science of nursing. These are based on recogni sed ho spital procedure, a n d are described in a s imple manner so that they can be readil y unders tood by readers who have had no previous introduction to medical subjects

The second part of the book is devoted to a brief description o f so me of the m ore common diseases , with general notes on the type of nurs ing required in each ca se a nd the whole thus forms a comprehensive volume of reference and guid ance for aU who may be called upon to carry out any form of nmsing.

DALE, REYNOLDS & CO. LTD. 32 Finsbury Square OR London EC2

BAILLIERE, TINDALL & COX 7-8 Henrietta Street London WC2

Please send me copy/ies of A Handbook of Elementary Nursing for which I enclose remittance of..

Namc Address

E. H. (Harrogate) writes;-

At a practice ),esterda)" the point lVas raised in connection with the first aid treatment of fracture of both legs, what 11'as the correct reading of the instruction on page 149 of the 40th Edition as regards treatment , when both legs are fractured and no assistance is available.' Should three splints be used, or only the one centre splint ? Instructions 1, 2, 3 and 4 are quite plain but there is a of opinion as regards Instruction No. 5. Personally, I think three splints are necessary but No. 5 reads.' , appl)' bandages round both limbs in the order sholVn.' Should this not read.' 'apply bandages and splints in the order sholVn in Fig. No. 105 ' ?

Reply

There can be little doubt that when bot.h legs are fractured and no assistance is available, only one splint should be used as described on page 149 of the 40th Edition of t.he S.J.A.A. Manual.

G. M. (Ola111.) writes ;-

In our Divisional Competition this year, under our nelV Edition (40), we had to treat a patient suffe ring from the follolVing injuries.' Severe haemorrhage from lvound in brachial region (right arm), simple fracture of right forearm 2 in. above )Vaist fracture of spine in dorsal region: and greatly shocked. Patient was lying on his right side, 011 his right arm.

queries

Answered by Dr. A. D. Belilios, M.B., B.S. (Lond.), D.P.H. (Eng.)

Our treatment.' Haemorrhage controlled digital pressure. Subclavian artery shock treated. Pads ankles, knees, thighs, figure of 8 to feet. Broad bandages over intervening pads and traction at head and feet, then gently turned on his back on to a blanket. Wound on arm treated, also fracture offorearm. Digital pressure relaxed, haemorrhage contr011ed lvith pads and bandage.

Doctor complimented our team on our excellent work, but we were p1aced second in the competition. On examining the marking sheet we were surprised in losing very high marks .' 5 marks for applying tourniquet to brachia1, 5 marks for releasing tourniquet, 8 marks for removing paNent on his side and 3 marks spTints to right forearm.

I would !ike to have your guidance for future competitions.

Reply

Competitions are not always marked strictly in accordance with the book and your question is not easy to answer since you do not describe the circumstances of the accident which might have influenced the judge- in drawing up his mark sheet. So far as the bleeding is concerned, a constrictive bandage must be applied if the haemorrhage cannot be controlled by direct pressure on the wound. It is only if the constrictive bandage cannot be used that indirect pressure at the pressure point should be employed. So far as

Miscellaneous Advertisements

the remainder of YOUL question is concerned, further information IS required.

H. S. W. (Chasetown) writes ;-

I lVould esteem it a great favour if you could put me in touch with a firm that make fake markings for ambu1ance competitions.

Reply

An article on the Faking of Casualties appeared in this Journal in August 1949, while textbooks have also been published on this subject. A firm of theatrjcal suppliers such as Barnum's, 67 Hammersmith Road, could be consulted, although 1 do not know of any firm which actually specializes on this work. The easiest method is to make friends with a local repertory company.

British Red Cross Society publIsh a booklet on Faking, and the Casualties Union, 12 Bedford Row, W.C.1, wjll give guidance on the subject.-Ed.)

A. J. M. (Dagenham) writes ;-

When using a ring pad' for controlling bleeding from the scalp, should we use a narrow bandage to control the ring pad or bandage for scalp' (ng. 33), or both ?

Reply

A narrow or even broad bandage is preferable to the' bandage for the scalp' since it exerts better pressure.

R. S. M. (Southend) wriles :Why is it necessary to relax a cO:1strictive bandage every tll'en!y mll1ules ?

(continued on page 16)

AMBULANCE GEAR

The Gear IlIustrated(A.B.C.D.) carries two stretchers on one

QUERIES (cant. from page 14)

Reply

A constrictive bandage not only stops the bleeding for which it is a'pplied but also deprjves all parts below the level of its application of their blood supply. Relaxing the bandages every twenty minutes, even if only for a few seconds, prevents complete ces sation of the circulation. Moreover, relaxing the bandage relieves pressure on muscles and other tissues over which it is applied; if these are damaged, the patient may develop symptoms similar to those which occur in crush injuries.

A . J B. (Charlton) writes :-

A m emb er of our Division has told us that if a pa tient s lvallows a needfe and ;t ent e rs the stomach, it finally lea ves th e body from the right s houlder. Other fri ends of mine say they ha ve a/s o heard of this. Is this tru e?

Reply

No. The fallacy arises from the fact that if a needle enters the body it can move for a long distance. This results from the action of muscles and the movements of the body.

NEW BOOKS (cant. from page J2)

British Red Cross Society Welfare Services Manual No. 12, Edited by R. G. Gilmour, A.M.I.A., price 4 /6, postage 3d. B.R.C.S., 14 Grosvenor Street, London, S. W.l.

It is hoped, says the author in her preface, that this textbook will serve a threefold purpose: that it may help students in their Welfare Services Course serve as reminder to Welfare members in their subsequent work, and also be of some guide to the selection of material for all those who set out to lecture in the course. The purpose is admirably met, but in addition many others will find this manual useful.

Welfare, as a distinct branch of Red Cross work, started during I'he last war when a great deal of social help was combined with first aid treatment following raids, etc. The need was great and it was decided that the work should go on, and should be extended to cover the needs caused by illness, incapacity or old age. Since then departments for welfare have been organized in every county , and many have a County Welfare Officer. Welfare workers work closely with members engaged on first aid or home nursing, and there is no rigid divergence.

It is a vast subject but the manual ranges concisely and in an informed manner over the whole field. The slatutory and social services are dealt with at length , and this is a most useful section. There are chapters , too, on the Red Cross Welfare Services , Diversional Occupation , the Tssue of Gifts, Services undertaken jointly by Red Cross and St. John , Individual Consideration, Home Visiting, Record Keeping, Family Case Work, and the\Almoner and her Duties. This new Red Cross manual will be read with profit by all connected with welfare.

'The Lamp is Lit.' The Story of the World Health Organization by Ritchie Calder. Stationery Office, 1 6.

The lamp of Mr. Calder's title is the lamp of health, which the World Health Organization seeks to light amid the darkness of disease and misery. Small as the light may be to-day, the shadows arc already falling back.

Leading us through the great range of W.H.O. activities- from the world-wide radio network, giving daily warnings of epidemic outbreaks , to the co-ordination of research on a score of diseases not yet fully understood by scientists- Mr. Calder still finds time to look down some fascinating byways the fact that evidence of poliomyelitis has been found in Egyptian mummies of 1500 B.C., that Alexander the Great may have died of malaria , that influenza was almost certainly the' sweating sickness' which raged in deadly epidemics during the 16th century.

The details which Mr. Calder gives of the work already being carried out by W.H.O. are impres s ive in themselves; but there is more to this booklet than a catalogue of dramatic material achievements. There is a clear reaLization of the wider functions of the Organization. 'It is in less dramatic but enduring ways that W.H.O. will have permanent effect,' he declares. 'Tt cannot itself create the social changes which will produce well-being for those who now lack it. It cannot do the job of governments, but it can help governments to do their job better and faster. It can send out its daily bulletins on the movement of epidemic diseases, but its real achievements will be when, for the good of themselves and the rest of the world , governments stamp out the conditions which breed and spread infection.'

FIRST AID:-

General Rules

Examination

Fractures

Dislocations

Sprains

Wounds

Hremorrhage

Types of Bandages

Splints

Shock

Artificial Respiration

Lifting

Transporting, etc., etc.

HOUSEHOLD PHYSICIAN ( UP-TO-DATE )

NEW EDITION

Describes in simple language, With helpful coloured plates and diagrams

The COMPLAINTS OF MEN, WOMEN AND CHILDREN

Thei r Cause, Treatment and Cure

A few of the Subjects treated:

First Aid

What to Do in Emergencies

Influenza, Colds, etc.

Measles, Mumps, Catarrh

Corns and Warts

Physical Culture, Self Defence

Treatment for all Skin Diseases

The Lungs, PleuriSY

Hygiene, Anatomy, Pharmacy

Fevers, Bladder, Kidneys

Pregnancy, Childbirth

Home Remedies, Diet MOVABLE MODELS OF

HUNDREDS OF TESTIMONIALS

" I am delighted with' The HouseholQ Physician,' and as I am an Ambulance man, I can appreciate them to their fullest extent."

"Being a Nurse it is of great help to me."

Principles of Nursing

Eye, Ear, Nose

Th roat, Live r

Chest, the Heart

Stomach, Duodenum

Teeth. the Muscles

PRESCRIPTIONS

375 proved remedies

MOTHER AND CHILD teaching pictures

BEAUTY TREATMENT

Child Welfare how to bring out your best points

Homceopathy, Arthritis

SELF DEFENCE

Neurasthenia what to do if attacked

Rheumatism,

Male

A "COMMER" AMBULANCE

Q4 'ta\ f inter-hosPI ted o r { 4 t\ y construe dation o r

Re cen h aving aceo mmo ith at t ent r ansport , d 8 sitting c ases (w dant) t etcher an (w ith atten s r 18 sitting cases fitted with dant) , or compartment. Separate \uggag e wire\es s . . d ambulances n specialise eonThis is one of ma Y designing and re continua\\Y nd yOU are that we a urposes , a . for variOUs P ur requl restruct lng d details ot yo b ad d se n h re a ro inv ite to try Of anyw e th iS eo un m ents In

Because of its many possible implications, headache can be an exacting problem in diagnosis. Often, indeed, it is only by response to treatment that its true origin can be determined Yet relief al ways remains the first consideration. Anadin Tablets provide a safe analgesic in all uncomplicated cases of headache. The tablets are rapid in action, well tolerated and combine the pain -relieving effects of aspirin and phenacetin with the mild stimulant action of caffeine and quinine.

aIf you are logical person ••.

... Then you will follow this point-by-point argument and reach the same conclusions as so many doctors, nurses, hospitals and clinics have done.

DO YOU AGREE ... that the causes of most skin infections are the cornmon strains of STAPHYLOCOCCI, STREPTOCOCCI and B. PYOCYANEUS ?

IN THAT CASE . a treatment which is effective against all three will be indicated for cuts, abrasions, burns, scalds, boils and most inflammatory skin infections?

THIS IS THE TREATMENT

ANTIPEOL Cutaneous Vaccin e Ointmen t contains the sterile vaccine filtrates of the three micro-organisms mentioned. The filtrates destroy the actual micro-organisms and at the same time act as a local immuniser against re-infection. This is a

purely biological action and there is no damage to delicate tissues.

RA PID HEALING is further expedited by the ointment base of proved efficiency. For burns and scalds, ANTIPEOL has special advantages. It is microbicide an d non-adhesive. Therefore dressings do not have to be changed every day.

AND HERE IS THE PROOF.

Antipeol Ointment is proving and reproving itself every day in dozens of su rgeries, clinics, hospitals and homes. Letters from the medical and nursing profession bear convincing testimony to its effectiveness.

THERE is the logical argument for including ANTIPEOL Ointment in every First Aid kit. As a logical person, why not send for full details an d a clinical sample?

antipeol

cutaneous vaccIne ointment

Produced by tbe makers of : ENTEROFAGOS for intestinal complaints; RHINO-ANTIPEOL for nasopbarynx infections; OPHTHALMO-ANTIPEOL for ocular infections; DETENSYL for reducing arterial tension.

Mass R adiography for igeria 5

Competition ews 6

British R ailways 8

Burns and Scalds 9

New Book s 10

Red Cross News II

Topical Notes for First Aiders n nd ur es II

Readers' Queries 14

WILL you plea c tell me 110\\ 1 can take up Fir t Aid ?'-

That query is a fairly common one at this office, and when we end on details of the nearest ambulance or nursing organization, we often wonder \vhat ha prompted the enquiry. Most recruits to first aid, we would say, are obtained by personal contact, by member of St. John or the Red Cros interesting their friends in the work and bringing them along to first aid classe.s. But now and again someone takes it into his head to learn about first aid, probably looks up the telephone book, ees our name and writes out of the blue. Why?

A group of first-aiders, returning from a competition in a motor coach, were recently discussing recruiting, and this question of why people join fir t aid organizations was debated. It so happened that nearly all those present had joined becau e their parent or friends were members and had roped them in. But one man told ho\\ a single incident had 0 affected him that he had felt compelled to learn first aid as a duty, and because his story impressed us we are repeating it here.

Returnin g home one night by car-a dark, dreary evening with a drizzle of rain-he was thinking with a glow of comfort of the warm firelight and pleasant meal awaiting him after a bu y day, when rounding a corner he came upon two cars locked together on the side of the road, an d a small crowd standing by, watching. The accident had happened only minutes before and no ambulance, policeman or fir taider had arrived to take charge. One man \Va stretched out 011 the pavement, another wa sitting by

Opi"i "

holding head. And the small cro\\ d, watching. We might almost call it a familiar ight on the roads.

The man WllO \\a s lelling the tale \yent on: One of the c.us \\ a a van. and as I appro ached my headlights revealed someone I) ing grotesquely in the bad , he a d right bac\., and leg d a ngling O\ er the side. 0 \\ a after him, although only a fe\\ a\\ d) people \\'ere standing taring 1 \Va indignant when I stopped the car and went back, but my indignation changed to di may and helplessnes \\ hen I realized that there was nothing I could do There was none of the ob\ ious thing to do, no limbs to bind up or blood to top flowing. Just a broken bod}. and for all 1 knew it \\ould do harm to shift him. All I could do \\ a to \\ ait for the ambulance - become one of the crowd. watching. And it \\'a so dark. ) ou could Ila rdly ee \,hat you were doing.'

As he went on his \\ ay he had a burden on hi mind. he realized thal he had been found wanting. A fellow being \\ a lying hurt en tbe darkness and he could give no help. He wa disturbed, and annoyed at hi u ele snes He \ owed then that it would not happ::n again. And so - a recruit out of the blue.

We can learn something from this story \\ hen we come to think about recruiting. We ometimes seek to attract recruit by empha izing the ad\ antages of belonging to a fir t aid organizalion - the good fellowship and 0 on. Many more people, \\ e imagine, would respond to a clear call to dUly- the obligation to kno\\' omething about fir t aid o that tlley an help in an emergency.

Hygiene

A N important object of these articles is to broaden the mind ·of the first-aider and, for this reason, during the past few years, much new ground has been covered such as Elementary Medicine and Medical First Aid without, however, losing touch with first aid itself.

ow, after a number of articles written to assist the student in his study of the 40th Edition of the S.l.A.A. first aid manual, the time has come to explore new fields, and for this purpose Hygiene has been chosen.

Both the S.J.A.A. and the B.R.C.S. publish textbooks on hygiene; courses of lectures are arranged and certificates are awarded to those who are successful in their examinations. But for some reason or other, the demand is not very high and there does not seem to be much enthusiasm for the subject. This is sad since hygiene is of the greatest importance in daily life and its practice essential to the well-being of the individual quite apart from the community as a whole.

Hygiene is a science which is concerned with preserving and improving health. It is a big subject since it can be studied from so many aspects such as the provision of water supply to the community, the construction of houses, the influence of climate, etc. The manin-the-street, however, is mainly concerned with hygiene as it affects himself; the more advanced branches are left to the experts such as Medical Officers of Health, Sarutary Inspectors and other officers of hygiene. It is appropriate, therefore, to begin this new series with a few hints on a branch of domestic hygiene of great interest to everyone, namely, how to keep fit.

Keeping fit depends on observing a number of rules of health such as eating the correct kind of food keeping the muscles in good order' looking after the bowels and many

(1) How to Keep Fit

By A. D. Belilio s, M .B. , B. S (Lond.) , D.P.H. (Eng.)

other points which will be described later. It is, however, only fair to point out that observing these rules can only produce the best degree of fitness for any particular individual. There are, unfoTtunately, a number of factors beyond control which may cause ill-health whatever precautions are taken. Certain diseases, for example, are inherited while others develop without known cause or means of prevention. It is essential therefore to preserve a balanced outlook and above all not to become a 'faddist' which, in itself, has its dangers and may produce false optimism. Thus an author wrote a book on 'How to live to be a hundred,' based on observing numerous rules of health which he practised rigidly. Deeply absorbed in his subject, on his way to give a lecture he failed to observe the rules of road safety and died, aged 60, from multiple injuries.

Exercise

Almost everyone appreciates the value of exercise, but in tbese modern days many temptations supply an excuse to avoid it. Those who live in towns, for example, often take buses for short distances and deprive themselves of tbat brisk walk which would be beneficial to health. Motorists, indeed, are bad offenders since they even use their cars to go to the post! Regular daily exercise is of benefit to health and it is usually estimated tbat one hour a day is desirable, whenever possible in the open air.

Exercise is nature's method of· the muscles well tuned up ; J t preserves muscle tone which is that slight tension always present in a muscle and necessary for it to act quickly and efficiently. Moreover, exercise ensures that muscles become and remain well-developed and not flabby; it is well known that wben not used they tend to lose their strength and even to waste.

But exercise does more than to keep the muscles in good condition. It benefits every otber system of the body; for example, stimulates the heart and circulation and ensures that the lungs expand efficiently. A few words of warning are necessary in regard to the nature and length of exercise. Obviously it must be suited to the age and physical fitness of the individual.

Sudden and violent exercise undertaken by those who are out of training may have serious consequences. Thus a man of 35 who had forgotten both his age and lack of training took part in a relay race, running as hard as when he had last taken part in the sports at school. At the conclusion of the race he collapsed from exhaustion. Fortunately, nature provides warnings when exercise is excessive. Undue shortness of breath, a rapid and forcible heart beat suggest over exertion. Feeling more than pleasa ntly tired is another sign that exercise has been overdone. Exercise immediately after a meal is generally agreed to be undesirable since the digestive organs need an increased blood supply to undertake their task; this cannot be obtained jf an extra supply of blood is also required for muscular activity. Much depends, however, on the age and fitness of the individual, but in all cases it is pro bably wiser to avoid strenuous exercise, e.g., swimming and running, immediately after a meal.

Ment al Exercise

It has long been appreciated that a healthy mind plays an important part in maintaining physical fitness; indeed, nowadays many physical diseases can be traced to a cause arising from within the mind. The subject of cultivating and maintaining a healthy mind is a big one and cannot be fully discussed in an article of this length. But the value

FIRST AlD & URSI ' G, MAY JU E 1952

of mental exercise can at any rate be mentioned. It is essential to keep the mind keen and alert. For this purpose everyone should indulge in some form of hobby apart from his normal occupation. The variety of mental exercise depends on the talents of the indivjdual ; art, music, study, social work and enlivening conversationall have their places provided they provide interest. Some hobbies are of considerable value, particularly if they require brain-work as well as being manual. It has been said that the happiest of men are those who work both with their hands and their heads.

Sleep

Both the body and the mind require rest if their efficiency is to be maintained and this need is supplied by sleep, ,vhich must be satisfactory both in quantity and quality. The amount of sleep required depends to a certain extent on age. Thus the newly-born baby should sleep almost continuously except for times when it is fed and bathed. At the age of one the child requires fifteen hours' and at six, twelve hours' sleep daily.

So far as adults are concerned, the average are satisfied with eight hours per night; some, however, require more and others less. Each individual has his own optimum which he must discover for himself and endeavour to maintain. Some possess the gift of being able to take a short nap at odd moments apart from their regular sleep; this is a good habit since it revives the activity of the mind and body. The quality of sleep is of considerable importance. Some people, for example, always awake tired and feel as if the} have not been rested. This may be caused by lying in an uncomfortable position while asleep and not permitting muscles to relax satisfactorily. In other cases, however, the mind may be too active and sleep restless, possibly disturbed by dreams; this in turn may be caused by a worry or conflict, known or unknown to the individual. Those whose sleep is defective in quality are best advised to consult their doctor or a medical psychotherapist rather than to treat themselves by taking the numerous remedies recommended for 'night starvation.'

D e , -elo p Ol e n t o f CWld Care in Uritain-3

By Agnes E. Parey, S .R. N , Diploma in Nursing (UniYersity of London)

The P art Played by Sunday Schools

IT is difficult to compare the standards of living in different ages, but aU the evidence seems to show that, in this country, the level reached in the 18th century was as low as at any time in our history. Not only were unemployed and disabled persons completely destitute but wage-earners frequently needed parish relief to keep them and their families from starvation. Children had to obtain work whenever possible, but they could not always find employment. Then they often begged or stole for sustenance. When caught by the police they could be imprisoned, transported in chains or even banged.

Charitable societies sprang up in great numbers and many schemes were proposed for helping the poor. It was during this period that the first efforts were made to educate poor children. Sunday schools had been established in Catterick in 1763 by Theophilus Lindsey, at High Wycombe a few years later by Hannah Ball, and in sundry other towns. But these were isolated effort which ceased when their founders died or left the locality, and they ,, ere little known outside their own vicinity.

The "Vork of Robert Raikes Born, in 1735, into a well-to-do middle class family of Glouce ter and becoming, in young manhood. the proprietor of a printing and publishing firm \\ hich owned the Gloucester Journal, Robert Raikes was in a position to give wide publicity to any movement which aroused his interest. He often visited the County Gaol, Gloucester, and was horrified by the terrible conditions. There was no segregation of the sexes or of children and there was much licentiousness and profanity. He realized that most of the criminals were quite uneducated and had never heard the precepts of Christianity. He felt that it was too late to reclaim the hardened offenders, but that something could, and must, be done for the potential criminals of the future-the ragged, hungry, unruly

and often blasphemous children who swarmed in the streets after nightfall and on Sundays. He thought that if they could be given a rudimentary education and be taught Christian principles and ways of earning an honest living they might grow up into worthy citizens. Most of them worked in various factories during the week, so that Sunday \\'a the only day on which they could be given instruction.

Robert Raikes enquired if there were any women who kept schocl in the neighb9urhood \,"ho would be willing to help, and he arranged with four such women to receive as many children as he could send on Sundays. A local clergyman named Thomas Stock undertook to "isit these school on Sunday afternoons and give what help he could. This was in 1780 and the schools ,,,ere for boys only. The children were taught to read and to be as clean and tidy as their ragged clothing \-vould permit, they learned singing and \"ere giYen religious instruction. A set of regulations was drawn up and printed on Raikes' own press. As m03t of the children were hungry as well as ill-clothed many charitable people helped to provide tbem ,vith dinners. Raikes published numerous articles in his Glouc ester Journal concerning the need for such school. and had letters and articles of hi own published in other papers and magazines. Before long, Sunday schools had started in many tovm and cities and, in 1785, the ' London Sosiety for the Establishment of Sunday Schools' v;as formed 'to co-ordinate the work of the chools, to spread the movement and to tart schools for girls or for both sexes together.·

In the following year it was estimated that 200.000 children were attending these schools. The subjects taught were reading, writing, simple arithmetic, personal cleanlines and the Christian way of life. Some critics accused Raikes of Sabbathbreaking because he et the children to work at learning secular subjects, and he himself realized that one day in seven was not enough to counteract the influence of the other

six; so he tried to arrange clas es during the week, especially for the children who \\ere out of work. It i strange that he ne\ er. criticized child labour or the unsamtary conditions in which the children worked in the local factories. There was strong prejudice, in some quarters, aaainst teaching the children of the lest they"" learned to despise manual labour and take employment away from middle class children. These opmlOns were expressed even in Parliament and William Pitt seriously contemplated introducing a Bill for the suppression of Sunday schools. The movement, however, had greater results than Raikes and his contemporaries \ isualizcd for in order to teach children and morality they had to be taught to read. Parents were also encouraged to corne to the classes; and thus the Sunday schools were the pioneers of a form of popular education that was to develop and endure.

Sarah Trimmer and the Teaching of Industries

Sarah Kirby was the daughter of an artist who was a friend of Gainsborough. Hogarth and Reynolds. She was born at Ipswich, in 1741, was brought up in a strictly religious manner and, \",hen 21 years of age, she married James Trimmer of Brentford. She had twelve children, educating her daughters entirely at home and partly educating her sons; but it was not until 1780 that she arranged the lessons that she gave her family into book form as An Easr Introduction to the Knowledge oj Nature. This reached its eleventh edition by 1802, and by that time she had become a prolific author of books for both children and adults. She turned her attention to Sunday schools in 1786, establishing three of thirty scholars each, one for big boys, one for girls and one for little boys; engaging teachers, hiring rooms and purchasing forms, books and other equipment. Young ladies at two boarding schools were encouraged to supply and make garments to replace the ragged attire of the poorest of the children. In two months the schools had 37 boys and 122 girls. Three months later Mrs. Trimmer was granted an audience by Queen Charlotte at Windsor Castle, and as

a result of her comer ation \\ ilh the Queen she undertook to \\ rite an account of the Brentford school and of other such enterpri e in El1gland. Queen Charlotte became a Patron of Brentford school and a1 0 a subscriber. Mr. Trimmer then tarted the exten ion of the work for which she is chiefly famous-she established schools of industry for weekdays. At first, flax spinning was the only industry taught, an exp"rt spinstress beil1g employed to teach the children. T\\ 0 other school \\ere started-one for knitting stockings and the other for plain ewing. Then cotton winding was introduced. The giri \\ ere allowed half their earnings and, in addition, they might win reward tickets. Similar school were established in other parts of the country, for example, those founded in the Mendips by Hannah M ore and her sister: but it was difficult to run them on an economic basis, so that although they marked another step in improving the lot of the poor or destitute child they had no lasting success.

Ragged Schools

These were a natural offspring of the Sunday schools and the schools of industry. The original founders appear to be unknown, but they were firmly established by 1839 and a Ragged School Union was formed in 1844 to give permanence, regularity and vigour to existing Ragged schools and to promote the formation of new ones.' early all the social reformers and philanthropists of the middle] 9th century were associated with the work of the Ragged schools, many of which gave food and night shelter to destitute 'street arabs.' Several of the important societies for child care of the present day started in these Ragged schools and the movement itself continued to grow until 1870, when the passjng of the Education Act rendered such schools unnecessary. Thus, once again, we see almost a century of voluntary work forming a prelude to Government action by demonstrating the value and the workabi lity of such a social service. The introduction of compulsory education could not have come about as it did had not the foundations been so well and truly laid by the Sunday schools and the Ragged schools.

St. JaIL"

B ltBIOGBAPHY FOB NI GERIA

The official handbook 1952 of the St. John Brigade of Ireland stale that the Ambulance Section consists of: Staff 14, Divisional Officers 52. Rank and File 534, Medical Officer 13, and the number of Divisions 19.

District Officer J. S. Smurthwaite report : During the year Divisions on the \\hole haye attended public duties in a satisfactory manner. Competitions perhap not as successful as we might expect or the standard as high as we would I think thi . is due to the difficulty of giVIng up the practlce of the old book and acquiring the technique of tbe new. We congratulate City of Dublin Division on \\inning the Iveagh Cup. and our friends from Limerick in taking away the Novice Cup. The School of lnstructio.nhas again fulfilled its purpose. Of the DIVISions I had the pleasure of in pecting last year it is pleasing to see many old faces among the new and I think the Countess of wa more than surpri ed to see so many Ser,ice Medals in evidence as she v.ent n the ranks of those v.ho turned out to bid her welcome.'

Chief Staff Officer Letitia Overend report (hat there are 18 Nursing Divi ions with approximately 265 members and II ursing Cadet Di\ isions with 248 members.

C ha r lto n

The C.112 (Charlton) Cadet Ambulance Division recently celebrated its second birthday when a party was held at Charlton House.

The Division wa inspected by the President of the Division, Councillor George Bruce, J.P., and Area Cadet Officer G. W. Woodhill, in whose Area (South-Eastern) the Division functions.

After tea the President congratulated the boys on th'e occasion and reminded them that although only two years of age, Division had already secured a place 10 Brigade history. It was, numerically, one of the strongest Divisions in the South-Eastern Area, and also held the record throughout the whole of the Brigade Cadet Movement for the most dut ies performed in one year (i.e., 1951, when 1,936 hours' duty were performed) and for having the boy holding the largest number of duty hours ever recorded in one year.

The party was followed at 6.30 p.m. by a social evening to which had been invited representatives of various other Divisions in the locality and also the parents of the Cadets. Master at' Ceremonies for the evening were Cadet Divisional Oftlcer S. A. Palmer and H. Sgt. P. R. T. Hall.

o,.er t,-, ('·0"·,1 A-If/t!llts

THE National Association for the Prevention of Tuberculo is has recently stated that in some of the Colonial territories of the Briti h Commonwealth tuberculosis may be about to increase. It i a great problem which is being closely watched and tudied. The ad ance guard in the attack en tuberculosi is detection, and X-ray apparatus is playing as important a pan in the campaign, a it does in this country.

In thi connection interest attaches to the new mobile mas radiography unit recently handed over to the Crown Agent for the Colonie, and which has been specially de igned to provide com-

MEDICAL

plete facilities for X-ray survey of the public of Nigeria in the detection of tuberculosi

The unit is complete with water STorage, electric power and all essential equipment for the purpo e. It has been de igned in two ection

to obtain greater scope, manoem rability and better di tribulion of weight to enable it to cope \\ ith rough and unmade road ' Jnd \\ ooden bridges which exi t in the territory in \\:-hich it will \\ork The unit have al 0 been to \\ ork under extremely high temperature ranging from 90 OF. to 130 OF. so that normal film de\elopment temperature can be maintained.

One ection (the darkroom) hOll es the electric power unit and complete facilities for developing, \\ a hing and drying X-ray film ranging from 35 mm. miniature to the large 17-in. by l-+-in. radiography.

The other ectiol1 function a an X-ray room complete \\ itll ma s miniature X-ray apparatus for taking films of the che t, and incorporate ' a epa rate control room and the doctor's room for the projection and examination of film.

The unit was manufactured by Messr. Pilcher of 31-+ Kingston Road, London, S. W.20, under the supervision of the Crown Agents for the Colonies.

The X-ray unit \\'3 upplied by \Vatson & Son (Electromedical) Ltd. and the whole unit wa contructed on Thornycroft Sturd diesel-engined eha is.

The mobile uniT ready for radiography

Seen here inspecting the unit before shipment to Nigeria are Ieft to right), ,Y1r; P .1.

Sir John A. Calder, K C. (Crown Agent for the Mr. J. "'. N0rn Inspecting Engineer), Mr. A. W. H. Keen (Deputy ChIef Engineer), and Mr L. A Ptlcher (Director of Pilchers. the 1l1nn\lfaCT\lrers).

Stanley Shields Competition

H.R.H. The Princess Rcyal, Commandant-in-Chief, presented the shields and prlzes to winners in the British Red Cross Society's Stanley Shield Competition, held at Friends House, London, on 10th May. Eight women's teams and six men's teams were in the finals, and the winners were :-

Stanley Shield (Women)-Somerset ,' 518 (Winners), E. Lancashire 8 (Runnersup); (Men)-Durham 79 (Winners), Middlesex 211 (Runners-up).

Hetherington Cup for Nursing-Somerset / 518.

Evelyn Wren Cup (Women)-for officer with highest individual marks, Mrs. R. Kennedy of Somerset 518.

Georgina E. Morgan Bowl (Women)-for member with highest individual marks, Miss L. Redman of East Lancs 8.

Margaret Gordon Harker Cup (Men)for team leader with highest individual marks, Mr. M. Hall of Durham 79.

Lt.-Colonel R. M. West Cu p (Men)-for member with highest individual marks, Mr. A. Harvey.

British Transport Commissio n Police

The position in which the teams were placed by the Judges in the Final Competition held at the Central Hall, Westminster, London, S.W.1, on 16th May 1952, is given below.

The challenge trophies were awarded as follows ;-

Sir Bertram Ford Shield (Championship): London Area (Liverpool Street).

Chief of Police Cup (runners-up) : Midland Area (Preston).

Lieut.-General Sir Henry Pownall (Chancellor of the Order of St. John) presided at the distribution of the cballenge trophies and the individual plaques were presented by The R ight Honourable Lord Hurcomb (Chairman of the British Transport Comrn.jssion).

1. London Area (Liverpool Street) 436$

2. Midland Area (Preston) 4141

3. Eastern Area (Parkes ton Quay) 372-

4. Scottish Area (Edinburgh) 364

5. South-Western Area (Exeter) 334t

6. Northern Area (Hull) 309t Members of the winning team, London, Liverpocl Street, were:

A. Murphy (leader), J Graham, W. Crotch, J. Pooley, J Gordon (reserve).

Judges were: F. M Hanna, M.A., F. R .C.S. (Team);

1. E. Whitehill, M. R .C.S., L. R .C. P (Individual Tests); J. C. Graham, M.R.C.S., L. R .C. P (Oral Tests)

B ritish Ra ilw a ys and L ondon Tra ns port (Rail wa ys) The finals of the National First Aid Competitions, British R ailways and London Transport (R ailways)

Li\erpool Street, winners of the Transport Police Competition, in action

were held at the Central Hall, Westminster, on 16th May, and the winners were :-

Me n:

Inter-Railway Shield (Championship): Western Region (Bristol D.O.S.O ). Corbet Fletcher Cup ( R unners -up): Southern Region (Exmouth Junction No.1)

Wo m en:

B urrows R ose Bowl (Championship): London Transport (R ailways), (Broadway).

Lieut.-General Sir Henry Pownall (Chancellor of the Order of

Bristol D O S.O. recei' e the Inter-Railway Shield from Lord Hurcomb, Chairman of British Transport

St. John) pre ided at the distribution of the challenge trophie and the individual plaques \"ere presented by The Right Honourable Lord Hurcomb (Chairman of the British Transport Commission).

Marks were a\varded as follows :-

Men

]. Western (Bri tol D.O.S.O.) 495}

2. Southern (Exmouth Junction o. 1) -+66t

3. London Midland (Derby M. &

E. E. Boiler Shop' B·) 442 ,t

4. orth-Eastern (York C. & W.) 435}

5. Eastern (King's Cross M.P.)

6. Western (Taunton) 419!

7. Scottish (Dunfermline) 409-

8. London Midland (Camden 'A') 405

9. Southern (Brighton No.1) 372!-

10. Eastern (Colwick) 365}

1l. London Transport (Lots Road) 361-

12. North-Eastern (Dews bury) 356

13. Scottish (Eglinton Street) 319}

Women:

1. London Transport (Railways), (Broadway) 435!-

2. Southern (Brighton) 407-

3. Scottish (Glasgow) 382

4. London Midland (Horwich Accounts) 38 H

5. orth-Eastern (Hull D.O.S.)

6. Western ( ewton Abbot) 375-

7. Eastern (Marylebone 'A')

Team members were: Bristol D.O.S.O.-L. A. Webber (leader),

S. E. Guy, J. V. Young, A. Nevett, M. H. Gard (reserve); London (Rai.lways), Broadway-

MISS E. Bnstor (leader), B. Frampton, E. Hunt, A. Banister, Mrs. C. Hockley (reserve).

Judges were: Men's Competition-J, Trefer Watkins, B.Sc.,

British Electricity Ambulance Centre

1."0 e 1 ational Fir t Aid Competltlons of the Briti h Electricjty Ambulance Centre " -ere held at the Hall. \Ve tmin tef. on 2nd ApnL the winners :Challenge Troph")- : SouthEastern. \Vorthing.

\Vomen' Challenge Troph\: South-En tern. \1 id-Su sex.The Chancellor of the Order of St. John (Lieut.-General Sir Henry PO\\ n311. K.C.B.. K. B.E.. D.S.O .. pre ided at the pre entation ceremony: The Right Honourable Lord Citrine, P.c.. K.B.E. (Ch'Jirman <?f the Briti h Electricity uthonty) pre ented the trophies and individual plaque.

i'.lark gained by the first four tenm \yere:-

I. South-Eas tern (\\ orthing)

2. London (London)

3. ter)

-t. Yorkshire (Sheffield)

\Yomen:

LB., B.Ch. (Team): "v. Logan

Jack, J.P., LB., B.S. (Indi"idual Tests): C. J. P. Seccombe

LR.C.S., L.R C.P. (Oral Te t ):

J1 7omen 's CompetiTion - F. 1.

Hanna. M.B., F.R.C.S. (Team): 1. E. Whitehill, l.R.C.S., L.R.C.P. (Indivjdual Test); J. C. Graham, Il.R.C.S L.R.C.P. (Oral Te ts).

Stirk Trophy

Area competitions for the Stirk Trophy were held at Glasgow (Northern Area), London (Southern Area), and at Sheffield (Midland Area) during 1ay when 22 Road Passenger Tran port Undertaking entered a team. The first two teams in each area go forward to the final \ hich will take place at Nottingham on Sunday, 6th July. Teams for the final competition are as follows: Liverpool, Glasgo\\', London, Plymouth, Huddersfield., and Birmingham. A separate competition for ladies will also take place when a team from the following undertaking will compete London, West Bromwich, and Newport (Mon.). The Secretary ( 1lT. H. D Lewis) \ ill be pleased to forward rules governing the Stirk Trophy Competition to any Road Pa senger Tran port Undertaking who may be interested. Applications for same should be forwarded to 68 Flora Street, Cathays, Cardiff,

1. South-Eastern Sussex)

2. 1idland- (Hale owen)

3. York hire (Sheffield) .. .

4. South Wales ( e\\ port)

London Transport First Aid Competition

The final Fir t Aid Competition for the Challenge and Probyn Shields took place at the Borough Polytechnic, Borough Road, on 19th April 1952 before a large audience

Thi is the major competition of the year. the leading road and rail teams going forward to repre ent the Centre at the ational Competitions. Thi has been a record year for this event, thirty teams having taken part in five district competitions. followed by two emifinal competition 10 elect the nine teams 10 compete in the final. Also for the first time the contest was extended to embrace both the Challenge and Probyn Shields.

The \, ·inner thi ear. as in 1951, \"ere Chiswick (leader J. Barnes) with 431 mark out of a po sible 600. Otber team members were A. Dolling, A. Darke, R. Terrell and R. Field. The Chiswick team was awarded tbe Challenge Shield. The runners-up were Lots Road who obtained marks (leader F. Ed\vards), other members were H. Godfrey, W Butler) S, Gosling1

H.R.H. The Princess Royal presenting the Stanley Shield to Somerset 518 team

8

F. Golding. This team represented the Centre at the Briti 11 Raih\ay!> and London Tntn..,port (Rdilway ) Competition organized by the St. John Ambulance A ociation at the Central Hall. Westminster. on 16th

The third team. and \\ inners of the Probyn Shield \\ as Manor House. This team was the leading Group Two team, and obtained 3 I marks (leader G. Foley), other

British

;\"orth-Eastern Region

The final at Bradford on 3rd May of the British R a ilway s "'orlh-Eastern Region

Ambu lance Competition \\a s won by York Carriage & Wagon l'o. 1 team. \\ho obtained 40'7 marks out of a possible 600. Dews bury wer e s econd \\ ith 395. The remaining eight team were : Central (3 8 2). 'v1iddlesbrough (366) , Darlington Hull (344), Bradford Forster Square (299), Wakefield (292), Harrogate (2 8 5) Huddersfield (2681)

Mrs. H. A. Short. \\ ife of the Chief Regional Officer, presented the Lloyd Wharton Shield to the winners and the Thoma s Horn s by Cup to the runners-up. All the team s had prize s as mementoes of the occasion

member" \\Tre K. Bo\ ne, R. \\'lliiam'), L. Temp ::: ..,!. \\ r , ould. lourtil placc \\,-h obtained hy Broad\\ay (\\omen) \\ith 370i marks (leader "\-1i E. \1. Bri tor), other members ,, -ere A. Bannister. B. Frampton, C. Hockley. L Duckett. Thi team later \\'on the Br iti h Railways and london Transport (Railways) 1 ational First Aid Competition for women (see abO\ e).

Tn pector. \\ho -urponed by \[r.

T. C. el13r Diqrie( Trame Supel illlcnJt:nl. \1r. C. \ calc Di"tllet nginecr. \11'. E \ Rogers. Di..,(rict \mbulanec cerct.II':", and e\eral local officer - The a\\ard:.. "hich included a number of long- en ice medals and were pre -ented b)

T. C. Sellar-.

Glouce-ter Ambulance Corps held their annual dinner at the Bell Hotel under the chairmanship of their Presiden!.

R. H. B. icholls. District Operating Superintendent. \\ ho \\'a - upponed by

1r. H. H. Srarr. A istant Commercial Superintendent. Paddington, j\[ r. A. C. Lisle. Docks & Inland Waterway Execuri\e, 1r. J. Fielding. PresideOl Gloucester Cit) Centre. St. John mbulance:\ - oeiation.

Mr. C. Wright. District Engineer. 7\1r. E. Po\\ell. A istam District Operating Superintendent. Mr. A. W. Sheppe). A - istant District Commercial Superintendent. 1\1r.

BIll-lIS "",1 Scalds

Western Region

Mr. A. W. Tully. Operating Department. Plymouth Road. has been appointed District Ambulance Secretar) for The Plymouth district in succession to J. H. Tippett. who has resigned. Mr. W. F. Will. \\ho had been Di - trict Ambulance Secretary, Bristol dIstrict. for up\\ards of 31 years. during which time he had rendered distingui hed en ice to the Ambulance 10\ement and endeared himself to a large circle of friends, died last year. To gi\ e expression to their admiration for his sterling qualities. and as a lasting tribute to his memory, the fir aid personnel in the Bristol district have since obtained (by subscription) two inscribed shields for annual competition by teams in the Bristol

C. Hearnsha\\'. A - sistanr Di trict Operating Superintendent. lr. K. G. H. Parkinson. District Ro ad Motor Engineer.

If. L. M. Starr, Goods Agent, and Dr. W. W. McGrath. present "ere r.

W. E. Flew. Hon. SecretarY. Glou ester City Centre SI. John A sociation, Mr. R. G. Harris, Chief Di tricr Inspector. Mr. W. E. J. Perk - District Ambulance Secretary, and lr. T. C. B. Davies. During the evening an enjoyable musical programme wa contributed.

Kemble Ambulance Class held a upper and presentation of awards under the chairmanship of Mr. W. Pritchard. Station Master. The a\ ards \\ ere presented by Mr. R. H. B i holls, District Operating Superintendent. Others pre ent were Dr. D. G. Cossham and fro \\ E. J. Perk.s.

Di strict Ambulance Secretary. the arrangements being carried out b) 1\1r. F. J. Radwa y, the CIa s Secretary.

Tornes awards were presented by the Ma)or, Councillor Jacka, and those attending included Mr. D. Ha\\'kes\\ood.

Di strict Commercial Supermlendent, 1r

A. W. H. Christison, District l otive Po\\er Superintendent. Mr. C. F. E. Di - trict Traffic Superintendent. Dr. Gordon Wells, Dr. Margaret \ ell, Mr. A. H. Selley. Station Master, and Mr. J. H. Tippett, District Ambulance Secretary.

AS mo t of u knO\\', burn are cau -ed dry heat. uch a fire, electricity, or corro i\ e chemical, while cald are cau ed by moi t heat. -uch a team. or liquids at a high temperature. The complication and treatment of burns a nd scald are the ame, and can be dealt \\ ith together. In eJch ca e there is a varving degree of 1i sue de truction. . There are -IX degrees of burn

First Degree Bu/'ll

There i superficial congestion, \\1th only reddening of the kin. accompanied b) pain.

Second Degree Bum

There i partial kin 10 : portion of the epidermis. or outer skin, become rai ed from the dermis, by erum, thu forming blister •

Third Degree BIII'I1

1. Shock

This \ nrie, a cording to the degree of burn or cald. b'Ut there i ome degree of - hock e'\cept \\ ith "ery small injurie. Sho k which immediately follow a burn i k.no\\ n n immediate or primary ho k.

Shock. which come - on a few hour Inter (6-J hours), in the form of colbp e, i, econdary' and aCCOllnts for 0 p.C of death due to It i of much more practical importnnce than primar) hock, be au e the burn, if not treated before econdary h ck ::lppe c}[, mu-t be left until the secondary hock i fully treated. Durin g this time the burn should be \\ ith terile dres -ing Burns of thorax. abdomen ::lnd face cau e more - hock than burns on the extremitie, and are, therefore. when e\'ere, more fa wI.

.Anti-shock Treatmen{

(a) Immediatel apply warmth, in the form of 110t water bottle. blankets. or electric cradles or blanket

(h) Hot weetened drink - may be gi\'en if the patient i - able to \\'a II 0 \\'

(c) Sedative ma) be gi\en if C1\ailable, and are ordered bv a doctor. -

\\ ill be c ('I!l idcrabh. Yomitin g (lI': ClIl' 1111..1 the 11;1tknt 111,\\ be · )l1lc dclirll'lu... ll the lllllle te ted, albumin \\ ill be round. . t thi stage, the kin 111:.1\ ha\e a slight, tinge (jaundice) . Sho k will be -e\ ere and will be recognized by a rapid. feeble puLe and 10\\ ered blood pre: ure. It 111 1\. i n ere ca -es, prO\'e fa ta l.Tr earlllellf ot Toxaem ia

If toxae mia and inflammation are marked, 10 al treatment. -uch a aline bath:. appli ation of penicillin powder or ulphonamide oimmenr, ma) be arried out. combined \\ ith injection of penicillin, gi\'en l11u cularl) _

3. Stage of Healing

Thi - stage i - determined by the -e\erity of the burn and not the extent 'of the area

An uncomplicated burn with onl) panial skin :uch as first LInd -econd degree burns hould heal ati - factorih in about three \\ed.s \\ ith the ri"ght treatment. A third degree co\'ering the ,- ame: area and treated in the ame ma\ take month (Q heal.

Third degree burn - are much more likely to become complicated b} ep i , than fir t and econd degree burn -

Complicarions of Bill/IS aild Scalds

(I) J ephritis (inflammation of the kidney).

(2)

The Llo yd Whart o n Shield presented to Y o k [earn b) Mrs. H A Sh o rr

The York team consisted of G. H. Parker (Captain) , H, Shipley, J. Shanks J. Taylor and P. Jackson.

The orth-Eastem Region Women's Ambulance Competition was won by Hull , George Street. Marks registered by the team of five Hull typists totalled 332 , Bradford were second with 301 and Leeds, Wellington Street, third with Dr. P. M. Scott of Hull judged the team test, Dr. R. F. MacKenzie of York the individual l'il a Foce test, and Dr. C. E. Phillip of Leeds the individual practice.

Hull went on to complete in the British Railways women's final held in LondOFl on the 16th May.

district. A miniature was also presented to Mrs. W. F. Wills.

Bala Ambulance Class held their annual dinner and presentation of awards under the chairmanship of Mr. W. Gordon Price.

The presentations were made by Mr. J. Roberts, 'Assistant Operating Superintendent. The guests included Colonel Price , Dr. Robert Jones, Capt. Jack Williams, Mr. E. J. Jones, Station Master, and Mr. H. Jones, District Ambulance Secretary. An enjoyable light programme of music and variety items was provided.

Builth Wells Ambulance Class held a dinner and presentation of awards. The Chairman was Mr. T. H. Griffiths, Di strict

The Western Region Fir t Aid Final Competition was held at Paddington on 29th April when a large number of spectator including officers of the Railw ay Executi,e and the Region witnessed the conte t. The subsequent presentation of prize and trophies was presided over by Mr. K. W. C. Grand, Chief Region al Officer, and the presentations were made to the \\ inning teams by Mrs. Grand.

The result of the test was announced by the Regional Ambulance Secretary, M r. F. Anstey, as follows: I. Bristol D.O.S.O. (winners of Challenge Shield), 510 marks:

2. Taunton (winners of Carvell CuP), marks; 3. Shrewsbury Loco. A' 474 marks; 4. Swindon A', 4634 marks:

5. Gloucester Eastgate A', 440 marks;

6. R edditch, 434 marks; 7. Cardiff Dock. 427 marks; 8. Bar ry, marks; 9_ Old Oak Common" A " 405 marks.

The Henry Butt Bowl wa presented to

year's competitions.

Bristol D.O.S.O went on to win the ational Competition in London on 16th May.

There is total 10 of the \\ hole skin in the area. with exposure of the nene ending, and on account of this third degree burn are the most painful. They are also the mO t difficult (0 heal and cau e a greater degree of hock.

FOl/rlh Degree BlI/ lI

The whole skin in the area ideslroyed, together with the underlying ti sue

F{(lh Degree Bum

The skin, underlying ti ues, and muscle art' destroyed.

Sixth Degree Bu/'ll

There i charring of the whole area, including the bones. When a or scald occurs. different stages are experienced during it cour e. There are three I1l a ins ages,

(d) If the patient i cyanosed (blue skin). oxygen must be gi\'en as oon as po ible.

The patient must be removed to ho a soon as pos - ible, \\ here further treatment \\ill be a\ailable.

2. Stage of Toxaemia and Inflammation

Toxaemia \ aries greatly in severit , and u -ually appear from -t to 10 day after burning. if at ali.

1t i 1110 t evident in third degree burn, and hould not be marked in fir t and second degree burns \\ hich have been properly treated.

The call e of toxaemia are not quite clear. but two main factors undoubtedly predominate: (a) the absorption of a non-bacterial toxin from the burnt area (autolysi ) : and (b) ep , or infection of the burnt area.

Signs and Symptoms of Toxaemia

Tn sc yere <.:ase , the temperature

(3) Duodenal ulceration in adults and exhau ti\e diarrhoea in children.

(-t) 1en i ngi i -

In the treatment of burn scalds. the the burn CO\er5 hould be con -idered, and not the depth of the burn In a case where more than a quarter of the body surface imol\'ed it may pro\c fatal. Thi is more likely to occur in the ca -e of a child (h:1n \\ ith an adult. presuming the affected area to be the same

First Aid Treatment of Burns and Scalds

When 111 edical A id is Readily -1 l'a i!ab Ie

(a) Do not remo\'e clothing and do not break bli -ter.

(b) Co\er the whole area, including clothing, with terile dre sing . . which are further covered with a coltol1wool P:1<.i. Clot hing

the Radstock O. 1 team, ,,\ho secured the highest position in Class 2 in this

• By"' . Jam .R.'I.

which has become burnt, would, in a sense, be sterile.

(c) Bandage firmly, except where blisters are present or suspected, in which case bandage lightly.

(d) Wrap the patient in blankets to keep him warm.

(e) In severe cases immobilize the the affected area with the aid of sllngs, splints, or bandages.

(f) If conscious, and able to swallow, give large quantItles of warm fluids, preferably weak tea, sweetened with sugar.

When Medical Aid is Not Readily Available

Adopt the above rules and saturate the whole area, including clothing, with a warm alkaline solution, such as baking soda (bicarbonate of soda), two teaspoonsful to one pint of sterile water at body temperature, or warm saline solution, one teaspoonful to one pint of sterile water at body temperature.

Apply sterile dressings soaked in one of the alkaline solutions and keep them moist with the solution.

If no solution is available cover the are with sterile dressings.

If the face is burnt, take a piece of lint, large enough to cover the face, cut it to the shape of a mask and cut a hole for breathing. Soak the mask in one of the alkaline solutions and apply it to the face, making sure that all burns are covered. Keep the mask moist with the alkaline solution.

A young child when severely burnt, should be placed in a warm bath, preferably one of the alkaline solutions being used. The child should be placed in the bath of solution without removing clothing, and must be kept there until medical aid is available. The solution must be kept at body heat, and must be tested frequently, bot water being carefully added when necessary, to maintain the required temperature. The temperature can be tested, in an emergency, with tbe bare elbow. In all cases of burns which may need hospital treatment, avoid using any greasy substance, as this will have to be removed before further treatment can be given and valuable time may be lost.

Surgical Treatment of Burns

This varies according to the surgeon but here is one example of treatment.

If necessary, the patient is

anaesthetized and the whole burnt area is thoroughly cleansed with soap and water or cetavlon. If grease is present, ether soap may be used, but soft soap must always be avoided. As far as is possible, debris must be removed, with the aid of saline swabs.

All blisters are laid open with sterile scissors, but violent scrubbing or scraping which may cause bleeding must be avoided.

The burnt area and surrounding skin are then dried with an electric drier, such as a heat lamp, and lightly dusted with sulphanilamide powder. This initial cleansing should be carried out within 6 hours of burning.

When the cleansing is completed, a coagulant is applied, one of the following usually being used: (a) triple dye, such as gentian violet or acriflavine; (b) tannic acid 10 p.c.

(if no sepsis is present) ; (c) gentian violet jelly.

More than one layer of the coagulant must be used if necessary, but each layer must be dried before the next is applied. The area treated should be larger than the actual burn. No dressings are required over the coagulated area, which must be covered with a sterile towel. The edges and any cracks which may appear, are dusted daily with sulphanilamide powder and gentian violet jelly applied.

This is a valuable method of treatment for burns of the trunk, especially for children and elderly patients. Although it is not advisable for other parts of the body, it gives a good example of treatment of severe burns.

H a severe burn does not readily heal, skin grafting will have to be performed.

New Books for First Aiders

'Collins Family Medical Encyclopedia,'

Compiled by George Somerville, M.D., D.P .M. Collins, 21 -.

This is an encyclopedia of medical knowledge designed for use in the home, and the amount of space given to the entries, arranged in the usual alphabetical form, has been fixed according to the degree of popular rather than technical interest. Emphasis is laid on the common ailments and there are particularly useful sections dealing with the care of children, motherhood, nursing in the home, and so on.

There is sufficint information on first aid given to meet the common emergencies of the home and daily life, and more would be ou t of place in a book of this sort. As a book of it should prove useful ter many example, it could be used ill teaching elementary nursing. But the main use wilI be the one for which it is designed, as a home guide, and as such it can be warmly recommended.

'Atlas of Human Anatomy' by Franz Frohse, Max Brodel and Leon Schlossberg, Text by J. F. Williams, M.D. New edition.

George Allen & Unwin, Ltd., 16/ -.

This. anatomical atlas is publIshed 10 thIS country for the first time. It is produced in America and has had a good receptlOn there and is apparently well known.

The seventy-one illustrations are beautifully drawn and are remarkably clear. The artists' skill is backed up by the perfection ?f the colour reproduction, and the whole IS an excellent handy-sized manual of great value to nurses, students and first-aiders. Explanatory notes are given, and a useful feature. is that with every drawing the anatolllic parts are named and are indicated on the same page.

A very fine work,

, Man-Picture Encyclopedia No.6.' AngloFrench Literary Services Ltd., 5 ' -. .little book sets out to be a popular eXpOSItIOn of the structure and functions of human body.' The extraordinary thing IS that the text is printed in four languagesEnglish, French, German and Dutch so that the necessarily condensed given, repeated times on each page, works out at nothillg more than a caption to each illustration, which are crudely drawn and convey very little. There must be some use for a pUblication of this kind but there is nothing here for the first-aider.'

Tuberculosis, not so long ago regarded as the main scourge of mankind and especially of the young, has of late years taken a more favourable turn , at least in Great Britain. Such is the message of the annual report of the National Association for the Prevention of Tuberculosis. An improvement, it is hoped a permanent one, is taking place in the campaign against this preventable and curable malady.

From the latest available figures (1950) it seems as though fewer people than ever before fall to the onslaughts of tuberculosis. At the end of the last war many more than 400 were dying each week. To-day the figure is nearer 300 and, for the first time in recent years , the flow of new patients coming to the doctor with symptoms has declined. There i.s hope in tuberculosis; hope in preventIOn. hope in treatment; and the N.A.P.T. feels justified this year in giving tills title to its annual report of progress.

It has to be remembered that this encouraging situation is found in England and Wales. In Scotland the position is not so favourable, while in some of the Colonial territories of the British Commonwealth tuberculosis has not begun to decline, and JIlay even be about to increa e,

Bed Cross

Alford Divi ion sent a team to Durham to compete in an eliminating round of the Stanley Shield. During the journey the team leader was called to an accident on the train. A man had fallen over several suit cases and sprained a knee. After treating the patient Mr. Daubrah returned to her compartment and referred to her first aid book to make sure she had used the correct bandage-she had, and what is more one of her questions at the practical examination was the treatment for a sprained knee!

The British Red Cross Society and the Royal Society of Arts gave a conversazione at the Royal Society's premises in Adelphi London, on 8th May, to celebrate the anniversary of the birth of Henri Dunan t, founder of the Red Cross. r Guests of the two Societies were received by Sir Ernest and Lady Goodale and Lord and Lady Woolton, and included members of the bxecutive Committee, representatives from the Branches and Dominion and Foreign Red Cross Societies, as well as Lady White, wife of the Resident Minister of the Australian Government in the U.K. and Monsieur and Madame Bernath of the Swiss Legation. It was appropriate that Monsieur Jaques Dunant and Mi s Patricia Dunant were amongst the guests.

Prof. E. N. da C. Andrade lectured on Dunant, and at its conclusion Dr. Follett demonstrated the Pyrophone (or the 'Singing Flames' as it was called). This curious instrument has notes which are produced by two or more gas Oames in a series of glass tubes arranged like the pipes of an organ. The notes of the octave are regulated by the varying lengths of the tubes, and the touch on the keyboard strikes the note and controls its time. It will be wondered what connection this instrument had with International Red Cross Day. In gratitude to a Parisian lady, Madame Kastner, who had made substantial contributions to his Red Cross cause, Dunant tried to interest the scientific and artistic circles of London in the invention of her son, Fr ed eric Kastner, and gave a lecture in 1875 in this very Lecture Hall, designed by the brothers Adam. During Dr. Follett's demonstration the room was in darkness. It was fascinating to hear the rather uncertain music which filled the hall and to see the gas jets flaring up and diminishing as the notes were played. At the finish Lord Woolton in thanking him for an interesting demonstration said he was not surprised the' Singing Flames' did not 'catch on ' in Victorian times. The guests were later served with refreshments in the library.

On 16th April Brian Maidlow, aged 5 years and 11 months, of 57 East Street, Canterbury, was playing with other boys po the river bank ne<lr Brett's gravel

washers when he fell into the water. He was carried along by the current for about 300 yards and was eventually recovered from the fiver by a lad named Swain. Cadet Bridger was cycling along Sturry Road when he heard of the occurrence and he at once went to give what help he could. Immediately on arrival he correctly positioned the boy and applied artificial respiration. He succeeded in expre sing a considerable amount of water from tbe patient, but on arrival at the hospital the child \\as dead. t the inquest the Coroner said: I commend the boy who occupied part of hi leisure time in learning how to revive the drowned and hope his-example \\ill be tbe means of getting more recruits for the Red Cross Cadets.'

During house-to-house collecting an S.R. T convalescing at Queen lexandra Hou e, called on an old gentleman. who crossly told her to go away as be disliked hawkers.' Turning, he o\ erbalanced and

:ell, cutting hi band on a broken flowerpot. you ee. \\ hat you hU\e done,' he explained boldlOg out his bleeding hand. o You t let me do fir t aid: the nurse. Oh. do you know anythm o about ? he in a .lightly tone.

\V.hY ye-, 1 m a Iramed nur e: she said taklOg out a prepared terile dressing from her bag. They entered the house and the hand was cleaned and dressed. As he turned to leave he said \\ ell. now I must put som.ethi.ng in your box,' plac ing half-acrown 10 It. She met him later while collecting in the street and he topped and asked how she \\'a getting on, \\hether people were g!\ ing well. and how was she a trained nur e, finding time to collect the street when nurses "ere so carce in hospital? She ewlained that he had had a erious operation and \\'a - not allowed to work for some time. \\ hereupon he placed another coin in the box and \\ :shed her luck. This lady col'ected o\er £ 1-

TOPICAL NOTES FOR FIRST AlDERS & NIJRSES

International Conference of Home Helps

The speed and scope of the development of the Home Help Service was amazingly demonstrated during its First International Conference, which was held in London last month. Delegates from eleven countries attended, and they were welcomed at the opening session by Miss Pat Hornsby-Smith, Parliamentary Secretary to the Ministry of Health, who said: 'It is a tribute to your work, a tribute to the need and also to the fact that the local authorities recognize that need, that although they were not under an obligation to provide such a service, every local authority has done so.' She also said that in Britain the number of whole-time staff in the Home Help Service has risen to 3,600, and part-time workers to 21,740, and that during last year 166,392 cases were attended.

The countries represented at the Conference included Austria, Belgium, France, Holland, Germany, the Scandinavian countries, Australia, America and Great Britain. The first day was devoted to the many aspects of the service in this country and the speakers included doctors, nur es and social workers. The importance of the home help in the domiciliary

care of the sick and aged was stres ed by several speaker. Mi s Norah Burr, County Home Help Organizer for 1 ent, spoke of the urgent need for tandardization in the provision of home help , \\.hich could only be obtained by a standard training for organizers; and she outlined a cheme of training and experience. On the second and third days of the Conference addresses were given by delegates from the other countries, and one realized that although there were many variations in the way in which problems were being faced and olutions sought, the need for home helps was increasingly recognized in all countrie. Britain has much to Jearn from the countries where the service is already more highly developed, entails a more extensive training and enjoys a higher social pre tige than it does here; but these countries pend much more money on the training of home helps.

National Survey of Cancer Problems

A Report has recently been published by the Joint National Cancer Survey Committee of the Marie Curie Memorial and The Queen's Institute of District Nursing (51 pages, price 2/6, from 124 Sloane Street, London, S.W.I, and 13

E g lington Cre scent Edinbyrgh

The s o '.:: ia l problem s a'ls o e latcd WLt 11 tlli s drcau di<.,casc arc truly a ppalling. About 70 p c. of the patients surveyed were over 60 years of age

Many were living alone and in very straitened circumstances, whilst others belonged to small households wherein the whole burden fell upon one person ; and although it ",:,as estimated that a home help serVlce was available to about 84 p.c. of these patients only about 8 p.c. made u s e of this service. Some did not know of the provisions of the Nation a l Health Service and others were not a ware that they might be eligible for financial help from the N a tional Assistance Board. There is surely a great need here for public education and the vop::tgatio :l of knowledge with reg a rd to th e help th a t can given to the pltients nursed at home , so th:lt much of the ir s uffering , both phys ical and m::nt a l, m a y alleviated and their life prolonged in comfort. The cond ition of many of these patients was aggravated by neglect of the disease in its early stages, very frequently through ignorance of the character of early symptoms and by fear of a diagnosis of cancer. This again stresses the urgency of an energetic camp 3 ign to inform all social groups not only about the early symptoms of the disease but also about the po s sibilities of its treatment and its cure.

Corneal Grafting

The Corneal Grafting Bill, introduced into Parliament by M r. Gerald Williams , the Member for Tonbridge , was fir s t read on 14th May and PJssed its second reading and the remaining stages on 21st May, without opposition. It is designed to correct the legal position in this country which the eyes o[ dead people may not be taken and used for corneal grafting even if a deceased person had bequeathed his eyes for this purpo se. The development of corneal grafting in this country h a s, therefore, been handicapped for want of material. Only if a patient had to have an eye removed for an injury or a disease that did not affect the cornea could this healthy cornea be used to restore the sight of a person in whom blindness was due to an 0p.lcity or injury of the cornea. The new Bill is intended to make it

pa s ible to e e s [or c orneal g rartin g (Illd oth e r 11111'and al s o to allow a relative to permit eyes to be taken provided that no objection is known to have been made by the deceased person during his lifetime. The establishment of eye banks,' such as exist in France, could result in the supply of material for corneal grafts becoming adequate to meet this particular need in the cure of blindness

Training Courses for Wardens of Homes for the Aged

The problem of caring for the aged becomes more and more important as the expectation of life increases and medical science develops cures or arrests the progress of disease. The adaptation of large houses into homes and hostels for old p eople is go ing on throughout the country , but thi s , in itself, is not enough to meet th e need . Wise staffing and control of these homes is also important, and this demands knowledge of the special difficulties and requirements in making the eventide oflife really happy and contented. The NationaL Old People's Welfare Committee h a s planned a four-month course of training for those wishing to become wardens of homes for the aged. It will begin in October, 1952, with six weeks ' theoretical training followed by four weeks' practical training in the geriatric units of London hosp itals , and conclude with six weeks' supervised practical work in selected homes for the aged. 0 qualifications are asked of intending cand id'ltes, but they must have a genuine interest in old p eople and it is naturally a great advantage to have some knowledge of home nursing or of the management of a large house. The course is p.1rticularly suitable for women bet ween 27 and 50 years of age Those who are interested in und e rgoing this training can obtain further information and application form s from the Secretary, National Old People's Welfare Committee, 26 Bedford Square, London, W.C.I.

The Guild of Hospital Librarians

At the Annual Meeting of the Guild a steady extension of the Hospital Library Service was reported, but it was inevitable that the more efficient the service became

the greater would b e the d e mand s ma d; upon it and , lil c rerore , the Ii br ,1rie:-, everywhere Il cec.kd morc suppOrL in regard botll to the provision of books and the services of librarians. The present deficiencies in the service were related mainly to children's wards , tuberculosis hospitals and san a toria and to certain mental ho p ita Is. In line with all other modern movements the Guild is extending its international contacts and has member.s in 15 different countrie , including India, Kenya, Argentine, Belgium, Australia and the United States It is at all times happy to welcome vi itors from hospital librarie.s overseas and hopes tha t British members travelling abroad wil L take any opportunities that occur to see the work of hospital librarian s in other countries.

Casualties Union

The Hon. General Secretary of Casualties Union writes :-

My Committee have been interested in reading in your March-April edition under Readers' Queries , " page 14 the reply given to H. S. W. (Chasetown) in which Ca s ualties Union is indicated as giving guidance on the s ubject or Faking. It is obser ved that our He a d q uarters a ddress is given a s 12 Bedford Row, W.C.l May I ask you to kindly issue a note of correction in your next edition ; the above quoted address is no longer our Headquarter , which is, for the receipt of all correspondeiKe 29 Whyteleafe Hill, Whyteleafe Surrey , Telephone Uplands 2482.'

London Transport

Dunton Green first aid team are the fir s t team to hold the Ki rshner Shield. Thi shield , recently given by Mr. W. I. Kirshner, Divisional Engineer , Country Bu ses and Coaches, South Divi s ion, for annual competition within the southern division was keenly competed for by the district finalists , Dunton Green Windsor and Dorking at Baker Sti eet Ambulance Hall on Friday, 25th April.

Mr. H. F. C. Adcock, Divi ional Superintendent (South) Country Buses and Coaches presided as Que s tion Master, while Dr. A. W. Gilks Medical Officer for the South-Eastern Division , adjudicated.

Tn Mis concluding remarks Dr. Gilks congratulated all the competitors on their high standard of the knowledge of first aid. The shield was presented to the winners by Mr. Adcock.

The proceedings were concluded by Mr. S. W. Harden, Ambulance Centre Secretary, proposing a vote or thank s and appreciation Lo Mr. Kirshner and tho e who had arranged s uch an enjoyable e venin g

FIRST AID:-

General Rules

Examination

Fractures

Dislocations Sprains Wounds

H<l!morrhage

Types of Bandages Spli nts Shock Artificial Respiration

Lifti ng Transporting, etc .• etc.

"PORTLAND"

AMBULANCE GEAR

The Gear IIlustrated(A.B C.D.) carries two stretchers on one side of Ambulance, leaving other side clear for Sitting patients.

The UP AND DOWN action is quick and easy for loading or unloading.

A. Shows the two stretchers in position.

B. Shows the top stretcher lowered read y fo r oad

(u

cato logue o(

Eq ui pment No. 7A will be sent on request.

GREAT PORTLAND ST., LONDON, W.l 'Phone: Langham 1049.

HOUSEHOLD PHYSICIAN ( UP-TO-DATE

)

NEW EDITION

Describes in simple language, with helpful coloured plates and diagrams

The COMPLAINTS OF MEN, WOMEN AND CHILDREN

Their Cause, Treatment and Cure

A

First Aid

What to Do in Emergencies Influenza Colds, etc.

Measles, Mumps, Catarrh Corns and Warts

Physical Culture, Self Defence

Treatment for all Skin Diseases

The Lungs. Pleurisy

Hygiene, Anatomy, Pharmacy Fevers, Bladder, Kidneys

Pregnancy, Childbirth Home Remedies. Diet

MOVABLE MODELS OF

HUNDREDS OF YESl JMONIALS

" I am delighted with' The Household Physician,' and as I am an Ambulance man, I can appreciate them to their fullest extent."

"Being a Nurse it is of great help to me."

Principles

Eye, Ear, Nose 375 proved remed es

Throat, Liver MOTHER AND CHILD

Chest, the Heart teaching pictures

Stomach, Duodenum BEAUTY TREATMENT

Teeth, the Muscles how to bring out your best points

Child Welfare SELF DEFENCE

Homa:opathy, Arthritis what to do if attacked

Neurasthenia

Rheumatism, Poisoning COMPLETE INDEX

Patent Medicines enables you to find Glossary, etc., etc. instantly what you require THE HUMAN BODY-hundreds of illustrations

Male and Female

W. F. (Stockport) writes :-

At a recent inspection, I was asked by the examining officer to apply the bandage for the hand.

I placed an open triangle bandage (with the hem turned inwards) over the palm with the base at the front of the wrist, carried the point over the fingers and dOl vn the back of the hand. I carried the ends round and tied the knot on the back of the wrist then carried the point over the knot and pinned this to the bandage over the back of the hand.

The examining officer asked: where is the wound supposed to be ?

I replied: [n the palm of the hand!

His reply \Vas that with a wound in the palm of the hand the knot should be at the front of the wrist not at the back. I disagreed with the officer and told Mm that the way [ had applied the bandage \Vas my interpretation of page 56, to which he replied: I'm examining you! That bandage is wrong! You IVant to read up your book !

As [ am responsible for training a competition team, I am very keen to make sure that all treatments are carried out strictly as per book for competitions or inspections, etc.

Would you be good enough to tell me if m y intelpretation of page 56 is correct?

queries

Answered by Dr. A. D. Belilios, M.B., B.S. (Lond.), D.P.H. (Eng.)

Answer

On the whole, I agree with your interpretation of page 56, but-and there is a big but-you are very unwise to disagree or argue with examining officers' on parade.'

* * E. H. (Rotherham) writes :-

At a recent class meeting a discussion arose on the subject of diluNon of antidotes for poisons taken by the mouth for children, as stated in the chapter on poisons of the 40th edition of the St. John textbook.

The book reads 'All quantities mentioned should be divided,' etc. Are we to understand that the quantity of water should be divided, as well as the various commodities mentioned? If so, children are to be given the same strength antidote as an adult, but reduced in quantity, or does it mean that the strength of the antidote is reduced as well as the quantity, by maintaining the full amount of water, viz., one pint?

We shall be pleased to await your valuable comments on this problem.

Answer

Both sets of quantities should be divided as stated. It is the usual medical practice to give fractionally smaller doses of drugs to children as recommended and so far as the quantity of fluid used to dilute the

Miscellaneous .Advertisements

Samples free-TrCES, 11 Oaklands Grove, London, W.12. HOLIDAYS. Excellent food, feather beds, H. & C. bedrooms, reduction to S.J.A.B.members and families. Hunter, 'Lynton,' Marine Rd., Prestatyn, N. Wales, Phone 639.

S JAB Badge Wall Shields 26s. 6d. S.J.A.B. Gold Cased Crested Cuff Links 42s. Ideal presentation gifts. Medals mounted immediately, medal ribbon bars, 9d. per ribbon ready to sew on. Stamp for leaflets, Jeffery, Outfitter, St. Giles, Northampton.

FOR SALE. S.J.A.B. Officer's Uniform complete (first-class condition). Height 5 ft. 9 ins., standard size. Hat 7 ins. Cane, etc. Box No. 685, First Aid & Nursing, 32 Finsbury Square, London, E.C.2.

WANTED Ambulance Officer's Uniform to measurements approx. Chest 37 ins., Waist 34 ins., Leg 26 ins., Height 5 ft. 4t ins , Hat 7t. Box No. 684, First Aid & Nursing, 32 Finsbury Square, E.C.2.

antidote is concerned, the capacity of the child's stomach has to be considered.

* * *

T. K. (Glasgow) writes :I should be pleased if you lVould give m(;: the follo\ving information :There is an artery running up the side of the nose in such a position that the pad of pad-bridge spectacles rests on it (or may rest on it).

(1) What is the name of this artery?

(2) What part of the h ead does it supply?

(3) What \vould be the effect of stopping the flow of blood in it for a long time ?

Answer

1. The termination of the facial artery which is called the angular artery. 2. The skin, muscles, etc., in this region. 3. None, because other arteries and their branches mingle freely with each other in this region and in any case it would be difficult to stop the flow for a long time since the artery is surrounded by soft tissues.

* * *

C. M. (Grimsby) writes :-

For burns and scalds in the mouth and throat the current B. R. C. S. textbook (page 141) recommends a cold application to the neck an.d sips of cold water. 'First Aid to the Injured and Sick' - the book edited by Dr. A. P. Gorham (page 222) recommends a hot application to the neck and ice to suck.

[ should be very gratefu l for your advice upon. this point, in case [ ever have to face such an emergency.

(continued on. page 16)

FIRST AID

HANDBOOKS ANATOMICAL DIAGRAMS AND CHARTS FOR LECTURES

H. K. LEWIS & Co. Ltd., 136 Gower Street, London, w.e.1 EUSton 4282 (7 lines)

FIRST AID & NURSING,

A NEW EDITION WARWICK & TUNSTALL'S FIRST AID

TOT H E I NJ U RED AND SIC K

AN ADVANCED AMBULANCE HANDBOOK

Edited by

A. P. GORHAM, M.B., (H.B., M.R.C.S., loR.C.P., D.A. Corps Surgeon, St. John Ambulance Brigade Police Surgeon, C ty and County of Bristol

At last this well-known First Aid manual is again available-in a completely revised edition w ith

Answer

Readers' Queries (continued) Institute of Certified A!ubulance Personnel

lee to s uck or sips of icc-cold water relieve pain and reduce swelling of the tissues of the throat. Hot compresses are more us ually advised and should be renewed frequently.

* * *

S. D (Sidcup) writes :-

Under what circumstances should first aid for abdominal hernia be undertak e n ? The book do es not see m clear on this subjec t.

Answer

Only when a complication arises called 'strangulation.' The swelling becomes ten se and tender and the patient complains of griping abdominal pain, vomiting and later inability to pass wind or motions. First aid sho uld include that for shock but no fluids should be given by the mouth An operation m ay be necessary.

* * *

1 . M. (Greenwich) writes :-

We hav e recelltl\' had an ep ide mic of ge rman measles in our factor), and our doctor recommended that BAILLlERc'S ELEMENTARY NURSING HANDBOOKS

, BAILLIERE TINDALL & COX Ltd.

A HANDBOOK OF ELEMENTARY NURSING

Arthur D. Belilios, M.B., B.S., D.P.H., and Dorothea Duncan-Johnstone, S.R.N.

This handbook provides, in simple language and without elaborate technicalities, an introd uction to the pl:inciples and procedures which underlie the science of nursing. These are based on recognized hospital procedure, and are described in a s imple manner so that they can be readily understood

The second part of the book is devoted to a brjef description of the more common diseases, with general notes on the nursing required in each case, and the whole thus forms a comprehensive volume of reference and guidance.

With 314 pages and 57 drawings, 7s.6d. Pos tage 6d.

pregnant ll omen s hould he advis ed not to come to \l'ork What is the reason for this instruction?

Answer

It has been discovered in recen t years that if a mother develops german measles during pregnancy there is a slight risk that her baby may b e born deaf or even blind

The danger i s greatesL in the early months of pregnancy.

* * *

L. N. D. (Leed5l) writes

What is the reaso n for raisillg the palient's arms above his h ead in se vere no se -bleeding ?

Answer

It has been claimed that this procedure enlarges the cavity of the chest and hence reduces congestion of the nose by a iding the return of venous blood. It is very doubtful , however , jf the measure has any beneficial effect and I personally have never seen it adopted by doctors or nose

HANDBOOK OF FIRST AID & BANDAGING

Arthur D. Belilios, MO., B.S., D.P.H., D. K. Mulvany, M.B., F.R.C.S., and Katharine F. Armstrong, S.R.N., S.C.M.

The most comprehensive and up-to-date book on the s ubject giving full detail s of the first-aid treatment of medical emergencies as well as of jnj uries and accidents. Third Edition.

With 520 pages and 244 drawings.

Postage 6d. 6s.

DALE, REYNOLDS & CO. LTD. 32 Finsbury Square London EC 2 OR

The following member s of the Institute of Certified Ambulance Per so nnel passed the Institute's Examination s held in April 1952 ;-

Final Examination

Ailmore, W. , Ripley , Derby Atkinson, T. Nelson, Lancs Banks , J E., Leek , Staffs Barton, D. H ., Withycombe Devon Calvert, M. , Leed s, Yorks Kidd J. M. Reading, Berks Mercer, P., East Kirkby Notts Nash , R. E., Weymouth , Dor se t Pye, J., Stoke-on-Trent , Staffs Rogers, G. M., Man sfie ld Nolls Spanton , R. H. , Dagenhan] , Es:,cx Mr. Spa nton won first place in the Examination.

Preliminary Examination

Atkin, A. W. Derby Bi shop, R. H., Tewkesbury, Glos Coates, J. , Leed s, Yorks Foster, D. F., Birkenhead , Cheshirc James, c., Northwich, Cheshire Mo ss, W. N., Breadsa ll Derb y Pearso n , P. Brockworth Glos Webb , D. McD. , Dagenham Essex Wes t, G. W. , Apsley, Nott s Wright G. H. , D e rby Mi ss W. N. Moss won first place ill the Examination.

ELEMENTARY ANATOMY & PHYSIOLOGY

Arthur D. Belilios M.B., B.S., I).P.l-l., D. K. Mulvany, M.B., F.R.C.S., and Katharine F. Armstrong , S.R.N., S C M. A handy, compact manual which gives a complete outline of the anatomy and physiology of the human body. 'A most stra ighlforward reliable lillIe book.'The Nursing Times With 194 pages and 116 drawings.

Postage 6d. 5s.

BAILLIERE, TI NDALL & COX 7-8 Henrietta Street London WC2 r···· · .... .. of First Aid and Bandaging

Please send me I ·· of A Handbook of Elementary t ······· copY / les of Elementary Anatomy and PhYSIOlogy for which I enclose remittance of Name

Address FA/ 452

THE HOUSE FOR HUMAN SI{ELETONS

Articulated and Disarticulated HALF SKELETONS, Etc., Etc.

ADAM, ROUILL Y & CO.

Human Osteology,

AID SING

A

f d or 4 ently constructe rnodat\on for Rec having acco rn ith transport, d 8 sitting cases (w dant). tcher an (With atten stre ) r 18 sitting cases t fitted with dant , 0 ornpartrnen Separate \uggag e c wireless. . d rnbu\an ces ecia\lse a of rnany sp .' and ,his IS one \\y designing ontlnua d yOU are that we are c pu rposes, an f variOUs require- structing or d details of your b ad d sen h re a ro invite to try or anyW e ·n thiS co un rnents I

Medical opinion may differ concerning the true nature and retiology of fibrositic conditions, but the need to ease the pain is still paramount. Thus, although methods of specific treatment vary, the agreed value of simple analgesics remains. Anadin Tablets provide an invaluable adjunct-both for the speedy relief of pain and as a mild stimulant against depression. They are non habitforming, well tolerated and perfectly safe in the hands of the patient.

If you are a person •••

Then you will follow this point-by-point argument and reach the same conclusions as so many doctors, nurses, hospitals ,and clinics have done.

DO YOU AGREE ... that the causes of most skin infections are the common str ains of STAPHYLOCOCCI, STREPTOCOCCI and B. PYOCYANEUS ?

IN THAT CASE . a treatment which is effective aga inst all three will be indicated for cuts , abrasions, burns, scalds, boils and most inflammatory skin infections?

THIS IS THE TREATMENT

ANTIPEOL Cutaneous Vaccine Ointment contains the sterile vaccine filtrates of the three micro-organisms mentioned. The filtrates destroy the actual micro-organisms and at the same time act as a local immuniser against re-infection. This is a

purely biological action and there is no damage to delicate tissues.

RAPID HEALING is further expedited by the ointment base of proved efficiency. For burns and scalds, ANTIPEOL has special advantages. It is microbicide and non-adhesive. Therefore dressings do not have to be changed every day.

AND HERE IS THE PROOF.

Antipeol Ointment is proving and reproving itself every day in dozens of surgeries, clinics, hospitals and homes. Letters from the medical and nu'rsing profession bear convincing testimony to its effectiveness.

THERE is the logical argument for including ANTIPEOL Ointment in every First Aid kit. a logical person, why not send for full details and a clinical sample?

antipeol

cutaneous vacczne ointment

Produced by the makers of: ENTEROFAGOS

intes ti nal complaints; RHINO-ANTIPEOL for nasopharynx infec tions; OPHTHALMO-ANTlPEOL for ocular infections; DETENSYL for reducing arterial tension.

July

& Nursin g

Disease Knows

pOLlO had broken out in Indi a; it had ap peared across the Andes, in Chile. Doct,?rs these countries were finding a comblDatJOn of symptoms to which they had been unaccustomed-healthy, robust yo ung sters were running s harp fevers ; then a stiffness of the neck ; then a limpness of the limbs; maybe a difficulty in breathing Poliomyelitis!

To their co lleagues in North America and Europe these signs would have been more familiar. They had the warnings and the experience of recurring epidemics of a disease all too common nowadays in industrialized countries It has not been so common elsewhere. Indeed, the rising curve of so -called 'infanti le paralysis' (althoug h it is by no means confined to children and doe s not always paralyse) is so closely related to the curve of prosperity that it is popularly lI ,.Ju ght to be a new disease' and a levy on a rising standard of living.

In response to appeals from India and Chile, WHO arranged for air-dispatch of 'iron lungs,' those mechanical respirators which, acting instead of the chest muscles crippled by the virus , keep polio victims breathing. That response was a reminder to the well-to-do countries that here was yet another disease which li1ey share with the rest of the world, a di seas e which strikes at rich and poor alike; a reminder, too that their knowledge and experience could benefit others.

While WHO was able to help Chile and India (in the latter case, with funds from UNICEF), it was also able to co-operate with Britain , which had never had poliomyelitis rates as high as the United States and whicp had a worse-than-usual epidemic. And WHO also called together, in Paris, polio experts from all over the world to share their late st research-findings and clinical experience.

Transportation o n Guernsey 4

News from St. John 7

The Call for Blood Donor s Artificial Respiration 10

Topical Notes for First Aiders and Nurses 12

Readers' Queries 14

Poliomyeliti s is an example of a disease which becomes prominent, partly because of improved diagnosis which recognizes it more frequently, partly because it excites a great amount of popular attention (Franklin D. Roo seve lt was a vict im , in adult life, who triumphed over hi s infirmity to become President of the United States) and partl y because it becomes more and more conspicLious as other communicable diseases dinlinish

Evidence of thi s disease is found in Egyptian steles of the 18th Dynasty (1580 B.C ); but, in common with many other diseases, it was like an understudy playing crowd-parts while more melodramatic tragedians like plague cholera, yellow-fever, sma llpox and typhus held the stage

Noln0uenza which people might lightly as 'fl u' or • grippe,' suddenly acqUired the proportion s of a maior pestilence in 1917-18 when it killed more victims than the total casualties of all t he belligerents in World War 1. But it was almost certainly the Sweating Sickness' which raged in deadly epidemics in the 16th century. And some form of it has recurred in every century

To-day no country can afford to neglect influenza. It is a major preoccupation of WHO among the communicable diseases.

To make sure that this killer never runs amok in the world again, constant watch mu st be kept. To check it when it does break out, research must discover the agent which causes an outbreak and quickly produce a vaccine.

It is known what causes it-a virus; but it is a virus with many different strains, each with distinct characteristics and each liable to cause an epidemic. Vaccines cannot be stockpiled. When influenza begins to show itself, the particular strain of the virus must be identified and special vaccines prepared. Once identified , the virus is cultivated by multiplying it in hen's eggs.

WHO endows a World Influenza Centre, at the National Institute for Medical Research , London , which acts as a clearinghouse for all info rma tion about influenza and as a centre for continuous research. Supplies of vaccine and sera are prepared at the State Serum Institute, Copenhagen, and facilities for training influenza experts are available at the National Influen za Strain Study Centre, Brooklyn , as we ll as in London. In addition, there are 38 regional centres for identifying viruses and for local research. The entire world-wide network o[ watch-towers against influenza is under the sponsorship of WHO, which also convenes an Expert Committee to assess results and direct future activities.

As long ago as 400 B.C. Hippocrates described a disease which was almost certainly brucellosis B rucellosis causes abortion in animals and undulant fever in human-beings. It has become obvious in recent years that this fever has been treated with less importance than it deserves. WHO has ranked it as a major communicable disease in all part s of Europe , the Medite rranean countries North and South Africa, and in certain parts of Asia and of North and South America.

For human beings, this is a milk-borne disease. In the U.S.A., in spite of the fact that 80 p.C. of the milk is pa teurized and that brucellosis is low in animals as

(col7lil1l1ed 011 page /6)

Hygi ene Keeping Fit-2

A s described in the last article, keeping fit depends on the practice of a number of rules of health. Some of these, such as the care of the teeth , nose, ears, etc., a re not difficult to follow since they o n ly req u ire p erson a l effort. Others, ho wever, such as obtaining sufficient fr es h a ir a nd ensuring adequate ven til a t ion ma y be more difficult to o b serve si nce, in m a ny ca ses, they are so me wh a t dependent on other fa ctors, e.g ., type and place of employment.

Fresh Air

The value of fresh air is recognized by everyone but the reasons f o r i ts b en eficial effects are not so cle a rl y u n der stood. It is well-known th a t it is s timula ting and invigoratin g, a n d ther e a r e many reasons for t his . In t h e first place, it contains pl enty of oxy gen while impurities such as car bon dioxide and other gases are diluted to a minimum. Seco ndly, it i s comparatively free fro m ger m s which in an occupied room m ay b e as numerous as 100,000 to 200,000 per cu. ft., a lt ho ugh fo r t un a tely most of these a r e o f a h armless variety. An im porta nt po i nt i s that fresh air is always o n th e m o ve which, as will b e seen la ter, is ess ential for the n o r ma l functioning of the skin.

Strictly spe a king, everyone should h ave a liberal daily ration of fresh air, and when it ca n be arranged tri ps into the open sp a ces or country are de sir a ble. This applies particul a rly to ma ny to wn-dwellers who m ay li ve in a district where the at m o sphere co ntains a relatively high amount o f dust , etc., arising fr o m dome stic chinmeys as well as fr om fa ctories and other places of bu sine ss

A d a ily r a ti o n of fresh air, however, is n ot sufficient; it must be co n tinuou sly supplied to every indi vidu al wh ether he is at home, at work or elsewhere. This introduces

the important subject of ventilation which can only be mentioned briefly in this article.

Ventilation

Formerly ventilation was thought only to be concerned with providing fresh air and removing impurities without causing a draught. This, of course, is still very important because the air in a room gradually loses its purity as the oxygen is used up by breathing, the burning of fires, etc., while the amount of carbon dioxide gradually rises from the same sources. More over, the air in a badly ventilated room becomes warmer and conta ins more water vapour, which contributes to stuffiness and fatigue.

Nowadays, in addition to supplying fresh oxygen, removing impurities and diluting the number of germs, it is recognized that ventilation plays a n important part in providing skin comfort and in the adjustment of body temperaturetwo factors which are considered essential to health.

To understand skin comfort' it must be realized that the skin is continuously swea ting although this is not usually noticed by the individual except in wa rm weather and as a result of exertion, etc. This sweat evaporates from the surface of the body or from the clothing by which it has been absorbed. Unless evaporation takes place steadily, the function of the skin is disturbed and the individual may feel tired. Skin comfort is ensured by air movement, a suitable humidity and a satisfactory temperature of the room.

Air movement is essential otherwise the air in the meshes of clothing becomes warmed up to body temperature and full of moisture. The rate of air mo v em ent in an occupied room should be a pproximately 30 ft. a minute in winter and greater in summer.

The term humidity refers to the amount of water vapour present in the air. This must not be too high since once again it would interfere with skin comfort, while so far as the temperature of room is concerned about 60 OF. is generally regarded as comfortable but it must be a little higher if sedentary work is being undertaken.

Clothing

This plays its part in keeping fit. It protects the wearer from alterations in temperature, particularly cold and also from mo i sture. In addition it has a psychological value since neat, tidy and tasteful dress contributes to the happiness of the individual.

It is often thought that protection from cold depends solely on the thickness of the clothing worn. A great deal, howe ver, depends on the fact th a t air which is station a ry is a bad conductor of he a t; a nd a considerable quantity of stationary air surrounds the body when clothing is worn. It is situated between the va rious l a yers of clothing, between the underclothes a nd the skin itself and is also contained in the numerous pores of the m a terial from which the garments are made. Hence the warmth of a material to a large extent depends on the amount of air it contains; it also follows that in cold weather greater warmth will be obtained from wearing several thin garments rather than one thick one.

A word of warning is necessary on the subject of over-clothing since this discourages the body to produce its own heat by muscular action with the result that the individual becomes disinclined for exercise.

Protection against cold includes preventing the body from cooling too quickly, for example after strenuous exertion such as playing games, etc. Too rapid cooling may lower the general resistance and make an individual liable to colds

FIRST AID & NU RSIN G JULY/AUGUST 1952 and similar ailments. This is the reason for the sweater put on by sportsmen when sweating after a game

Cooling of the body results largely from the evaporation of sweat which is normally absorbed by the underclothes and then passes through other layers of clothing. Underclothes, therefore, must be porous and for this reason are usually made of pure wool or of a mixture with cotton since wool in itself may irritate the skin. Wool is of course a good non-conductor of heat. Silk is an excellent alternative to wool. Underclothes must be washed and changed frequently otherwise they develop an unpleasant odour.

These few paragraphs on clothing cannot be concluded without reference to the important subject of comfort. It is essential to avoid garments which restrict movement of any part of the body or which contain constrictions which impede the circulation of blood. Tight garments, e.g., body belts, should be av oided whenever possible. Although they supply comfort and improve appearance, they tend to cause muscles to become fl a bby.

Oral Hygiene

This refers to preserving the mouth in a healthy condition . The mouth, of course, is one of the few entrances into the human body, hence the need for its hygiene is of obvious importance. It contains the teeth, tongue a nd in some people , tonsils.

The teeth are of grea t importance to health since the proper mastication of food contributes to the efficiency of digestion. Unfortunately, however, unless properly looked after they are liable to decay and may then be lost.

The first rule for preserving the teeth is to pay regular visits to a dental surgeon for inspection. He can quickly examine every tooth in the head and if he discovers that a small cavity (or hole) has begun to form can easily fill it without causing pain. If, however, the cavity has been allowed to progress, filling may be more difficult and incidentally more painful. There are some foolish people who allow their teeth to decay and have them extracted rather than filled; they should remember that artificial teeth, however well made, can never

approach natural teeth in their efficiency, quite apart from the fact that decaying teeth tend to lower the general bodily health.

D uring the inter vals between visits to the dentist, the teeth should be thoroughly brushed at least twice a day if not after ea ch meal. Brushing must be comprehen sive including all exposed sides of each tooth and paying particular a ttention to place s where food is li a ble to coliect, e.g., between the teeth. Particles of food in such situations encour a ge dec a y they cannot be remo ved by mg a soft tooth pick or piece of dental twine m a y be employed.

. The tooth-brus h should be k ept 10 a cleanly condition; after use it should be rinsed i n hot w a ter a nd then placed upright to dry in a position where it does not collect dust. So far as the dentifri ce employed is con cerned, modern opinion inclines to the view , ODe which liberates th e a mmonium i on in the mouth help s to prevent dec ay As import a nt as the teeth ar e t he gums. Sometime s t h ey beco m e so ft , fl a bby and bleed easily when the teeth are cleaned. This is often a n early sta ge o f p y orrhoea a nd if allowed to progr ess, small qu a ntitie s of yellow-white di scha rge may a ppe a r between th e gum s a nd the teeth, particula rly wh en the former are pressed. T his conditio n is detriment al to hea lth, since the discharge is continu o u sly swallo wed. Tre a tment ad vised by a dent a l surgeon may cur e this condition otherwise the teeth must b e extracted.

The tongue m ay be a guid e to the general health o f a n individual a nd for this reason is often ex a mined by the doctor. A furred tongue suggests a digestive disorder such a s constipation but there are m a ny other causes which cannot be discussed in this article. It must be emphasized, however, that a slightly furred tongue may be of no si gnificance and compatible with perfect health. Indeed, fur tends to form during sleep. Those who desire to keep the tongue in perfect condition can regularly eat fruit such as apples and also use a mouth wash after cleaning the teeth.

If the tongue tends to be rough and sore, a search should be made for the cause. This m a y include oversmoking, taking drinks which are

(continued on page 16)

Bed Cross

A m ost successful o ne -day exhibition of h omecrafts m ad e by war -disabled was held at the G uildhall , London, on 2nd July. It was spo nsored by Lt .-Co l. S. Shaverin Ch airman of the Ley ton, Walthamstow and W a r Pensions Committee, and exhI bIts came from the 26 War Pensions Co mmi t tees of L ondon The exhibition was op en e d by the Minister of Health, Mr. H ea thcot e Am o r y, who was supported by he Lady M ayoress, Sir Frederick Wells dep utiz in g fo r the L ord Mayor of London: an d 32 M ayors and Mayoresses from the G reat er Lo n d on and Metropolitan area, as well as repr esentatives from the Society and th e O r de r.

The Barnet H o pital Management Committee to stimulate .H S.R. recruiting, asked local R ed C ross and St. John D ivisions o enter a decorated lorry in the E ast Barnet Whit-Monday Carnival. (Last year they wo n first prize. ) This was agreed an d a lor ry was dressed. When the parade was entry was awarded first prize, an d lllstructlOns were then given for the lorry to move to the head of the procession. T h e driver started the engine the lorry l urched forward, and in so doing threw the t wo girls at the rear on to the roadway The o ther tw o nurses immediately jumped down an d rendered first aid The casualties were t a ken t o hospital. An onlooker said she was am azed th at two p eople, who must themse ves h ave been considerably shocked. could h ave r eacted so quickly It is interesting to not e that when this comment was passed to the girls concerned they said their training m ade their action instinctive The injuries sustained were not serious

T he R egional R epresentative of R egion 10 s tate d that a conference on . Mountain Rescue a nd F irst Aid Arrangements in the Lake D istrict Nationa l Park' was held at Ambleside o n 17th May to consider esta blishing a compreh ensive and coor dinated scheme for fir t aid and rescue for mountain acci dents of all types . T he aim was th a t her e should be first aid and rescue eq uip ment available in each main valley a nd t h at p ers o nnel should be trained in its u se. T he con ference considered every aspect of the su bjec t and it was finally recommended th at a Su b-Committee of the Join t Comm itt ee of the Or der of St. J o h n and the Br itis h R ed Cross Society m ight be formed, with p ower to co- o p t representatives of the Police, t he R. A.F .. the M o untain R escue Committee, the Youth H ostels Asso ciation, the R am b lers' As oeiation, The H oliday Fell owshi p, an d the ocal Medical Officers of He alth a nd any ot her or ganizati ons which a re will ing to h elp.

B y A . D. Belilio s, M .B. , B. S. (Lond. ), D.P. H. (Eng .)

FIRST AID & NURSING, JULY/AUGUST 1952

Ambulance Transportation on Guernsey

¥ Basil C. de Guerin

3.45 p.m. on Thursday, 6th March, 1947, His Excellency the Lieut.-Governor of · Guernsey, Lieut.-General Sir Philip Neame, v. c., K.B.E., C.B., D.S.O., Knight of St. John, made history when he sent the first message over the island system of radio - controlled ambulances, and thus inaugurated the initial service of this kind in the St. John Ambulance Brigade in the whole of the United Kingdom.

This was the realization of the dreams of a small body of 15 members headed by County Officer R. H. Blanchford who had worked for such a system since the foundation of the Transport Section of the local St. John Ambulance Brigade on 13th January, 1934, work which had of course to remain in abeyance for the five years, 1940-1945, while the Germans occupied Guernsey and the other Channel Islands. Apart from lhis delay the idea met with much opposition and even when this was overcome there was considerable trouble in obtaining a licence for radio transmission.

To-day, Guernsey County St. John Ambulance Brigade, Transport Section, is responsible for the removal of all surgical, medical and accident cases, the supplying of blood donors to the hospitals, and the keeping of all records relating to the same, emergency oxygen service, medical comforts, and arranging for transport of accidents occurring in the Channel. Personnel either accompany the lifeboat or proceed to the distress call by highspeed launch. Similar arrangements are made when called upon to remove patients from the adjacent islands of Alderney, Sark and Herm. Four ambulances and two cars are fitted with radio telephone. Simplex operation is employed on a freq uency of 76.2 Me.s and provides two-way communication between mobiles and

a standard G.E.C. 10-watt frequency modulated transmitter-receiver housed in the top of a 100-ft. observation tower built by the German occupying forces during the war. This equipment is connected by land-line, and is remotely controlled from the combined operation room, which in addition has receivers, Marconi C.R. 300 and Halicrafter S.X. 27, for the monitoring of ships and aircraft, etc., in the case of a combined search.

When an emergency call is received, an operator whilst still obtaining full details from the caller presses a series of buttons. The first automatically starts an A.C. rotary converter in the tower, as it is unfortunately situated in a D.C. area; the receiver and transmitter are then ready for use. The second operates a siren in the garage where all the vehicles and crews are located, the smash crew turns out immediately (9-10 seconds) and proceeds towards the exit.

There, other buttons having been pressed, they find the traffic lights on, and a left or right-flashing arrow indicating their direction (up or down the road). Once on the road they receive full instructions by radio of the exact position of the accident.

The time of receiving the call and the subsequent radio telephone reports from the ambulance are recorded in a radio log.

A diagnosis of the patient's injuries is communicated to the control room, and in turn notified to the hospital, so that when the ambulance arrives there is no delay in the reception of the patient, the ambulance staff having already been informed by radio of the ward, etc.

On arrival at the hospital, doctors and nurses are all ready to go into action.

The service is fully equipped to deal with all kinds of rescue work,

including cliff, quarry and wells, etc. In the case of cliff rescues tbese are often carried out by land and sea, and G.E.C. F.M. pack sets are used to co-ordinate this work. These sets are invaluable, and are used for many types of emergencies.

A standard G.E.C. end-fed dipole is employed, situated on the top of the 100-ft. tower. Connection to the aerial is by a Perelli-General concentric feeder-cable which uses polythene insulant and has an impedance of 70-75 ohms. The mobile aerials are i-wave radiator rods counter-balanced by the earth formed by the car roof.

Exide Ironclad batteries, 190 amps., are used in the vehicles, and have proved most satisfactory.

Contact with control up to 20 miles has been established at sea using a lO-watt mobile transmitter/ receiver, and 7 to 8 miles with the F.M. V.H.F. pack type. In addition, short distance walkie-talkie' apparatus is used for cliff rescues, etc.

Besides the ambulances and cars referred to above, the island Brigade owns a mobile first aid trailer unit. This was presented by Victoria Hospital Incorporated in memory of

the late Dr. Robinson who was the initial instigator of SL John Ambulance work on Guernsey and who founded this hospital in 1888.

Although presented to the nursing divisions, whose nurses staff and operate it, the Transport Section undertake its removal to shows, fetes, and other public gatherings, when their members alw provide facilities for use of their wal kie-talkie wireless co mmunicatio n.

That there is a need on Guernsey for all this equipment is proved by statistics for the year ]95], which show that during that time 8,845 patients were carried in the ambulances; there were 450 street or other accidents; and that 602 cases were given first aid at the St. John Ambulance Station alone. Mileage covered by ambulances during the year was 26,801, which is considerable when it is considered that Guernsey is only 25 miles in circumference and one can drive around its entire coastline in less than an hour.

In addition to this local traffic, a further 17,400 miles were covered by personnel escorting a total of 83 cases, by air or sea, to England for treatment; and arrangements were made for 41 more cases to travel unaccompanied.

The value of the radio transmitter is shown by the fact that no less than 343 diversions of ambulances were made by this means, apart from regular messages and calls.

Since the inauguration of the Transport Service in 1934 there has been in force a scheme to enlist the interest and support of the public which will also be to its own benefit. Under this an annual subscription, of which the minimum was originally only 1/- but later rose to 2/6 and is now 3/-, entitles husband, wife and all their children up to 15 years of age, to free transport by ambulance or car in cases of accident, collapse or maternity, as well as, by medical instruction, for surgical, medical, X-ray, and electrical treatments, and invalid house-to-house removals.

Naturally, many people donate more than this sum and there is no maximum, and subscriptions in this way for the year 1952 reached the fine total of £3,052.

In addition to this source of income the' States,' or Parliament,

of Guernsey makes an annual grant of £2,000 toward :: the expenses of the Transport Section, in recognition of the good work which it is doing for the community.

There is, however, one avenue of expansion in which Guernsey County S1. John Ambulance Brigade, is desirous of making organized progress. This is in the establishment of a properly equipped Air-Sea Rescue manned by specially trained personnel.

Many instances of rescues made by boat from ro(; 1,;.s and the base of cliffs around the island's coasts, of help rendered the injured aboard ships in the English Channel, and of the swift relief by conveying distressed inhabitants from the smaller islands to hospital in Guernsey are recorded, and such work, which is essentially of an emergency character, is rapidly growing in volume.

At presen't the staff of the Transport Section deal with each instance as it occurs according to the particular circumstances. Fast speedboats are chartered as available and, with their portable wireless, it is possible to range up to 10 miles at sea without losing touch with Headquarters. This gives a radius including the island of Herm and Sark

where a number of calls have already been attended, but it is felt that a fast speed-boat, properly equipped and always ready for action, should be a permanent feature of this Section.

The matter is, at the time of writing, under consideration by the authorities, and all supporters of the St. John Brigade will hope that the outcome will be successful and thus put Guernsey County once more in the forefront of pioneers of rescue work.

In spite of all its routine activity the Transport Section finds time to make its mark in another sphere of island life. From a builder's dump of waste material which formed a large part of the property on which the Station is situated, has been fashioned in a few years, and entirely by staff labour, a most attractive garden which annually wins prizes in local horticultural competitions.

The result is that not only is the Station a model of efficiency and progress, but it is now also a thing of beauty which thousands of islanders pay to see during the summer when the flood-lit gardens make a pilgrimage to them one of the outstanding features of the 'visitor' season. Last year the sum of £254

County Officer R. H. BI?nchford recei \ling messages at the wheel of one of the cars of the Transport Section

Guernsey ambulance two-way radio control in operation

FIRST AID & NURSING, JULY / AUGUST 1952

was thus raised by sightseers' contributions.

The growth and development of this Transport Section has been the result of one man's experience, in the approved fairy tale style. In 1930, at the age of 15, Mr. Reginald Herbert Blanchford was seriously injured in a motor cycle accident and during subsequent months in hospital he vowed that he would devote the remainder of his life to relieve the sufferings of others.

This he was able to do with the formation of the St. John Ambulance Brigade to supplement the local branch of the Association some few years later. Shortly afterwards with the presentation of a second-hand ambulance by the late Mr. John Roussel , and the loan of garage accommodation on the premises of Mr. Blanchford's father, the Transport Section came into being.

With the help of a few other enthusiasts this became established and today numbers a permanent staff of eleven with other volunteers.

Recognition of Mr. Blanchford's work has come in the following se quence, Transport Corporal 1936, Transport Sergeant 1937, Transport Officer 1939, Corps Transport Officer 1944, County Officer in Charge of Transport 1946. Honours, too, have come his way. He was made a Serving Brother of St John in 1946, and awarded a Certificate of Honour for Gallantry in the same year, as well as the King's and Queen's Certificate. In 1949 he was awarded the Service Medal of the Order of St. John. As a mark of recognition for outstanding bravery in one of many cliff rescues in which he had taken part Mr. Blanchford was made a Member of the British Empire by King George VI on 13th December 1950.

In addition to the regular work of all branches of the St. John Ambulance Brigade, Guernsey County also instituted the island Hostel of St. John for the aged, which is situated in the beautiful surroundings of the public park once the home of Lord de Saumarez a Guernsey-born Admiral of Royal Navy who had a distinguished career during which he was secondin-command to Lord Nelson at the Battle of the Nile.

This hostel caters for up to fifty persons, who contribute according to their means, and is controlled by a voluntary body known as the Friends of the Hostel of St. John. The premises are lent free of rent by the island Board of Administration and the balance of the upkeep is by voluntary contribution.

There is also a Library Service for local hospitals which is tended by voluntary workers, and is much appreciated by patients.

Al though these notes are confined principally to a selection of the history of the Transport Section of Guernsey County St. John Ambulance Brigade, mention must also be made of the work of the Red Cross Society on the island.

An officjal branch was formed in February 1952 to continue the work of the initial movement which had been formed in January 1941. One of the leading workers on behalf of the Red Cross has been Miss Leonie Trouteaud, who, together with a small staff, handlpd many thousands ?f messages to and from beleaguered Islanders the Occupation, and who smce the war has been the

representative of the Red Cross Council of the Order of St. John of Jerusalem on the island.

In recognition of her valuable work in this sphere Miss Trouteaud was awarded the M.B.E. in the King's Birthday Honours in June 1951.

The work of these and similar organizations on Guernsey is to-day widely known, and honours have been bestowed upon many of their members. Royalty, too, has frequently gone out of the way to visit the island to inspect the work and personnel of this progressive station.

Soon after the war Their Majesties King George VI and Queen Elizabeth made the journey and were fonowed in 1949 by Princess Elizabeth and the Duke of Edinburgh, and islanders now await with pleasure the impending visit of T.R.H. the Duke and Duchess of Gloucester who will no doubt take particular interest in the St. John Ambulance Brigade and the Red CrC'ss in view of His Royal Highness's occupancy of the highest rank in each.

lIospital lteserve Changes

Some changes in training for members of the National Hospital Service Reserve have been announced.

The part-time hospital training for nursing auxiliaries has been reduced from 80 to 60 hours. Their' full-time' hospital training of 48 hours, which formerly had to be completed in one week, can now be taken over two months, in separate periods of not less than two days each.

Fully qualified members of the St. John Ambulance Brigade or British Red Cross Society with two years' efficient service will now be asked to do only 48 hours' hospital training whether taken full-time or parttime.

For all members of the Reserve taking their annual Refresher Course, the time spent in hospital first-aid exercises, up to a maximum of 16 hours, will count towards their 48 hours.

The former upper age limit of 60 for enrolment in the Reserve is extended to 65 for all men, for women trained nurses who have retired from full-time nursing, and for efficient women members of the St. John Ambulance Brigade and the British Red Cross Society.

* London Transport

The presentation of first aid awards, London Transport Ambulance Centre, was held at the Porchester Hall, London, W.2, on 25th June, and was accompanied by a dance and social. The presentation was made by Mr. A. H. Grainger, member of the London Transport executive, who was introduced by the Centre Chairman, Mr. Alex. J. Webb.

About 250 out of some 500 awards gained during the second half of 1951 were presented to members, and were followed by special awards and long service medals to the undermentioned :Long Service Medals

IS Years-F. Cursons, C. Morris, W. Perry, H. Taggart, R. Terrell, E. Young; 20 Years' Bar-R. Procter, W. Skelton, R. Weekes; 25 Years' Bm'- W. Harper, S. Weekes; 30 Years' Bar-A. Brudenell, H. Mortemore; 35 Years' Bar-E. Dunn. Hally Tablet Medals 1st Year- E. Talbott; 2nd Year-Po Dowling; 3rd Year-To Clift. Team Plaques Probyn Shield Competition, ' Manor House; Challenge Shield Competition, Chiswick. Furtherance of First Aid Certificates Miss J. Hunt, Broadway; Mr. W. Maxted, Charlton; Mr. W. Butler, Lots Road.

In addition, a framed Diploma granted by the Order of St. John on his admission as Service Brother of the Order was presented to Mr. F. W. Smith, and a framed Diploma granted on his receiving the honour of M.B.E. was presented to Mr. J. A. Gravestock, Hillingdon.

,News from St. John

mord

No. 46 (Ilford) Division held its first field training day at Laindon recently. Those present were divided into two teams Red and Green, in order to introduce competitive spirit. The first period was devoted to and the setting up of two dressmg statIons from which the two teams were to work. This gave the members practice in the erection of some new tentage recently purchased by the Division as well as serving as a preliminary to the main part of the training which was to follow.

The periods immediately before and after lunch-3 hours in all-were devoted entirely to practical first aid. Casualties were placed at various spots in the fields and woods adjoining the training site and were dealt with by Red and Green teams respectively, such major injuries as fractured spine, fractured femur (open), internal haemorrhage and other smaller incidents were aU made up and fully staged. This gave the practice in diagnosis, treatment, liftrng, carrying and disposal.

During the afternoon tea-break the site was visited by Area Sergeant-Major E. F. J. Weston, who saw the teams at work.

The catering was undertaken by Cadet Superintendent T. J Chesterman and a party of Cadets from C.15 Ilford Cadet Division. Casualties were supplied by Wanstead Branch Casualties Union under the direction of Instructors A. G. Bone and H. Waud.

The whole scheme was conceived and planned by Cp!. Bone. to whose indefatigable efforts the success of the day was largely

due. The operations were under the direction of Divisional Officer Everett.

Chertsey

The annual garden fete of the Chertsey Division was a great success. It was opened by Dr. O. St. Peter's Hospital, at a ceremony presIded over by Miss M. A. Eastaugh, President , and supported by J. A. Tulk and A. T. Ledger, VicePr.esldents , Mrs. Ledger, Miss J. Macey, Dlv. Supt. of the Nursing Division, and Pte. Baker, Social Secretary.

Dr. Plunkett said that he had come in contact with many people who had met with accidents, whose injuries might have involved many months in hospital had it not been for the timely treatment they had received from membe rs of the Brigade, which left them at the hospital little to do. He had the greatest admiration for the experienced work they had done and were doing in Cbertsey.

Askern

At the annual social of the Askern Main Corps on 12th July, over 130 awards were presented by the Corps President, Mr. Llewellyn Jones. A presentation was made to Dr. John Malloch and to Mrs. Malloch as a mark of appreciation on his retirement from the members of the Askern Main Corps and the Underground Colliery Officials.

The Chatrman was Mr. R. Bell (Manager of the Askern Colliery) and amongst the guests were Mr. Llewellyn Jones (Corps

Two of the permanent office staff on duty at the H.-Q. Transport Section of the Guernsey County SJ A B.

8

President) and Mr s. Llewellyn Jones; Assistant Commissioner Dr. B. Hart , O B.E. , CO.S.J. ; County Officer E. Soar, S B.S.J. ; Area Staff Officer J. Dea rden and Mrs . De arden; Corps Supt. A. Wyld and Corps Officer Mrs. A. Wyld.

Bradford

On Wednesday, 25th July 1952 Bradford Corps held their Annual Inspection at Belle Vue Barrack (wh ich had been kindly lo aned for the occasion). The Inspecting Officer was Area Commissioner Dr. R. Chester, M.D. Ch.B., M Sc. , M.R.C.S., L.R.CP. , along with County Officer Mrs.

O. M. Geldard, also Area Superintendent Mr. M. Hill, Cadet Officer Mr. Mason, and Cadet Officer Mrs. Dickin so n. About 500 ambu lance personnel were present ; Corp Supt. Mr. Bray having c harge of the Parade. Dr. Chester and Mr. Gadie (the President of the Corps) spoke of the work done and appealed for more members. Following this a number of service awards were made by Dr. Chester.

Essex

Annual inspections were recently held at Chelmsford an d at Manningtree The Parade on Chelmsford cricket ground , numbering in a ll abo ut 350, compri sed members of the Ambulance Brigade and Nursing Divisions, Ambulance and Nursing Cadets.

The Parade, whic h was in charge of Supt.

E. Barber, was inspected by Sir Otto Lund

K.CB., D.S.O., the Chief Commissioner of the S.J.A.B., who was acco mpanied by Mr.

G. F. Quilter the Brigade Secretary , and Dr. J. T Whitley, the Essex County Commissioner.

Addressing t h e P ara de , Sir Otto told them they were doing som e really first-class work in Essex and keeping up the high traditions of the S J .A. B.

The response to the call for recruits for the Brigade in the country had been encouraging, but sti ll more were needed. They must have quality as well as quantity , and so they placed great emphasis on the constant training of members.

Manningtree divi s ion was celebrating the 50th anniversary of its formation. One of t he founder-me mber s was on parade, and two more lookmg on, when Sir Otto Lund inspected.

Sir Otto Lund was acco mpanied by the County Commissioner, Dr : J T. Whitley ; the D .eputy County Co mmi ssioner Brigadier

T. Rigby, a nd t he Brigade Secretary Mr. G. F. Quilter.

A past followed the inspection, the salute bemg take n by Col. Sir Francis Whitmore, Lord-Lieutenant of Essex, who is the S.J.A.B. County P resi dent. He was accompanied by Col. J. L. Hamilton, D.L., formerly County Commissioner of the S.J.A.B. Mu sic during the inspection and the march past was played by Burnt Heath Sliver Band.

THE CALL FOR BLOOD DONORS

A Sel·vice Which Saves Lives

MANY hundreds of thousands of men and women volunteered to give their blood for civilian and military casualties during the war. Their magnificent response saved thousands of lives, and helped to establish a service which is proving of ever-increasing value. As a result of discoveries during and since the last war, there has been a great increase both in the number of cases treated by blood transfusion and in the amount of blood given to individual cases. Transfusion has become par t of everyday medical treatment; because of this the service must expand steadily if it is to keep ahead of the rising demands of hospitals.

The Need

In 1944 there were 1,005,000 donors enrolled on the regional panels. The number dropped to 270,000 by the end of December] 946. Since then there has been a growing appreciation of the fact that blood transfusion has an important role in peace as well as in war and there are now over 465 ,000 donors in England and Wales

This addition of 195,000 donors in five years has not, however, satisfied the increasing demands on the Service, which, in order to reduce calls on the individual don or to a minimum of one every s ix months, and to provide for the future expansion of the Service, has a target' of another 170,000 donors - or over 600,000 donors in all. Donations have doubled since the war.

In 1947 they were 296 ,000 ; in 1951 they numbered over 593 ,000 not far short of the record of 669,000 in 1944. Hospitals are now using about 60 ti mes as much blood as before the war; more than one donation for every minute of the day and night.

Doctors are now more aware of the value of transfusion for the treatment of accidents haemorrhage, burns, anaemia, childbirth and operations, to mention some of its many uses.

How the Serl'ice Operates

In 1921 four membrrs of the Camberwell Division of the County of London Branch of the British Red Cross Society volunteered to give blood whi-ch was urgently needed at King's College Hospital. From this donation grew the fir s t blood transfusion service in the world. Now there is a National Blood Transfusion Service administered by the Regional Hospital Boards under the National Health Service with ] 2 regions in England and Wales.' Each region is centred on a university town , and at of these towns an organization is ma!ntamed for collecting blood within the reglon. The bottles of blood collected are placed in a refrigerator and taken to the region al blood laboratory for groupmg and testmg. The whole blood is kept in the Regional Blood Bank , or lssued to Area Blood Banks which are maintained at large general hospitals. Each of the princ!pal hospitals holds a supply of blood suffiCient not only for its own needs, but also for the smaller hospitals nursing homes and general practitioners in its This supply is rep lenished from the Blood Ba.nk every week or

often if the need arises. In this way , It IS ensured that no one who need s a transfusion will have to go without, even if the patient lives in a remote country district.

Since red cells cannot be preserved for longer than 21 days outside the body , blood which has been is s ued but not used within 21 days , is returned to the Regional Transfusion Centre, where the fragile red cells are removed. The fluid which remain s (plasma) is then sent to the Medical Research Council Blood Products Research Unit at the Lister Institute in London to be dried

Blood plasma in this dried state can be stored indefinitely and is a valuable adjunct to whole blood It is particularly valuable in cases of severe haemorrhage, in maintaining life until supplies of blood of a suitable group can be obtained. For this reason , small hospital s, es pecially in remote pa!'ts of the country, carry a s upply of dned plasma for emergency use. The dried plasma has two great advantages in these places. It can be stored without refrigeration and it can be gi ven to patients of any blood group

Early Discoveries

The idea of blood tran s fusion is one of the Qldes t in the hi s tory of medicine. I t is vaguely referred to in the medical writings of the ancient Greek s, but the first rec orded attempts to transfuse blood from one body tc? another ,:"ere not made until after Harvey disco ve red JD 16]6 that the blood circulated through the body. In 1665 Dr. Richard Lower s uccessfull y tran sfused blood from one dog to another. Hi s experiments became known abroad and two years later a French doctor made the first blood tran sfusion on a human being , a boy of 5. The practice of transfusing human beings with animals' blood was taken up in many countries but so many deaths were caused that it was made illegal. For 200 years the discovery remained dormant, but in 1818, a London doctor working at St. Thomas' and Guy' s Hospital s invented an apparatus for tran sfusing blood and suggested that only hum a n blood should be u se d for human being s

The Four Main Blood Groups

Why some blood transfu s ion s were successful while others were not wa s not U1;derstood 1901 when a young Viennese SCientist named Landsteiner discovered that there were different kinds of human blood and that the red cells were clumped and destroyed if bloods of the wrong kinds were mixed . The unsuccessful transfusion s of the past can probably be explained in this way It was finally determined that there were four main groups of human blood. These are called Group 0, Group A Group B, and Group AB. A patient should always be given blood belonging to the same group as his own. In emergencies, however, Group 0 blood may be given to patients of any blood group

Several other blood group systems are now known, Rhesus, Kell, Lewis, Lutheran, Duffy , etc., and the most important of these, the Rhesus blood group system is described later.

FIRST AID & NURSING, JULY / AUGUST 1952

Another difficulty was caused by the fact t hat blood clots s oon a fter removal from t he body, making it difficult to tran s fer blood from one person to another. The problem was so lved by th ree scie nti s ts working independently in America, and the Argen tine, who in the s pring of 1914 discovered that the addition of sodium citrate prevented the blood from clotting without causing h armfu l effects w hen introduced into the body. Blood transfus ion was first used wide y during the 9 14- 8 wa r.

Storing Blood

The ne xt problem was the storage of blood. Jt was known that blood s hould not be allowed to freeze or the blood cells wou ld be destroyed, but that it had to be brought to the lowest possible temper a ture s hort of freezing to delay decomposition. The technique of stori ng blood was successfully developed in Ru ss ia, following di scover ie s by a Ru ssian doctor named Andre Bagdasarov, and in 1937 in the United States a system of blood banks was s tarted. A preservative so lution , de velo ped in G reat Britain, durin g th e last war, s now use d in many countries.

Early in the last war it was found t hat transfusions of plasma alone were successful and apparatus was set up to prepare plasma o n a arge sca le.

What is Blood ?

Blood is m ade up of minute elements or cell s s uspe nded in a pa le ye llow fluidplasma. The ce ll s are so sma ll that a drop of blood con tain s abo u 250,000,000 red corp uscles, 400,000 w hi te corp uscles an d 15,000,000 platelets. R ed corpuscles ha ve the job of taking oxygen from the lungs to every part of the body so that the tissues may breathe. They are m anufact u red in the red bone marrow. White corpuscles form part of the body's defence system and will normally increase in number to a tt ack a nd destroy a ny disease-producing germs which invade the body.

Platelets take part in the clotting of blood, a nd so help to sto p bleeding when bloodvesse ls are cut or damaged. Plasma acts mainly as a carr ier , transporting the cor pu scles and platelets to all parts of the body, a well as food stuffs a nd waste products.

Plasma and Serum

Pla sma, the fluid portion of blood which ha s been rendered in coaguab le and from which the red cells h ave been re mo ved , is a valuable transfusion fluid and h as the advantage tha t it can be stored for many month s without deterioration an d if s uitably prepared can be given safely to p a tient s of a ny of the four blood groups.

Serum - the Auid separated from blood a fte r it has clotted-can be used in the sa me way as plasma. It is mo re easily filtered than plasma, and has similar keeping properties.

Plas m a and se rum are u sua lly dried. Tn this form the y keep indefinitely and are prepared for u se by adding s tel'i le di s tilled water or sa lt and glucose so lution.

Treatment by Transfusion

There are two m a in ways in which blood transfusion can save life.

(a) By su pplying red blood cells. Lack of red cells may arise becau se of lo ss of blood from a wound or because the

is not producing the red cells as It should or because the red ce ll s are t?O rapidly destroyed. 111 any o f these c ircum s ta nces anaem ia develops.

Anaemia can be treated successfully by the transfusion of concentrated red cells. When blood is st ored the red corpuscles settle into the lower half of the bottle leaving the layer of plasma above. The plasma can then be removed and the concentrated red cells transfused. In this way the deficiency of red cells is. rep aired, without g iving plasma, of which the anaemic p at ient has no need

(b ) By s upplying plasma. Pl asma a lon e ma y be l ost when the s mall bloodvessels or capilla ri es are damaged by crush injuries, by bu rnin g or by some types of intestinal disease. When pl asma is lost blood becomes thicker and circu lation slower, which mean s that the tissues are starved of the oxygen transported b y the red cells. The transfus ion of plasma dllutes the blood and so gets it flowing at the normal speed again.

Pla sma is also of great valu e as an emergency transfusion fluid in cases of h ae morrh age The factors which determine the main blood groups are limited to the red corpuscles and are removed when preparing pla sma, thus it may be transfused to patients of any blood group. Since plasma is de void of blood corpuscles, a patient sufferil}g from a serious h aemorrhage needs at lea st one pint of whole blood to about every two pints of plasma if the plasma transfusion is not to cause anaemia.

The Rh Factor

Early in 1940, a new group called the Rhesus or Rh factor was found in the red blood cells. This factor is present in the red cells of 85 p.c. of Europeans, who are termed Rh-po sitive; the remaining 15 p.C. whose cells do not contain it, are termed Rh-neg ative.

The Rh factor is of importance in transfusion because Rh-negative people may, under certain circumstances, produce antibodies to it wh ich appear in their blood and will destroy red blood cells containing the Rh factor. Such peorle are said to have been immunized, or sensit'Led to the Rh factor. Immuni zation may occur if an Rhnegative patient is transfused with blood from an Rh-po sitive donor. 0 harm usually res ult s the first time suc h a transfusion is given, but if the Rh-neg ative person receives a second tra nsfusion of Rhpo sitive blood a reac tion , wh ich may be serious, may OCCLlr.

Likewi se, the Rh-negative wife of an Rh-po s itive hu sband, may bear an Rhpositive child. The mother may be immuni zed by the Rh factor present in her child before it is born, and produce antibodies which p ass into the c hild and, by de stroying its red blood cell which contain the Rh factor, cause a ser ious for m of anaemia , accompanied by jaundice (h aemolytic di sease of the newborn).

It should be emphasized that only a s mall propo r tion of the off-spring of Rh-negative mothers and Rh-po s itive fathers suffer from thi s disea se, and th at the disease usually appears only after a s ucce ssion of healthy Rh-positi ve children ha ve been born. It does not follow th at, because the Rh gro ups

9 of mother. and fa th er differ in the way deSCrIbed, t heIr chi ldren will be affected.

To end the National Blood Transfusion Service .has organized and encouraged the testing of patients at ante-natal clinics }946. 1n 1951, some 453,0 19 tests of thiS kmd were made.

The djscovery of the Rh factor has made transfus ion safer, and, by explaining the cause of thiS obscure form of anaemia in mfants, has enabled appropriate treatment to be given. The Rh antibodies lose their effect wit hin a few weeks of birth. Transfusion of. blood will usually save the lives of seriously affected infants by helping over this critical period. Moreover, It lS now possible to avoid sensitizing women to the Rh factor by the of the wrong Rh group: such lmmUJllZatlon may cause anaemia and jaundice to appear earlier in their off-spring, who would have been healthy had the mother not become sensitized.

If it can be determined which women are Rh-n egative and these Rh-negative women are forming Rh antibodies it is possible to diagnose haemolytic disease during the ante-natal period. Preparations can thus be made to have suitable blood ready to give to the baby, when it is born.

Blood Products

Fibrin Foam made from blood plasma can be used to control bleeding in operations where the tying of blood vessels is not advisable. It is also of great value in brain and spinal surgery where nerve cells, which might be destroyed by other methods of stopping bleeding, would not grow again.

Thrombin also extracted from blooCl plasma, is a valuable agent for clotting blood and can be used either alone or in conjunction with Fibrin Foam.

Fibrinogen is an extract used in skin and nerve grafting as a kind of glue to keep the graft in position. Fibrinogen also contains a substance, anti-haemophilic globulin, which will temporarily control the bleeding in haemophilia.

Gamma Globulin, another part of plasma, carries various antibodies. Gamma-globulin has proved of value in the prevention and attenuation of measles.

Plasma Substitutes

There is no substitute for blood, but certain solutions have been made which have some of the properties of plasma. Gum saline solution, little used now, was introduced in the first world war. Since the last war solutions of dextran (a sugar), pol yvinylpyprolidone (a plastic) and gelatine (derived from bones) have been tested. All of them have the ability to replac(l temporarily pl asma which has been lost from the circulation, but insufficien t is known about them at present to compare their relative merits.

The Future

Ob viously, blood transfusion is destined to play an even bigger role than at present in saving life and combating disease, for transfusion is now an essential part of the country's ordin ary health services. The National Blood Transfusion Service is responsible for providing hospitals in all parts of the country with adequate supplies of blood and plasma: it is also responsible for meeting the needs for plasma of the Armed Forces of the Crown. But it cannot succeed without continual reinforcement with new donors

Artificial

Respiration

THE teaching of artificial respiration is an essential part of first aid training and the choice of the best method is, therefore, a matter of paramount importance . _ To obtain a clear idea of the methods actually used by the various national Red Cross Societies, the Health Bureau of the League recently requested information from all Societies as to the methods employed by them. The results obtained showed that the Schafer method is by far the most popular, being used by 16 out of the 27 national Societies who have so far repli€d to the request for information. Other methods such as Silvester's, Nielsen's Eve's Emerson's and Laborde's ever, employed by a number of Societies and seem to have served the purpose equally well.

The popular Schafer method has undoubtedly saved many lives but recent American investigations, the results of which were published in 1950 and 51 issues of the Journal of Applied Physiology and the Journal of the American Medical Association, seem to indicate that other methods may be better.

Emergency artificial respiration poses two questions :-

(1) What is best for the patient? and

(2) What is practicable for the operator?

With these questions in mind the Americans compared the following methods :-

(1) -rhe Silvester arm lift/chest pressure;

(2) The Schafer prone pressure ;

(3) The Eve prone rocking ;

(4) The Nielsen prone arm lift/back pressure;

(5) The Schafer-Nielsen-Drinker arm lift/prone pressure;

(6) The Emerson hip lift; and

(7) The Schafer-Emerson-Ivy hip lift/prone pressure.

The illustration gives an indication of how these methods are carried out and the pulmonary ventilation.

The figures 0btained by the different groups of workers varied somewhat but their conclusions were identical. All agreed that the Schafer method gave the smallest pUI.monary (485-296 cc.)

whIle the SIlvester, Nielsen and Schafer-Emerson-Ivy gave figures more than twice as high.

Since the normal pulmonary ventilation is 4:'10-500 cc., Schafer's method might seem to provide ventilat:oD and the high ventilatIOn obtainable by the other methods judged unnecessary. On the ot?er. hand, a patient requiring has been deprived of aIr; hence his arterial oxygen is low and his carbon dioxide high. The American studies show that for

many reasons, but in particular to avoid heart failure and irretrievable damage to the central nervous system, it is essential to introduce as much oxygen as possible into the circ,:!latjon as quickly as possIble: It IS, therefore of the utmost importance that the ventilation is as high as possible. second. problem-namely, WhICh method IS most practicableagain has two aspects. Can the most method be taught to, and carned out by, those who will have to use it; and can it be continued for a long enough period ?

A number of trials showed that all the methods can be taught quickly and be performed well, but that the two whIch were most accurately performed were the Silvester and the Nielsen: Both men and women could perform all methods for 15 miputes, the hip lift/back pressure belDg the most tiring. Thus from the point of view of good ventilation and good manipulation, the choice lay between the Silvester and the Nielsen.

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IT PAYS TO STANDARDISE

In,plrotio-n

Elplrotlon

The conclusions of the Americans may be summarised as follows. Compared with the other methods, the Schafer gives only a sma ll pulmonary ventilation, the lungs are poorly expanded and thus much of the blood reaches the heart unoxygenated. As it is important that oxygen reaches the heart muscle and the central nervous system before irreversible changes take place, a . , push-pull' method is better than one of push' only. Therefore, the Nielsen is the choice method; in it the subject is prone so that his airway is unlikely to be blocked by the tongue, epiglottis or mucus; and this method can easily be taught and properly executed without undue fatigue for a fairly long period.

Based on this and other evidence, the American National Red Cross, together with many other American organizations, recently adopted the back pressure/ arm lift method of artificial respiration-which is essentially the Nielsen method-as preferable to the prone pressure Schafer method which had been their standard for many years.

In view of the importance to the Red Cross of adopting the best possible method of artificial respiration and to give all national Societies an opportunity of expressing their views on the subject, a Symposium on Artificial Respiration was arranged at the meeting of the Health Advisory Committee of the League held in Toronto in connection with the 18th International Red Cross Conference, 26th July to 7th August.

Dr. Archer S. Gordon of the University of Illinois, who carried out a major part of the investigations mentioned in this Article, opened the meeting and was followed by experts from the American, British, Canadian, Danish and Soviet national Societies. Delegates from all national Societies took plrt in the subsequent discussion.

It is hoped that this Symposium will result in the adoption of a method of artificial respiration wh ich can be recommended for general Red Cross use.

(We are indebted to the Canadian , Red Cross World' for p er mission to publish the above article.)

TOPICAL NOTES FOR FIRST AlDERS & NfJRSES

N.A.P.T. Third Commonwealth Health and Tuberculosis Conference

This Conference , organized by the National Association for the Prevention of Tuberculosis, was held at Central Hall, Westminster, from 8th July to 11 th July inclusive. Over 800 representatives from 5 I countries were present, including doctors, administrators, public health officials, nurses, social workers and private individuals. At the opening session the President, H.R.H. the Duchess of Kent, referred to the progress which had been made in the last few years, and mentioned two problems which, if they could be solved, would greatly help the control of the disease in this country -the shortage of houses and the lack of nurses trained in tuberculosis work.

The Chairman, the Duchess of Portland, said that tuberculosis was one of the most vital subjects in preventive medicine. In Great Britain more than 25,000 people died of the disease every year; but in India about half a million.

Among the speakers were Dr. J. B. McDougall, of the World Health Organization, WItO advocated an all-out attack on the' black spots' in every region; Dr. Retief, of South Africa, who described the Witwatersrand Native Labour Association's arf2.ngements for Xraying new entrants to the industry to the number of 300,000 a year; and Professor' Neubauer, of JugoSlavia, who said that before 1940 not much had been done in his country. There were then only 40 dispensaries and 2,880 hospital and sanatorium beds ; whilst now there were 197 dispensaries - all with X-ray machines-and 13,000 beds. With international help, a B.C.G. campaign had been carried out, and B.C.G. vaccination was now compulsory for all persons up to 25 years of age. Attendance at mass X-ray examinations was very highup to 99.4 of the population.

Speaking from the floor, Mr. Donald Barlow told of his recent visit to Ceylon to investigate the

serious problem of tuberculosis in that country. He was sure that Ceylon was going to take its place as one of the leaders in coping with th is disease, for the Government had already agreed to the following measures: a basic living wage, children's allowances, an active housing programme, an l8-month subsidy for all tuberculous patients, and the notification of tuberculous cases.

The Nursing Position in Britain

Miss E. Cockayne, Chief Nursing Officer, Ministry of Health, spoke of the shortage of nurses in Great Britain-a shortage that is paralleled all over the world-and said that although there had been an increase since 1948 in the number of tuberculosis nurses and staffed beds, there were still 2,300 un staffed beds needing 2,600 nurses. It was therefore of the greatest urgency that every effort should be made to prevent the spread of the disease both amongst the public and amongst nurses themselves.

It would seem, however, that the shortage of nurses has been brought about by the great extension in the scope of nursing work and opportunities, and not by a lack of entrants to the profession, for the Annual Report of King Edward's Hospital Fund for London was published about a fortnight after the N.A.P.T. Conference, and from its pages we learn that Britain now has the highest total of student nurses in the world in proportion to the population. Despite fierce competi60n from all other occupations open to women the nursing profession has increased its active membership by 50 per cent. since 1939. There are, moreover, 100,000 fewer girls reaching the age of 18 each year than in 1939; but over ] ,070,000 more women are employed than before the war. The problem would, therefore, appear to be the making of the best use of the nurses we have by restricting their work to essential nursing duties, and very much is already being done in this direction in many up-to-date hospitals and other organisations.

PATENT B "PORTLAND"

carries two stretchers on one <4ii side of Ambulance. leaving other side clear for sitting patients.

The UP AND DOWN action is quick and easy for loading or unloading.

A. Shows the two stretchers in position.

B. Shows the top stretcher lowered ready for loading.

C. Illustrates the same Gear w th the top stretcher frame hinged dcwn use when only one stretcher case 1S carried.

D. Shows the same position as in "C' only with cushions and back rest fitted for convalescent cases.

Where Ambulances are required to carry four beds iwo Gears are fitted. one on EITHER SIDE, and the same advantages apply as described above.

full catalogue of Ambulance Equipment No. 7A will be sent on request.

Telegraphic Address ;-

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The second part of the book is devoted to a brief description of the more common diseases, with general notes on the nursing required in each case, a.nd the whole thus forms a comprehenSive volume of reference and guidance.

With 314 pages and 57 drawings, 7s.6d. Postage 6d.

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D. K. Mulvany, M.B., F.R.e.S., and Katharine F. Armstrong, S.R. N., S. C.M. A handy, compact manual which gi ves a complete outline of the anatomy and physio!ogyofthe hU!Dan 'A m,ost straightforward, relJable httleThe Nursin g TlIne s

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Name Address

FA/4S2

1. H. (Winnipeg) writes :Regarding treatment for burns in the eye, would ypu please tell me the treatment for Calcium Carbide ?

Reply

The burning action is immediate owing to the reaction of the Calcium Carbide with tears which incidently increase in flow directly the accident occurs. If olive or castor oil or liquid paraffin is readily available it should be used liberally. As much as possible of the chemical should be brushed away. When an oil cannot be obtained flushing with water should be undertaken. Cold compresses may relieve pain pending medical aid which should be sought as quickly as possible.

* * *

A. V. H. (London, E.S) writes :-

Please could you answer these questions for me concerning the eye:

(1) Does the eye leave the socket to be examined ?

(2) Can sand, grit or foreign body get behind the ey e?

(3) Is the eye joined to the lower or top lid ?

Reply

(1) No, this is impossible since it is held in position by muscles and other structures.

(2) No, the covering of the front of the eye called the conjunctiva turns forwards to line the inner surface of the eyelids and hence

Queries

Answered by Dr. A. D. Belilios, M.B., B.S. (Lond.), D.P.H. (Eng.)

prevents particles getting behind the eye.

(3) No, it is only held to the lids by the conjunctiva as described above.

* * * T. 1. G. (Dagenham) writes :-

In a recent conversation with an analytical chemist, he remarked that phenol or cresylic acid was not soluble in watef'. This statement started a discussion on the first aid treatment for phenol poisoning, and he averred that 1 oz. of Epsom salts in water would not act as an antidote, but would merely fill the patient with wind. Could you give me an idea of how the antidote as detailed in the 40th edition of the St. John Textbook, does its job.

Reply

The poison exerts its harmful effect not only by its action on the intestinal tract but also through absorption into the bloodstream. Epsom salts have been by experience to be of value; they do not act chemically out delay absvrption. It is also thought that the small quantity of antidote which may be absorbed may convert the poison in the liver into a harmless substance. Firs t -aiders should appreciate that Phenol (carbolic acid) and cresylic acid (cresol) are not the same substances.

Miscellaneous Ad vertisements

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B. E. (Nottingham) writes :-

I have read with interest the article by Dr. Gilbert Burnet, M.C., on page 9 of your January/ February 1952 issue of FIRST AID & NURSING. In view of the controversy aroused on this subject I am wondering opinion has been expressed to you by any other members of the medical profession and whether you could please supply me with a copy of same.

Reply

There can be no doubt about the value of Carbon Dioxide as a stimulant to respiration in certain cases, e.g., coal gas and narcotic poisoning and in drowning. But once the desired effect has been obtained it should be discontinued and often, for this purpose, only a few whiffs are required. The difficulty about its use in first aid is the selection of cases and judging how much to give. * * , *

B. F. B. (Rugby) writes :-

Soon after receiving a blow on his forehead a man developed a large swelling which the hospital doctor told me was a haematoma. What is the condition and how should it be treated in first aid?

Reply

This is a swelling like a cyst but filled with blood, derived from blood vessels which have given way under the skin. The blood cannot escape because there is no wound of the skin. A pad firmly bandaged over the swelling is often successful in treatment but must not be adopted if there is a suspicion of a fracture.

.. .. ..

M. E. F. (Woking) writes :Recently my boy had a few teeth out under an anaesthetic. He was

FIRST AID

HANDBOOKS ANATOMICAL DIAGRAMS AND CHARTS FOR LECTURES

H. K. LEWIS & Co. Ltd., 136 Gower Street, London, w.e.1 eUSton 4282 (7 lines)

FIRST AID & NURSING, JULY/AUGUST 1952

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TO TH E I NJ U RE 0 A NO SIC K

AN ADVANCED AMBULANCE HANDBOOK

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A completely revised edition with over 280 illustrations,

FINAL-Saturday,

sick as lie came round and a felt' dal's lat er developed 1,,!Jat Ihe cloclor cailed' aspiration pneumonia ' What is this?

Reply

Aspiration pneumonia is the name applied to a variety of bronchopneumonia caused by inhaling foreign matter. Tn this case it probably occurred through' drawing in ' (aspirating) a few particles of the vomit. It can also result from attempts to feed a semi-conscious patient.

* * *

For some years I Iial'e kept a scrap book olarticles of interest that appear in AID AND NURSI G. It is dffjicult, however, to deaf with articles 11'hich are printed 011 both sides of a page. Can J'ou suggest any beller means of preserving useful articles ?

Reply

The simplest method is to buy an automatic binder and file each issue of the journal. Such a book-binder can be obtained through any good staUoner. You should make your own index, adding to t each lime you file a new number.

A SET OF EIGHT

Colourful

PHYSIOLOGY

CHARTS

Size 40 In. X 30 In.

No Frontiers (continued Fom page 1) copared mwith other infected countries, over 40,000 human cases occur every year.

The ravages of this disease are parti c ularly noticeable in rural popu lations. The physical suffering and prolonged ill-health which it causes reduce the working capacity of land-workers.

Here is an example of a combined operation between two U.N. specialized agencies. It is passed from animals to humans; by the havoc it wreaks among the animals themselves, it lowers milk and meat production and causes nutritional lo ss The Food and Agriculture Organization therefore joins forces with WHO in attacking the disease and its causes.

Bilharziasis has been identified in mummies of 1000 B.C. and its cause, a blood Auke was identified by the German, Bilhar z, a hundred years ago. Whole populations in African and Mediterranean countries are infected and invalided by this disease, also known as schistosomiasis, which-though it starts in humans--i s conveyed by watersnai ls In areas of infestation, work in irrigated fields or washing or bathing in rivers leads to the fluke's entering the human body through the skin. It is necessary not only to treat cases in order to prevent its being passed on but also to eliminate the carrier-snail-a tremendous undertaking.

But it must be tackled, not only to help the millions who are al ready infected and the areas already infested but also to prevent its spread. And, unless preventive measures are employed, it will certainly spread to new areas as irrigation schemes, to increase the acreage of food supply, are extended.

In drawi ng up its part in the U.N. programme of Technical Assistance for Economic Development WHO included bilharziasi s as a disease of first importance, the curing and prevention of wh ich can itself help economic development and the neglect of which may undo new development. As medically advanced countries reduce to relative insignificance communicable diseases like measles diphtheria and scarlet fever, and when pestilential diseases are held in check, the diseases of the so-called under-developed countries assume a new importance in a world which, through WHO , has accepted as a common responsiloiility the common ills of mankind.

(From' The Lamp is Lit,' tlie story 01' tlie World Health Organization. Text by Rit cliie Calder.)

Hygiene (continued /rom page 3) too hot or excess of condiments, pickles, etc. No source of chronic irritation of the tongue, e.g., caused by a broken tooth, should be permitted.

The tonsils are two lymphoid glands lying one on either side of the back of the mouth. Their function is protective since they :filter germs and prevent them from entering the blood stream. Healthy tonsils, therefore, are an asset but if they become infected the doctor may advise their removal since otherwise they may affect the general health.

This attractive set of eight elementary physiology and hygiene charts, printed in clear and striking colours, Inakes the ideal visual aid for all First-Aid and Ambulance Instructors.

No.1 THE SKELETON. Entire figure with J 0 enlarged details or parts.

No.2 THE MUSCLES. Entire figure, with 6 enlarged details or parts.

NO.3 THE BRAIN AND NERVOUS SYSTEM. Entire figure, with 10 enlarged details or parts.

NO.4 THE CIRCULATION OF THE BLOOD. Entire figure, with 12 enlarged details or parts.

E. f. Arnold

THE HOUSE FOR HUMAN SKELETONS

Articulated

No.5 THE ORGANS of DIG ESTlON AND ASSJM[LATlON, ill sill/ With 11 enlarged details or parts.

No.6 THE STRUCTU RE OF THE EYE. With 5 enlarged details or parts.

No.7 THE STRUCTURE OF THE EAR. With enlarged details or parts.

No 8 THE SKIN and EXCRETORY ORGANS. With 9 enlarged details or parts.

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Medical opinion may differ concerning th e t rue natur e and re t iolog y o f fibrositic conditions , but the need to ease t he p a in is still paramo un t. Thus.

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... Then you will follow this point-by-point argument an d reach the same conclusions as so many doctors, nurses, hospitals and clinics have done.

DO YOU AGREE . .. that the causes of most skin infections are the common strains of STAPHYLOCOCCI, STREPTOCOCCI and B. PYOCYANEUS?

IN THAT CASE . a treatment which is effective against all three will be indicated for cuts, abrasions, burns, scalds, boils and most inflammatory skin infections?

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First Aid

&: Nursing

The Holge,' Nielsen Controversy

Sept.IOct. 1952

Editor:

DALE ROBINSON, F.R.S.A., F.S.E.

As we go to press the country is shocked by the terrible rail disaster at Harrow and Wealdstone. Early reports speak of the wonderful work of first-aid teams from St. John, Red Cross, POlice, Fire Service, British Railways and the American Air Force.

In these moments of disaster the long labour of training comes to fruition, the patient work of learning and practising yields a splendid return in the instant readiness to save life and relieve suffering. The whole country renders thanks to the first-aid workers at the Harrow crash. In this shocking disaster, as in the everyday incidents of home and factory, they were ready and qualified to play their part.

WEpublished in the last issue a short a rticle from a Canadian source which examined and commented on methods of artificial re spiration practised by first-aiders and life savers in various countries. We printed the article because we thought it had an interest to firstaiders here, but we have been astc:mished by the interest displayed, which indicates that this is indeed a subject of controversy.

Those whu wrote to us seemed to imagine that we were urging the replacement of the well-known Schafer method with either the Nielsen or the Silvester systems, but of course we are not proposing anything of the kind. All we ask is that any nc:w method or practice of first aid should be carefully considered on its merits, and not overlooked because of prejudice or laziness.

Editorial

Unconsciousness 2

of Skin Disease s 3

of Blood Donors

Not that the Holger Nielsen method can exactly be called new; we were cescribing and illustrating it in this journal in 1935, and have often published reports on it. In recent years, however, it has gained popularity, especially in America, where it has been adopted by the Services and the First Aid movements. The method has gained much support over here, and in March of this year The Lancet published an article in which it was suggested that Schafer's method should no longer be recommended. Now, the Royal Life Saving Society has stated that they are adopting the Holger Nielsen method because it considers it is ' far superior to the Schafer '. Moreover, the St. John Ambulance Association has recently included the Holger Nielsen method in its syllabus of training, and is shortly to publish a pamphlet giving particular s of the system. The British Red Cross Society , it i understood, also have the method under consideration' it is already included III their syllabus of instruction.

It is no wonder, then, that we receive inquiries from readers as to the best method of artificial respiration. These queries, it must be

noticed, do not come from qualified first-aiders, who recognize that there is a place for the Nielsen method in training, and who have had knowledge of the system for some years. There is, of course, no 'best' method of artificial respiration. The Bolger Nielsen method, in our opinion, is not better than the Schafer, but in certain circumstances, it will give better results. Every qualified first-aider and life saver must therefore be perfectly acquainted with all methods. The danger is that in seeking to popularize the newer methods, there has been a noticeable tendency to under-rate the Schafer. On another page we publish a letter from Dr. Gilbert Burnet, whose work in the first aid movement is well known. Dr. Burnet's long practica I experience and wide knowledge enable him to speak with authority on such subjects, and when he champions the Schafer method, we may be sure that there are good reasons why that method should be retained.

It has been the foundation or training in artificia I respiration for many years and is well known throughout the country. To supersede the Schafer with Holger ielsen or Silvester would only put obstacles in the path of those whose duty it is to train life savers, and any suggestion that the Schafer system was an inferior method of artificial respiration would confuse the wider public to whom Schafer is familiar through training at school, in the Boy Scouts or Girl Guides, or in the Services.

This is not to say that there is not a need for the Holger Nielsen and Silvester methods to be studied and practised by first-aiders. As we have said, under some conditions these methods will give better results than the Schafer, and we welcome the fact that St. John and B. R.C.S have recognized this. But the Schafer continues to be the foundation of training, and we see no reason why this should be changed because American opinion inclines towards the ne\ver methods.

If you are a logical person .••

MEDICO- BIOLOGICAL LABORATORIES LTD., CARGREEN RD. , SOUTH NORWOOD , S E.2S

Unconsciousness

By A. D. Belilios , M.B.; B.S. (Lond.), D.P.H. (Eng.)

ALTHOUGH the articles on keeping fit have not been completed, they will be interrupted this month for the benefit of first-aiders who do not wan,! to be long out of touch with their main subject. For this purpose, common causes of unconsciousness have been chosen for revision since it is some years since this subject was discussed in these columns. Of these, fainting must first be mentioned.

Faints

It is interesting to notice that fainting is not classified in the list of causes of unconsciousness in the S.l.A.A. Manual; this is because it is now included, quite correctly, under the heading of shock. Nevertheless fainting is a common condition and there is no harm in retaining the term which certainly causes less alarm to a patient who has just recovered consciousness than if he were told that he had suffered from shock.

Fainting may be caused by physical or nervous causes. Physical causes include exhaustion, lack of food, or over-exertion while in a state of fatigue. Nervous causes, however, are more common and include emotional upsets such as fright, fear and many others. Faints occurring after minor accidents, especially those accompanied by the loss of a small amount of blood, fall into the nervous category. Some people, indeed, often faint at the sight of blood.

The symptoms and signs of a faint are well known. The patient feels giddy, swoons and falls to the ground. His pulse is generally quick and feeble, occasionally almost imperceptible while his face is pale sometimes with blueness of the lips, cheeks, ears and finger nails. The skin is cold, clammy and covered with sweat. It is important to remember that breathing may cease momentarily.

Recovery is rapid when treatment is given and this is the same as that

recommended for shock. It is always desirable to get the patient lying flat with his feet raised but when this is impossible, e.g., in a crowded hall, church, etc., his head can be lowered by placing it between his knees.

The first-aider must satisfy himself that the faint has not been caused by lIlJury or an emergency which req uires further treatment and it is generally advisable for the patient to consult a doctor to discover the cause. Thus, to quote an example, a young woman who had fainted on two occasions without obvious cause was found on medical inves tigation to be suffering from a minor ailment of the' nerves' which in the absence of treatment would have handicapped her throughout her life. Now cured, she reflects on the faints as blessings in disguise.

Epilepsy

In this disease of the nervous system the patient suffers from fits. The causes of the complaint are not known with certainty although it is probable that it is associated with some form of nervous instability which, however, in many cases, cannot be traced.

Fits occur at variable intervals and again usually without traceable cause. In some people they only occur at night during sleep and may then be difficult to diagnose.

Many patients have a warning or aura just before the actual fit occurs. This warning may be the twitching of muscles, giddiness, numbness of a part of the body, mistiness of vision or possibly noticing an aroma which does not in fact exist.

Soon after noticing the warning, the patient drops to the ground as the fit begins, sometimes but not always uttering a shrill cry. In the first stage of the fit, the patient's body is absolutely stiff since his muscles are in a state of spasm. His teeth are firmly clenched and his mouth cannot be opened. His eyes remain open and turned to one side ; they become red and inflamed.

The breathing stops because the respiratory muscles are in a state of spasm and for this reason, the colour ch anges from pallor to bvidity. This stage of the fit lasts for about forty seconds and is called the state of rigidity; it is followed by the stage of convulsions. Convulsions are violent and irregular movements caused by involuntary muscular action. They affect all parts of the body and may cause the patient to injure himself by hitting a nearby object. Through the movements of the jaw the tongue and cheeks may be bitten and saliva beaten up into a foam, hence blood-stained froth escapes from the lips. Urine and motions may be passed involuntarily-an important piece of evidence to give to the doctor who may not himself have witnessed the fit.

The convulsions pass off gradually in about three minutes and the patient is left pale, sweating and exhausted. His frequent desire for a sleep should be encouraged. Occasionally fit after fit occur in rapid succession-a condition called status epileptic;us.

The above is often called Major Epilepsy or Grand Mal but there is another variety of the complaint called Minor Epilepsy or Petit Mal. In this there are no convulsions but the patient is liable to attacks of brief spells of unconsciousness. While talking, or even walking, he may develop a dreamy stare, not reply to questions and become pale. H walking he may stumble or fall. Either variety of epilepsy may be followed by compbcations called post-epileptic automatism and mania. In the former, the patient may automatically perform an action of which he is entirely ignorant at the time and cannot recall afterwards. His behaviour may be unsocial, e.g., like that of the wellknown judge who proceeded to undress in full view of the court.

FiRST AID & NURSING, SEPT. jOCT. 1952 in mania, there 1S temporary insanity.

Apoplexy

This is a common cause of unconsciousness from middle-age onwards. It is unusual for it to occur before 50. It is due to bleeding from a vessel into the substance of the brain or to the clotting of blood in a cerebral blood-vessel which conditions are called cerebral haemorrhage and cerebral thrombosis respectively. They are generally caused by hardening of the arteries (arteriosclerosis) and may be associated with high bloodpressure.

Commonly called a ' stroke,' the onset is usually during the day-time, often occurring in susceptible patients who have undertaken overexertion particularly, for example, when hurrying . to catch a bus or train soon after a meal. Sometimes, however, the' stroke' occurs while the patient is resting or even asleep. Giddiness, faintness, severe headache and vomiting are common initial symptoms, leading to collapse and coma. But loss of consciousness is not invariable and sometimes the patient may discover that he has lost the use of part of his body or the power of speech yet still may be able to understand everything that is said to him.

In a typical case of cerebral haemorrhage, the patient becomes , deeply unconscious. His face is flushed and the temperature of the body raised. His pupils are fixed and unequal while his eyes are often turned towards the side of the brain tha t is affected. His pulse is slow but strong and his breathing deep and accompanied by snores. Incontinence of uri ne and occasionally convulsions may occur.

On recovery of consciousness, there is usually loss of function of some part of the body, e.g., paralysis of one side or loss of speech as already mentioned. This will only slowly recover while sometimes it is permanent.

Infantile Convulsions

Fits in infancy may be caused by sickening for an infectious illness such as measles or result from a source of irritation in the body (reflex causes), for example, disorders of digestion, worms, ear-ache, etc. Occasionally, of course, they may be the early onset of epilepsy which, however, should never be assumed

by first-aiders or parents without a positive medical opinion.

Often, for sometime before he develops a fit, the child is irritable, restless and' jerky' in his manner. The fit itself begins suddenly, the child throwing his head back and becoming rigid. The breathino becomes irregular and may stop momentarily. The colour becomes pale or even bluish. Twitching of muscles, frothing at the mouth and squinting may occur.

Usually the fit is of short duration and the child has recovered before the doctor arrives. A recurrence, however, is always possible and sometimes a succession of fits occur.

Infantile convulsions always cause great alarm to parents and reassurance is essential. It is the cause of the condition that requires investigation; the fits in themselves are really only symptoms.

Head Injuries

Concussion and compression of the brain are common causes of unconsciousness but cannot be fully considered in this article. There is generally a history of violence supplied by witnesses of the accident but sometimes it cannot be obtained, at the tin .e. Thus a boy who had been out on his bicycle did not return home until the following morning and then appeared in a dishevelled condition; he was unable to give a satisfactory explana-

tion for his delay but complained of a headache and was somewhat confused. Enquiry from his school friends, who took two days to trace disclosed that he had fallen his bicycle on to his head but after a short interval during which he was dazed, had remounted and ultimately left them, as they thought to return home. From his clothing it was easy to deduce that he had been vomiting.

This example demonstrates some of the characteristic features of concussion, namely unconsciousness in varying degrees, i.e., sometimes complete and prolonged and sometimes short and not amounting to more than being dazed, loss of memory for the accident and the events that led up to it, frequently vomiting during recovery , headaches and some mental confusion at a later stage. To these must be added in many cases, the symptoms and signs of shock.

Compression of the brain results from pressure caused by blood clots or a fracture of the skull. It may come on gradually in a concussed patient or develop later after apparent recovery. When established its symptoms and signs are similar to those of apoplexy. It must be suspected in any head injury when the patient is unconscious for longer than twenty minutes particularly if the pulse is becoming slower and fuller and coma is developing.

of Slii" BisellS(!S

Towards the end of luly the Tenth International Congress in Dennatology was held at Bedford College, London, and it was attended by doctors from 44 countries-an indication of the very wide interest and research now given to the causation, prevention and treatment of skin diseases. There is probably no group of comparatively minor diseases that give rise to so much distress , both mental and physical, especially in the young, or are so difficult to treat; and even when they are apparently cured so many of them recur at intervals throughout almost the whole of life. Moreover, the incidence of skin diseases is increasing with the mounting anxieties and stresses of modern life and with the development of some

of the newer industrial processes. It is encouraging, therefore, to learn of the progress that is being made in this branch of medicine, and of the research into the emotional as well as the physical factors underlying the comparative intractability of some of these diseases. Quite apart from bacterial, parasitic and industrial causes of skin conditions, the influence of endocrine secretions, allergic tendencies and emotional conflicts have been shown to play an undoubted part, both in the causation and progress, of some types of skin lesions, so that various forms of psychotherapy are now employed in addition to hormone treatments, sulphonamides, local applications and physical treatments.

FI RST AID & NURSING, SEPT. / OCT. 1952

National .Blood

Panel of Donors

NATION-WIDE hunts for donors of rare types of blood should no longer be necessary with the coming into use of a National Panel of nearly 2,000 donors whose red blood cells have been classified down to the finest sub-divisions of the blood groups.

Several hundred distinguishable kinds of blood are included in the Panel, which is the first of its type in the world. All the donors have volunteered to give blood in an and duplicate panel regIsters at the twelve Regional Centres of the National Blood Transfusion Service, and at· the corresponding centres in Scotland and Northern Ireland, will enable a donor of the type of blood needed to be found without delay.

Donors and recipients of blood transfusions are usually classified into four groups known as 0, A, B and AB ; but recent researches have shown that they can also be subdivided in many other ways, the best known being that into Rhesuspositive and Rhesus-negative. Since each new kind of subdivision at least doubles the previous number of classes the total effect is that there are now many thousands of distinguishable kinds of blood.

For most transfusions only the main and Rhesus groups need be matched between donor and recipient but very occasionally a patient is found who desperately needs blood but can only tolerate blood which completely matches his or her own. This extreme intolerance of the recipient's system sometimes arises in the course of a disease which needs treatment by repeated blood transfusions over a prolonged period. It also arises in a small proportion of women who have given birth to children suffering from haemolytic disease of the newborn C' yellow babies ').

When it is found that a patient needs blood of a special kind the local Regional Transfusion Centre will be asked to provide blood of the kind required. Arrangements will be

made for the blood to be obtained from one of the donors on the Panel or the donor will be asked to attend at the hospital. If the only available donor is in another region the Director will ask his opposite number to arrange to collect and dispatch the blood to the hospital where it is needed.

The register will be kept up to date by replacing any donor who resigns by a new donor. The Regional Transfusion Centre in whose region the resigning donor lives will be responsible for replacing him and the Blood Group Reference Laboratory will carry out the necessary detailed tests and issue periodical amendments to the register.

The preliminary testing and selection of donors for the Panel was made by the Regional Transfusion Centres of the National Blood Transfusion Service, the Scottish National Blood Transfusion Association and the Northern Ireland Blood Transfusion Service. The Blood Group Reference Laboratory, run on behalf of the

Ministry of Health by the Me di ca l R esearch Council, was responsib le for the detailed testing and classification. The testing of the donors and the classifying and checking of the results have occupied several members of the laboratory staff for about a year.

No other country has a panel of donors in any way comparable with this one, which has only become possible through the uniq ue organization of the National Bl ood Transfusion Services of the United Kingdom, and the leading position which the country holds in blood group research and technology.

The country is, however, also unequalled for the size of its body of unpaid volunteer donors in proportion to population, and in the spirit that has maintained this body from its inauguration in the dark days of 1939. No service, however good it may be on the technical side, can exist without continuous recruitment of new donors. The need for these was clear to all in wartime, but owing to rapid advances in surgery, especially of the heart and lungs, the opportunities for life-saving are just as great to-day and volunteers are needed by every Regional Transfusion Centre, the address of which can be 0 btained from any Post Office, or from the Telephone Director under the heading , Blood Transfusion.'

Report o n Hom e Accidents

IN an article on accidents in the horne published in the Monthly Bulletin of the Ministry of Health for January 1952, it has been pointed out by Dr. Boucher that :-

1. Four-fifths of the fatal horne accidents in England and Wales happen to young children under 5 and people over 65 years of age.

2. More children under IS die from accidents in the home than from any single infectious disease.

3. More children under IS are killed in their homes than die from accidental causes elsewhere, including road accidents.

Many fatal home accidents result from burns or scalds, which are also responsible for hundreds of serious non-fatal accidents every week, condemning people to the misery of injuries which leave them maimed and disfigured for life, in spite of long stays in hospital and new treatments.

Burns At the Birmingham Accident Hospital, 90 p.c. of the cases of burning accidents from coal, gas or electric fires, happened when no guard was in use at the time of the accident, and in most of the remaining

10 p.c. when the guard was not attached to the fire and had been remo)'ed by lire ictim.

Experience shows that such. accidents as these do not normally affect the same family twice, but obviously education before the event and the use of fire guards could do much to eliminate the tragic results of preventable accidents.

1f by mischance somebody's do thing does catch fire, the flames should be smothered by being wrapped in a blanket, coat, or even floor rug quickly snatched up.

It is vital that all fires where children may be playing, or where the elderly or infirm can harm themselves, should be adequately protected by a securely fixed fire guard. Fixed-mesh screens are considered by experts to be the only real safeguard.

The open grate fire guard should be hooked on to staples driven into the wall on either side of the fireplace. If it is only hooked on to the bars of the fire it can easily be knocked off. Replacement of the guard after putting coal on the fire is a thing to be remembered. Clothing can easily catch fire if there is no guard and the wearer leans over an open fire to reach something on the mantel-piece.

Electric and gas fires if not properly p.rotected can be highly dangerous. A Single rod or even several bars in front of such stoves do not prevent contact with the element or with the flame and a mesh guard should be fixed to secure this. New British Stand.ards have been passed for guards on electriC and gas fires to prevent contact with element and the flame, but it will be some tune before every fire on the market is thus protected and obviously years before those now in use will be scrapped. If therefore electric or gas fires have not a factured as part of them which will prevent inflammable contact, a separate mesh guard should be attached.

Precautions Against Scalds 67 p.c. of those suffering from scalds who. were tr<:ated at the Birmingham ACCIdent HospItal were children under 5 and half these accidents were considered easily with ordinary care. The kitchen IS the scene of most accidents from scalds, which can be quite as serious as burns. A playpen in a safe corner of the kitchen can keep a child out of harm's but other precautions against scalds WhICh. should be taken including the careful handhng of all hot liquids' saucepan handles turned inwards over ' the stove' stockings (or cloths) should not be left hanging to dry from handles of utensils as they !TIay be care in handling or carrymg hot thmgs over a child's head flexes of electric irons and kettles should be kept out of reach; matches, candles and safely placed Boiling bath water is a further cause of many scalds, and when getting a tub of water the cold water should always be put m first, so that if the child plays with it or falls in it while the mother is out of the room no harm is done.

Treatment

In the event of a burn or scald, no attempt should be made to pull the clothes off the skin. A doctor should be summoned at once; if the doctor is not immediately available an ambulance should be called and the burn or scald described to explain the urgency.

While waiting for the doctor (or ambulance) the patient should be kept warm and as comfortable and calm as possible and given a hot, sweet drink. If the burn or scald is on a hand or foot or lower leg it may be held u.nder the cold water tap to relIeve the pam, and then covered with sterilized (or absolutely clean) linen or cotton. Nothing should be put on a burnt or area except sterile (or absolutely clean) lmen or cotton to cover it from the air, and whoever applies the material should wash their hands before so doing. Much original infection of such wounds is caused by dirty-banded first-aiders.

It is suggested that every home should have a packet of sterilized linen or cotton material ready in a cupboard. To sterilize material wrap it in stout brown paper and bake it in the oven. A piece of white paper should be put in the oven at the same time and when this begins to turn brown, sterilization has been achieved. The brown paper packet should be put in a convenient, dry place, unopened unless an accident occurs. If no sterile linen or cotton is ready, clean laundered handkerchiefs, towels or pillow-cases, etc., may be llsed to cover burns or scalds.

Admi nistration 01 Ca r bon Dioxide

D r. V. V. Brown, Medical Officer

Workington Iron & Steel Co.' writes: 'In your issue for Julyj August 1952, on page 14, there is a query about the use of Carbon Dioxide as a respiratory stimulant in first aid, and in the reply full support is given to its use.

, This is contrary to the Memorandum issued by the Medical Research Council, reference MRC.52 / 205 CRBA.52/20 entitled" The Administration of Carbon Dioxide during Resuscitation." The last paragraph of this Memorandum reads as follows :- -

For First Aid Resuscitation therefore, in which these cannot be met, the Committee recommends tha t only oxygen be used.'

Mr. S. W. Dore, Surbiton, writes: , In May of this year at the B.R.C.S. Training Centre, Barnett HIll, Surrey, a two-day course was devoted to the subject of Artificial Respiration. This matter was one of the subjects raised and was fully discussed.

'Among those present were a number of medical men including a professor of physiology of international repute, not one of whom was prepared to give a definite statement for or against the use of Carbon Dioxide.

'Dr. Belilios, in his reply to the query states, "There can be no doubt about the value of Carbon Dioxide as a stimulant to respiration in certain cases, e.g., coal gas and narcotic poisoning and in drowning." This would appear to leave no grounds for equivocation. Yet Dr. E. J. Gordon Wallace, writing in the British Medical Journal, 2 August, page 279, writes:

"In the past it has been thought that Carbon Dioxide acts invariably as a stimulant of the respiratory centre, but it is now believed to be dangerous to give it, even mixed with oxygen, to anyone who has been asphyxiated. Carbon Dioxide should therefore never be used in treating cases of drowning and the administration of pure oxygen should be begun as soon as possible." (My italics.)

'Research workers in Canada have hown that the oxygen satura-

tion of arterial blood falls to within 2. and. 3 volumes p.c. by the end of SlX mInutes and to almost zero in seven to eight minutes.

, Therefore it would appear to be wrong to administer Carbon Dioxide to apnoeic patients whose blood stream may be already overloaded with this substance.

'As this is a matter of great Importance ambulance, industrial and first ald worker generally, I would suggest that in vie\v of the diversity of opinion, it would be unWlse to administer Carbon Dioxide even with oxygen until the position has been more clarified. Especially as Dr. Behhos agrees that there is some difficulty in the selection of ca ses and in judging how much should be given.'

Dr. Belilios has replied: I cannot agree with Dr. Brown's interpretation of my reply that" full support is given to its use." This was certainly not the intention and the article on Asphyxia in the March-April issue discusses the subject more fully. It is understood that the Medical Research Council Memorandum has been revi sed, but has not yet been published. At the moment, however, there are schools of thought on this subject although everyone is agreed that its use must be restricted. It must also be remembered that these columns cater not only for the pure firstaiders but also for those who work in any capacity in hospitals where Carbon Dioxide is available for use under medical in tructions

BACK COPIES OF 'FIRST AID'

A reader is anxious to obtain back copies of this journal for 1942, especially September ]942. Unfortunately, our files were destroyed during the blitz; would any reader who has spare copies please communicate with the Editor. Copies are wanted of all the issue during 1940-1945.

By AGNES PAVEY, S.N.R.

Development of Child Care in Britain-4

The Shaftesbury Homes and Arethusa Training Ship

I N 1843, a solicitors' clerk named William Williams, who as a result of an accident had been crippled in childhood, saw a number ,of handcuffed boys being marshalled into a train fm a seaport town to be transported to a convict settlement in the Colonies. The sight so affected him that he enquired into the reasons for the transportation; and he felt that if only these boys had been taught proper standards of life they might have been saved from criminal careers. He had no money and no influence; but with the help of a few friends he started a Ragged School in a dingy old hayloft over a cow shed in St. Giles, then the worst slum in London. This hayloft became known as 'The Rookery.' Evening classes for adults and a Sunday School were also held hete, and within a year the work was so established that the Dowager Queen Adelaide, widow of William IV, had heard of the venture and, all unsought, had sent a donation of £5. Slowly, other donations followed.

Many of the children were completely homeless, so, in 1846, a House of Refuge was opened where homeless boys could sleep. Three years later a second was established at Marylebone and within ten years several others had sprung up in different parts of London-for girls as well as boys. At the St. Giles Refuge a free hot dinner was provided once a week to 500 hungry chjldren. Lord Ashley (later the 7th Earl of Shaftesbury) became very interested in this work and when it was organized into a society known as' The National Refuges for Homeless and Destitute Children' he became its Patron and, later, its President.

Mainly owing to his efforts, in and out of Pc:rliament, the Government arnnged to send 150 youths from the various Ragged Schools in London to Australia and to provide each with the necessary outfit free of all expense. Sixteen of these were

from Mr. Williams' Ragged Schools. In April 1857 the first emigrations to Canada were arranged. Mr. Williams continued as Secretary to the Society until his death in 1892. In 1904 the Society became Incorporated. By 1920 it was felt that the old title was no longer appropriate for the work it was carrying out and it was changed to ' The Shaftesbury Homes and Arethusa Training Ship.'

Its Homes and Residential Schools

A home for 40 girls was opened at Acton in 1860, and as the number grew it moved several times and eventually became settled in Ealing in 1867. Three years later , Sudbury Hall, near Harrow, was opened as a second home for girls and accommodated 160. In 1908, Shaftesbury House, at Royston , Hertfordshire, was opened for little girls, and after the first world war it took little boys as well. Later, it was usec1 entirely for boys.

In 1930, the Society bought the beautiful mansion known as Esher Place, in Surrey, as a Girls' Home, and thereafter both Ealing House and Sudbury Hall wele closed.

Fortescue House Boys' School at Twickenham was established for boys between 7 and 10 year s of age, and Bisley Boys' School , near Woking, for boys from 11 to 13, after which age they may be drafted to the Arethusa Training Ship if they wish to be sailors, they may gain scholarships for further education leading to professional, technical or commercial qualifications, or they may be taught a trade. For many years, the Society maintained Fordham House at Hampstead as a hostel and club for their boys between 15 and 18 who were working in London.

Recent Reorganization

Extensive reorganization has been rendered necessary in order to comply with the provisions of the recent Education Act. The Newport Market Army Bands School, which was founded in 1863, amalgamated with the Shaftesbury Homes in ] 929

and was associated with Fortescue House, but as this school now becomes a Primary School for both girls and boys it is no longer effective for Band boys or boys of Cadet Corps age. The Bisley Boys' School in Surrey is to become entirely a Secondary School and it already has a flourishing Cadet Corps, and so the Newport Market Army Bands School was transferred there Jast autumn. Shaftesbury House has completely altered its status. Girls of 11 and 12 have been transferred there from Esher Place and now attend the Royston Secondary School. The little boys have been moved to Fortescue House. Esher Place will no longer be required so it is in the market for sale; but plans are made for building considerable extensions at the other homes and schools. The Society still has 1,100 ch ildren under its care.

The Making of Sailors

On St. Valentine 's Day, 1866, the Society arranged an evening banquet for the homeless boys of London and invitations were sent to the various night refuges and casual wards. The menu consisted of roast beef, bread, hot plum pudding and coffee, and the guest of honour was Lord Shaftesbury. After supper they all adjourned to a large room in the Refuge and Mr. Williams told the boys of a scheme that was taking shape to gi\ e naval training to suitable lads. Lord Shaftesbury then addressed the meeting and said, Now, boys, if a ship were moored in the Thames, how many of you would be willing to go aboard?' Instantly, hundreds of hands went up. A few days later Lord Shaftesbury applied to the Admiralty for a ship to be used as a training school. This resulted in the hull of the 50gun frigate 'Chichester' being handed over and permission given to draw masts, sails and other stores for the fitting up from the Dockyard. The Society gave an undertaking to repay the Admiralty £2,120 ISs. 8d. within nine months. The fitting up was completed and the 'Chichester' anchored off Greenhithe; and 50 boys entered their new home on the last day of that year-want of funds prevented the number from being much greater. However, a gentleman attending the Inauguration gave a donation of £ 1,000 and so another 50 boys were

FIRST AID & NURSING, SEPT.jOCT. 1952

taken in without delay. The ship's complement was 200, and within two years 400 boys from the Refuges were drafted in to the ship. From the very commencement of the scheme the boys had to be of good character and never convicted of crime. At the end of twelve months' training they were drafted into the Merchant Service or the Royal Navy. By 1872, the demand for these trained lads had so increased that the Committee considered the possibility of raising £5,000 to equip a second ship or to exchange the , Chichester' for one having twice the accommodation. The Baroness Burdett-Coutts offered to give the £5,000 immediately if the Committee could find the funds for the maintenance of the extra boys.

The new ship lent by the Admiralty was the 3,000-ton 'Arethusa.' The cost of the alterations and fitting-out reached £8,000, so that when the ship was opened, in August 1874, only 200 boys could be taken on board. With the coming of steamships which could accomplish journeys to all parts of the world with much greater speed the number of men required grew less. Thereafter, 300 boys were in training on the 'Arethusa,' and the , Chichester' was used as a barque and was later replaced by a smaller , Chichester' as a sea-going tender operating on the Thames and so giving the boys some practical acquaintance with a seaman's life.

In 1933, the old' Arethusa was condemned by the Admiralty as being past repair, but was replaced by the' Peking,' and the Board of Trade agreed to her being re-named , Arethusa.' She is a four-masted steel barque of over 3,000 tons which now lies in the River Medway near Chatham. In her are classrooms, a large gymnasium, a sick bay, library and chapel, as well as cabins, galleys and so on. The boys live on board and most of their instruction is carried out on the ship.

Happily, boys are no longer found starving in cellars and under arches; but many have lost a parent or their homes have been broken up by trouble, and boys whose ambition it is to go to sea can apply for a place in the 'Arethusa' from the age of 13 to about l4!. Those who wish to enter the Royal Navy stay on board for six terms, during the

DEAR SIR,

Artilicial Bespileation

I notice by the article in your July-August number, that the prediction of' First Aider' in your MarchApril issue has come to pass; the American renunciation of Schafer's method has reached your valuable paper.

Anyone looking at the diagrams illustrating the inefficiency of Schafer's compared with other methods (even with Eve's, which utilizes the same structure-the diaphragm), must be confused. To my mind, they indicate that those who took part in the experiments at the laboratory, must have known what methods were being tested.

It reminds me of an incident in Professor Schafer's laboratory fifty years ago, when the 'Lab-boy' hardly mo ved the spirometer during Silvester 's test, but nearly burst it when his own chief's method was being performed. So absurd was the difference that a newsboy, selling papers in the street, was called in for the test. It was then that we had an honest indication of the greater efficiency of Schafer's method compared with Sylvester's.

Any first-aider who has had practical experience from Schafer 's method, can certify that sufficient inspiration is produced; and personall" in dozens of cases, I have never required to use any other

last of which they sit for the entry examination into a Royal Naval Training Establishment. Those who choose th e Merchant Service remain until they are 16, when they are placed with one of the large shipping companies.

The' Arethusa ' is recognized by the Ministry of Education as a Secondary School and the boys receive a good general education as well as the specialized instruction in all that pertains to seamanship. The high standards of both character and training of ' Arethusa ' boys is well known to-day, and many of them have reached the rank of Commander in the Royal Navy and Ca ptain or Chief Officer in the Merchant Service.

method. I do , however, teach an added shoulder llft, by an extra operator, when dealing with a patient of greater physique than the first-aider. If there is -so little inspiration produced as is suggested by the diagram s in the article how is it that so many of successful resuscit ations have been done in this country.

In addition to the prejudice against Schafer's method, shown in the diagrams on the respiratory movements, another paragraph indicates that Silvester's method is less laborious than Schafer's.

It doesn't need a first-aider to recognize the absurdly unfair bias of this suggestion, if the two actions are correctly described.

In spite of the American conclusions that the Nielsen method should take the place of Schafer's, I still adhere to the opinion that Schafer's method, utilizing the upward stretch of the diaphragm, should remain the British choice, and should continue to be taught as the foundation method. As a secondary adjunct, if two helpers are available, and there is a suspicion of deficient inspiration, Nielsen's arm-lift can readily be applied in addition.

GILB ERT BURNET, M.B., Ch.B. Hemel Hempstead.

DISTRICT NURSES MAKE 831,676 LONDON VISITS

London's 400 district nurses made 831,676 visits to patients in their own homes during the first six months of this year-an increase of 9 p.c. on the corresponding period in 1951 when 762,667 visits were made. This represents an average of over 2,000 visits each nurse, by foot or cycle.

Announcing these new figures, an official of the Central Council for District Nursing in London said , 'This is a record , and underlines our need for more trained nurses. It also brings extra financial problems and means a large increase in the sum required to supplement official grants. For every £1 spent, the service must find 2s. from vol unt ary sources, under the arrangement by which it is able to preserve almost complete independence.

More than 50 p.c. of the visits were to elderly patients who cannot be admitted to hospital because of the demand on beds,'

Red Cross NEWS

West Country Floods

Disaster came suddenly to the peaceful countryside of Lynton and Lynmouth, on Friday, August 15th, when the waters of the West and East Lyn, the Bray, the Barle and tbe Exe broke their banks, devastating the lower parts of the valleys.

The Devonshire Branch went into action without delay and by Saturday night the W.V.S. and the Red Cross had prepared two fully equipped Rest Centres and a Sick Bay for the reception of the first refugees. The Red Cross worked in the closest cooperation with the W.V.S. and Commandants and Members of the North Devon Detachments were on duty, day and night, alleviating the distress of the homeless.

On Sunday, an urgent message for relief supplies was put through to National Headquarters. A van load was packed and by 6.30 a.m. on Monday, was delivered to the Lynton Town Hall, where rooms had been cleaned and prepared for their reception. Throughout tbe day, there was a stream of people applying for toilet and household necessities.

Early on the Monday morning, the Medical Officer of Health asked the local representatives of the Order and the Society to set up a First Aid Post for rescue workers in Lynmouth. A suitable post was found and by the afternoon, the post was ready for use.

The plan of campaign established, routine work continued and house-to-house and village-to-village reconnaissances were made by British Red Cross and W.V.S. workers and, on the basis of reports received, clothing and household goods were distributed to the flood victims.

Somerset. - Immediately news of the floods was received two ambulances were loaded with blankets, mattresses, food, clothing, urns and cooking utensils, and on police instructions the ambulances reported to the police at Porlock and eventually were directed to Minehead, where assistance was given to local members of St. John who were preparing a rest centre for some of the people being evacuated from Minehead.

Some of the equipment was also taken to Dulverton where there had been disastrous flooding. The Divisional President and the Commandant of Dulverton were both temporarily cut off by the floods and bridges and telephones were down. A Red Cross member, with the assistance of the Detachment Quartermaster, had established a Red Cross Depot at her home, and the Red Cross stores were delivered to her. Later reports of flooding in other villages in Somerset were received and relief supplies were immediately dispatched. During the next two days the ambulances toured the

whole of the Exmoor area and many isolated hamlets, farms and cottages were disco ered which had been badly damaged and needed help. Distribution of br<;,oms and for cleaning purposes contmued durmg the week, and vast quantities of fruit, vegetables and eggs from the fruit growers in Worcester were warmly welcomed by the flood victims.

Farnborough Air Disaster

Once again this year the Hampshire Branch undertook First Aid arrangements at the Farnborough Air Show for the period 1st to 7th September inclusive. A total of 488 members covered the duties, but on Saturday, the 6th, the day of the shocking air disaster, there were 127 officers and members on duty (10 trained nurses, 71 women and 46 men, plus H.Q. staff and drivers of vehicles), when 8 First Aid Tents and an H.Q. Tent were manned.

The crash occurred at 3.46 p.m. Flying debris fell everywhere bringing death and destruction in its trail. First Aid personnel went immediately into operation; mobile parties moved swiftly to the various incidents and casualties were brought without delay to the tents. From the telephone in the H.Q. Tent all hospitals were notified that beds were required, each hospital having previously given its 'bed-state.' Branch officers provided emergency equipment where necessary; tea vans were emptied of food and visited all First Aid Tents carrying tea, extra equipment and so on.

In reporting this disaster to the September meeting of the Executive Committee, the Controller of the Home Department, who was at Farnborough at the time of the crash, said that although spt"cial tribute should be paid to Miss Balfour, Miss Pilkington and Major Grant, everyone had worked magnificently. There was no panic and First Aid work had been carried out calmly and efficiently under the guidance of the Branch's State Registered Nurses. The value of Casualty Faking training was proved, and after the tragedy had been dealt with many first-aiders said that without realistic training it would have been impossible to have dealt with such terrible casualties.

At the Cambridge Hospital, Aldershot, which is always prepared to take casualties, Service Hospital Welfare Officers had been allotted their place in the scheme, and as the casualties began to come in the two Welfare Officers opened a canteen in the Red Cross room, and undertook the- care uf the many distressed relatives who continued to arrive up till 5 a.m.

CATAL O GUE O F FILM STRIPS

The Central Council for Health Education, Tavistock House, Tavistock Square, London, W C.!, has published 'A Catalogue of Film Strips for Health Education,' price 2s. 6d It is as comprehensive as possible, and will be of utmost use to all working in health education.

Full information about each film strip is given, number of frames, price, and so on. In each case there is a brief comment on tbe strip, the views expressed being those of experienced individuals working in the field.

Britishl Railways

Lo nd o n M idl a nd R eg on

For their skill in rendering first aid to seriously injured colleagues and members of the public, nine members of British Railways (London Midland Region), including a driver, signalman, ganger, yard inspector and goods clerk. each received a handsome clock or meritorious certificate.

Mr. J. W Watkins, Chief Regional Officer. made the presentations in his office at Euston recently.

At Morecambe. Driver Baldwin, on hearing that a man had fallen from a railway bridge on to the main line, immediately stopped his engine and rushed to the scene. The man had serious injuries to both legs and until the arrival of ambulance materials Driver Baldwin made use of boot laces and sponge cloths to secure the man's legs. His improvisation earned high praise from the Medical Officer at the hospital.

Signalman Constable at Nuneaton called to the assistance of a colleague very badly injured by a shunting engine acted so efficiently and expeditiously that the victim was treated and transferred to an ambulance in 7 minutes.

Yard Inspector Hatfield of Warrington, who was called when an army corporal fell from a train in motion, enlisted the aid of a bystander who had no knowledge of ambulance work, and with this unskilled assistance successfully dealt with a severe haemorrhage.

Other equally meritorious actions were performed by Crane Driver Clements. Poplar Docks; Wagon Maker Hollis of Woodford Halse Shunter Gray of Carlisle; Capstanman Smith of Nottingham: and Ganger J. Smith of Primrose Hill.

N or t h-Eas t ern R egio n

The Regional Ambulance Centre Secretary's report for the year ended 30th June 1952, states that the number of students who were successful in passing the examination during the 1951 1952 session was 2,953, an increase of 49 on the previou session.

'It is very p leasing to note that the figures continue to show an increase in spite of the fact that the new edition of First Aid is now in o peration,' the report adds.

The first aid returns for the year were:

D arlington district 22,469, Hull district 12,61 1, Leeds d istrict 2,200, M iddlesbrough district 5,170 Newcastle district 24,752. York district 16,377, total 83,579, making a tota l of 2,924,966 cases since January 1896.

R eco m mendations for Honours have been submitted on behalf of Messrs. W. E. Twinham, J. T. D alby, S. Jackson, W. E. Jones, S P earson, W. Bromfield, W. Dick and Dr. A. M. B oyne, but up to the present

WhereYOUI' training is needed

YouARE TRAINED in first aid and nursing, and may have worked in hospital. But unless you are a mem b er of the N.H.S.R., how will your local hospital know that it will be able to count on you in the event of war - how can it organise the first aid and nursing teams now, as it must do? That is why the hospital wants you to join nozl..'.

The Reserve has been formed to provide men and women already trained and organised in units for first aid and nursing duties in the event of war. It is the only war-time reserve for first aid and nursing you can join to help your local hospital. D o you know about the special concessions for "efficient members" of the St. John Ambulance Brigade and British Red Cross Society which shorten hospital training and extend the recruitment age?

It would be a terrible thing if a sudden emergency found your hospital's Casualty Services unorganised and unprepared through lack of trained personnel. Ask your Area Officer about joining the N.H.S.R. now.

00 intimation has been received of any Honours being granted

Presentation to Mr. H. Grady

A presentation was recently made to Mr. H. Grady, a foreman in the Carriage Wagon Dept., York, who rendered first aId to Driver Harry Hiscock, of Hull , who was injured on 15th January 1952.

Driver Hiscock was knocked down by a train, and was found to be suffering from concussion, a lacerated wound on the back of the head, simple fractures of left arm an? both legs, also shock.

Grady obtained coats, coverec;l the patient and held the injured limbs untIl they were secured by triangular bandages , the head wound was also covered. A bystander instructed to obtain a stretcher. On arnval the patient was loaded and carried carefully to the Station Master's Office and placed in front of the fire to counteract the effects of shock.

The Medical Officer reported that Hiscock had been treated in a most efficient and competent manner so much so. that 'the ambulance, arriving only two mmute.s after my arrival, was able to .take the patIent as he was immediately WIthout any treatment from me. I consider that the action taken limited his shock to a minimum.'

Grady was assisted by F. H. Wilson, Pump House Attendant, Carlton who is also a qualified first-aider.

Western Region

A pleasing ceremony recently took place when Mr. Gilbert S. Hill, Welfare Officer, London Midland Region, was presented by the members of the Standing Committee of Railway Ambulance Cen!re with a silver entree dIsh, followmg hIS relinquishment of the of !hat body, which he had held contml:l0usly Slllce 1945. In making the presentatlOn, Mr. P . Anstey the succeeding Chairman, referred to Mr. Hill's sterling qualities and thanked him for all the guidance and help he had given over a long difficult I?er iod. Other speakers voiced theIr appreclatlOn of good services he had ren.dered, and a spe<;:lal tribute was paid to hIS long assoclatH"?n with the railway ambulance movement m general.

Southern Region

Dover Class Competition held recently , was a most successful event. Mr. E. Thurston won the' Huckle' Cup, with Mr. E. Church in second place. The beginner's prize went to Mr. G. Wells. Dis t rict Nos. 1, 2, 3 and the London Area Police are planning a Knock-out First Aid Quiz Competition. It is understood that classes favour the proposal; this will encourage the organizing committee.

Dover Annual Class Dinner was held at the Priory Hotel and the event was well supported. Mrs A. J Hemens presented the awards and congratulated each recipient.

Mr. R. R. M. Barr, District Marine Manager (President of the Dover class), proposed the toast of the evening, The Southern Region Centre of the St. John Ambulance Association,' paying tribute to those who were willing to give up some of their spare time in service to others, in return he assured them that he would do aU possible to help them to expand their numbers.

N OTES FOR TOP I CAL

FIRST AlDERS & NURSES

World Health Organizatio n D iscusses Leprosy

There are many analogies between those two great scourges of humanity -leprosy and tuberculosis-and, indeed, in the causatory organisms themselves, which are distinguished as being the only two acid-fast' bacilli known to cause disease in human beings. Tuberculosis is rapidly being conquer ed in the more ad vanced countries of the world and expert opmlOn in Britain has prophesied that it could be practically eliminated by the end of this century. But progress in the control of leprosy is far behind that standard. It is estimated that there are still two to seven million lepers in the world. The wide variation in the figures mentioned is due to two factorsthe difficulty in detecting the early signs of the disease and the inadequately equipped medical services in the regions where leprosy is most widespread. III recent years new drugs h ave been used which have been found to arrest the progress of the disease and in many instances to result in a complete cure.

At the meeting of the World Health Organization in Geneva from 22-27 September, experts in leprosy from all over the world took part in a discussion of the problems of its control and treatment. The highest incidence of the disease is in Asia, and it is estimated that there are over a million lepers in India and a similar number in C h ina. Africa has two to two and a half million lepers. There are very few known cases in North America, but in South America the highest incidence is in Brazil. In Europe there are a few cases in most countries, particularly on the shores of the Mediterranean. With adequate treatment most lepers can now, within limits, lead normal lives. Apart from drug treatment and good hygienic care, surgery and orthopaedic measures are helping those who have been crippled by leprosy, and there appears to be every hope that W.H O., working in close collabora-

tion with the countries most affected, may eventually establish such control that the disease may become almost eliminated in the next generation.

British Rhe um atic Asso cia tio n and E mplo yment of t he D isabled

The special schemes for the employment of the disabled appear to touch only the fringe of this problem for, according to recently published figures, only about 8,000 of the 83,000 registered disabled persons in Britain have been resettled in commerce or industry. Even these 83,000 form only a part of the disabled persons in the country, for the British Rheumatic Association estimates that a much larger number are unknown and unregistered, many of these being housebound or unemployable, but that probably 98 p.c. could be rehabilitated and become wholly or partly self-supporting if facilities existed for advice , assessment of capabilities and training.

The Association is making a determined effort to inform the public of the present position in the hope that nation-wide efforts may be made to increase the facilities for rehabilitation and to provide work for the disabled. The Association stresses three important factors connected with this problem-the national necessity to mobilize every available unit of manpower, the carrying out of training by personnel with a thorough understanding of the needs and problems of the disabled in addition to skill in the subject or process being taught, and the provision of a steady flow of suitable work for all those who are capable of undertaking it. Some very constructive suggestions are then put forward. These include the recognition of the fact that the partially disabled cannot compete with their more fortunate fellows in the open labour market, and, therefore, industrial undertakings must be set up for the production of goods which are suitable for the rehabilitated to make, so that they are not kept waiting for work that

(continued on page 14)

To Local Governments and other undertakings using large scale transport there are very many advantages in a One-make fleet. Methods of maintenance standard throughout and interchangeability of spare parts make organisation and stocking extremely simple. With a vehicle for every load , Bedford are ideal for instituting One -make transport. To this

add the economy of low initial cost and low running cost, easily available spare parts, and nation-wide Square Deal Service. There are Bedford chassis covering loads from 10 cwts. to 10 tons to accommodate any type of body.

Full particulars from your local Bedford dealer, or write direct to the Municipal Vehicle Dept. , Vauxhall Motors Ltd., Luton, Beds.

C. G. O. (Wimbledon) writes :-

Would y ou please be so kind as to let me kno w the correct return of the arms to the expiration position in Silvester Method, 40th edition, S.J.A.B. (page 84).

Bringing the arms back along the same route has caused our class some difficulty to the way we used to do it. Trusting you will be kind enough to help us in this matt er.

Answer

Carry the bent arms slowly forwards, downwards and inwards with a sweeping movement similar to the first.

* * *

J. B. G. (Portsmouth) writes

When a bronchitis case is being nursed, and the temperature indicate s a fire at night, is it better to run an electric fire, 01' keep a coal fire burning? Last winter we chose the electric fire, thinking it less vitiating, but a friend has just recommended one of the new' all-night' coal fires, and we are hesitating about the installation.

I don t know if this query is within the usual bounds of First Aid but should be grateful for advice if possible

Answer

This is a matter of opinion. In theory, the coal fire ' is best since it assists in ventilation, is cheerful for the patient and can be used for keeping a steam kettle (if needed) boiling. If an electric fire is used, adequate ventilation must be ensured and a shallow dish of water placed in front of it. It is doubtful in your case whether the expense of installing the 'all-night' fire will carry sufficient ad vantages. In hospitals the patient's warmth would be provided by central heating or sometimes, in private rooms, by electric fires.

* * *

M Me. (Bristol) writes :-

I am the first-aider in a factory. A small number of our workers have

queries

Answered by Dr. A. D. Belilios, M.B., B.S. (Lond.), D.P.H. (Eng.)

10 do a long da)' in a temperature of 85 F. which ma), rise to 100 oF. in hot weather. Is ihere any drink which lI'ill prevent them suffering from symptoms due to the heat ?

Answer

A drink containing common salt (Sodium Chloride) can be given with advantage. Tablets are available containing the salt h combination with other chemicals. They are effervescent and pleasantly flavoured. One tablet dissolved in half-a-pint of water makes a pleasant drink of which the worker can take from 1-3 pints every shifL General measures for keef1:n.g fit, e.g., attention to bowels , etc., are also essential.

* * *

J. R. T. (Epsom) writes :-

Recently [ took m y girl friend for a ride on th e mot cr -t " :6 but we had a slight crash in a country lane. Neither of u s were seriously injured but she had large g razes on her shoulder, quite deep in places and very dirty. What is the best dressing for this condition ?

Answer

This is a dangerous question to answer since it suggests you considered undertaking the treatment. I hope you didn't, since this type of case must be treated by a doctor or at a hospital since (a) it is very difficult to remove the dirt, (b) an injection of anti-tetanic serum is generally necessary to prevent lockjaw. Hence at this stage, a dry dressing is all that is required. After (a) and (b) have been undertaken, a dressing such as Tulle Gras with penicillin may be advised.

* * *

1. F. S. (Wandsworth) writes

After careful saving for some time, my wife and I bought a second-hand car but so far our trips to the sea (about 50 miles) have been spoilt by our two children being sick on the journey. What is the cause of this and what can be done about it ?

Answer

This is one or the varieties of travel sickness. It is probably due to disturbance of the semi-circular canals of the ear but may have other contributory causes, e.g., nervousness the fear of being sick, etc. A called' Kwells containing a drug known as hyoscine is often a good preventative while a newer remedy called 'Avomine' is also claimed to be good. Dosage for children varies with age * * *

R. J. H. (Watford) writes

A !Vorker was trying to move a crate when he developed an agonizing pain in his back which spread down th e back of his thigh. J gave firs t aid for a strain but his doctor 's certificate says 'displaced disc .' Please explain this condition.

Answer

This term refers to the intervertebral discs which are thick plates of cartilage between the vertebrae of the spine. Occasionally, one of th e discs becomes displaced and then presses on the roots of nerves leaving the spine. In the case you quote, the disc was probably in the lumbar region and hence produced not only pain in the back but pain along the sciatic nerve. * * *

E. J. V. (Manchester) writes

I have just taken over the first ai d room in a small factory and hav e been told to look after the chrom e workers. What are my duties please ?

Answer

You must inspect them all twice a week. They are liable to three mai n ailments-ulcers on the hands called , chrome holes '-dermatitis, a ski n disease beginning with small, red and irritating spots on their hand s and forearms, and ulcers in th e nose .which can only be seen with a special instrument but which may cause soreness and nose bleeding i n their early stages. You mus t fill in the chrome register by putting a n , 0 ' against each man's name if h e is fit and an 'X' if you suspec t trouble. In the latter event, you will be wise to arrange for th e Appointed Factory Doctor to be informed even before his next visit which should be every fortnight.

PATENT "PORTLAND" AMBULANCE GEAR

The .Gear lIIustrated(A.B.C D.) carnes two stretchers on one side of Ambulance, leaving oth.er side clear for sitting patients.

The UP AND DOWN action is quick and easy for loading or unloading.

A. Shows the two stretchers in position.

B. Shows the top stretcher lowered ready for loading.

C. Illustrates the arne Gear with the top stretcher frame hinged dcwn for use when only o ne stretcher case is carried

D. Shows the same

FIRST AID HANDBOOKS

ANATOMICAL DIAGRAMS AND CHARTS FOR LECTURES

H. K. LEWIS & Co. Ltd., 136 Gower Street, London, W.C.I eUStDn 4282 (7 lines)

A NEW FIRST AID FILM FOR YOUTH

'H£1P' is a brillian tly produced film designed to introduce children to First Aid.

Here is an interesting and often exciting les son in pictures t ha t you ng people can easily understand and remember.

, Hel p , teaches them t be principles of First Aid in a way that they will enjoy, and leaves them with a real enthusiasm for its s ubject.

'Help' can be obtained on free loan by schools. the

Junior Red Cross and all youth organizations. It is a 16mm. ouod film that lasts 13 minutes. Help' bas been seen and approved by leading aut ho rities and can be obtained from : The F lm Librarian, Sound-Services Ltd .• 269 Kingston Rd ., London, S.W.19

• The Public Relation& Dept., T J. Smith & Nephew Ltd., Neptune Street, Hull

T. J. Smith &: Nephew Limited, lIlallll/uc/llrers 0/ Efastopla s alld

FIRST AID COl\1PETITION

The next issue will be published a few days before Christmas, and we are inviting readers to take part in a competition, the results to be published in that issue. The theme is: 'First Aid at Christmas Time,' and details are given below. Entries must be addressed to The Editor, and be received no later than Tuesday, 25th November 1952. Competitors who wish to have their entries returned must enclose a stamped addressed envelope.

A prize of two guineas is offered for the best tale, true-life story, or poem, humorous or otherwise, on the theme of 'First Aid at Christmas Time,' and one guinea will be paid for all other entries published. Not more than 500 words or 12 lines of verse.

A prize of two guineas is offered for the best black and white sketch or cartoon on the same theme, and one guinea will be paid for all others published.

Competitors' names and addresses must be given with each entry. The Editor's decision is final.

TOPICAL NOTES

(continued from page lO} is within their power to accomplish ; as they would be in an ordinary factory.

These undertakings would need to be sponsored, probably by the Government, for, although they could be run without loss, the profits might be small; but this would be offset by a saving in maintenance grants. Moreover, the relief of boredom and the happiness of, once again, becoming self-su pporting would have a vitalizing effect of great value. The person suffering from a disability has the best chance of success when work is adapted to his capacity in an environment that is healthy and relatively free from emotional stress, and where he is under medical supervision. Many voluntary associations, particularly those concerned with the rehabilitation of the tuberculous, have successfully carried on such industries for many years past; but the problem of finding employment for the partially disabled needs to be tackled on a wider basis than is possible within the limits of any voluntary activity.

First Crossword

Compiled by W. A. Potter

FIRST AID & NURSING, SEPT.IOCT. 1952

Nineteenth Edition. Completely revised. 261 st thousand 286 pp., 286 illustrations, some coloured, 65. 6d., post 4d.

WARWICK AND TUNSTALL'S

Edited

by

THE

INSTITUTE

FIRST AID OF CERTIFIED AMBULANCE PERSONNEL TO

THE INJURED AND SICK

A. P. GORHAM, M.B., Ch.B.,M.R.C.S.

JOHN WRIGHT &

(Answer next issue)

Enquiries are invited from all those who wish to see an Increase in the standards of efficiency and training of ambulance and allied first aid workers , and who wish to increase their own qualification s by taking the Institute's Examinations.

Full details from THE GENERAL SECRETARY, l.e.A.p.

LTD., BRISTOL, 8 61, Cheapside LONDON, E.C.2

A set of eight colourful

Not of the profession [5] 25. Extremely [4] 19. A way to conquer? [8]

28. House Rino cared for and fed... [9] 22. Thigh-bones [6] 29. Prodromal period of infectious 24. Often examined in medical wards [5] fever [5] 26. Chase away the end of a sneeze [4]

31. Unfortunate means of hypo- 27. Dad's increases... [4] dermic injection [5 , 2, 6] 30. Perceive visually. [3]

Two New Films

The Ministry of Information has recently made two new films for the Ministry of Health. One of thesecalled 'There's a Way' - deals with the first steps in rehabilitation, and shows how, with improvisation and relatively small expense, a modest Rehabilitation Department can be set up in a hospital, so that patients from different wards and departments can meet for instruction

and practice. They can often be brought back to normal life more quickly through group treatment ; and quicker recovery enables existing hospital resources to be used to better advantage, with a quicker turnover of patients.

The second film is called ' Prevention of Cross Infection; GastroEnteritis in Infancy,' and shows by means of a 'detective' treatment how the spread of infection by contact may be avoided.

PHYSIOLOGY CHARTS

Size 40 in. x 30 In.

attractive set eight. elementary physiology and hyglene charts,. In. clear and striking colours, makes the Ideal vIsual aId for all First-Aid and An1bulance Instructors.

No.1 THE SKELETON. Entire figure with 10 enlarged details or parts.

No.2 THE MUSCLES. Entire figure, with 6 enlarged details or parts.

No.3 THE BRAIN AND NERVOUS SYSTEM. Entire figure, with 10 enlarged details or parts.

No.4 THE CIRCULATION OF THE BLOOD. Entire figure , with 12 enlarged details or parts.

NO.5 THE ORGANS of DIGESTION AND ASSIMILATION, in situ. With 11 enlarged details or parts.

No.6 THE STRUCTURE OF THE EYE. With 5 enlarged details or parts.

No.7 THE STRUCTURE OF THE EAR. With enlarged details or parts.

No 8 THE SKlN and EXCRETORY ORGANS. With 9 enlarged details or parts

Complete set, unmounted, with lath at top edge Price 30/Also available singly either mounted or unmounted.

Please write for illustrat ed brochure offull series

@0 LD & SON LTD BUTIERLEY STREET LEEDS 10 BRANCHES AT LONDON EDINBURGH AND BELFAST

GARROULD .'S for the Regulation Uniform for

OFFICERS & MEMBERS (Female only) OF THE ST. JOHN AMBULANCE BRIGADE

r;:;:;:::====================- Established over 100 years

We have specialised in the making of Nurses' Uniforms for nearly 100 and have a reputation for good quality materials and superb workmanshlp

You can order your St. John AmbuJance Uniform knowing that every detail will be In accordance WIth regulatIons.

W e shall be pleased to send full details upon request

E. & R. GARROULD L TD.

150-162 EDGWARE ROAD, LONDON, W.2

HOUSEHOLD PHYSICIAN

Describes in simple language , with helpful coloured plates a,nd diagrams

The COMPLAINTS OF MEN, WOMEN AND CHILDREN

Their Cause , Treatment and Cure

A few of the Subjects treated:

FIRST AID:-

General Rules

Examination

Fractures

Dislocations

Spra ns

Wounds

Haemorrhage

Types of Bandages

Splints

Shock

Artificial Respiration

lifting

Transporting , etc., etc.

First A id What to Do in Emergenc ies

Influenza, Colds etc

Measles , Mumps, Catarrh

Corns and Warts

Physical Culture, Self Defence

Treatment for all Skin Diseases

The Lungs , Pleur isy

Hygiene , Anatomy, Pharmacy

Fevers , Bladder, Kidneys

Pregnancy, Childbirth

Home Remedies , D iet

MOVABLE MODELS OF .-HUNDREDS OF TESTIMONIALS

I am deiighted with' The Household Physician,' and as I am an Ambulance man, I can appreciate them to their fullest extent."

Princ iples of Nursing PRE SCRIPT IONS

Eye Ear, Nose 375 proved remedies

Throat Liver MOTHER AND CHILD

Chest, the Heart teaching pictures

Stomach. Duodenum BEAUTY TREATMENT

Teeth. the Muscles how to bring out your best points

Child Welfare SELF DEFENCE

Homceopathy Arthritis what to do if attacked

Neu rasthen ia

Rheumatism, Poisoning COMPLETE INDEX

Patent Medicines enables you to find Glossary, etc. etc instantly what you require

Male

THE

"Being a Nurse It is of great help to me."

The unit IS complete with water storage, electric power and all essential equipment for the purpose. It has been designed in two sections to obtain greater scope, manreuvrabil ity and better d istri but ion of weight to enable it to cope with rough and unmade roads and wooden bridges which exist in the territory in which it will work

The units have also been designed to work under extremely high temperatures ranging from 90 to 130 fah renheit so that normal film development temperatures can be maintained.

One section houses the electric power unit and complete facilities for developing washing and drying X-Ray films ranging from 35 mm. miniature to the large 17" X 14" radiography, i.e., Dark Room.

The other section functions as an X-Ray room complete with mass miniature X-Ray apparatus for taking films of the chest, and incorporates a separate control room and the Doctor's Room for the projection and examination of films , i.e., the X-Ray Room.

AMBULANCE

YOU ARE INVITED TO APPLY FOR FULL DETAILS OF MOBILE MEDICAL UNITS , AMBULANCES, ETC., BUILT TO YOUR PARTICULAR REQUIREMENTS FOR SERVICE IN ANY PART OF THE WORLD

DOSAGE: Two tablets at the onset 0/ symptoms, repeated two hours later if reqrlired, brillg speedy re lief

·/N THE THICK' OF INFECTION

Closed windows and crowded humanity offer s wift conveyance for the common cold. In humid warmth, the droplet-laden air passes from one nose and throat to another. When exposure to wintry elements follows, resistance to infection all too collapses. The discomfort of c01ds and chills, though difficult to avoid , can nevertheless be reduced, by the timely taking of Anadin a s kilful combination of aspirin, phenacetin, caffeine and quinine.

aIf you are logical person ...

Then you will follow this point-by-point argument and reach the same conclusions as so many doctors, nurses, hospitals and clinics have done.

DO YOU AGREE ... that the causes of most skin infections are the common strains of STAPHYLOCOCCI, STREPTOCOCCI and B. PYOCY ANEUS ?

IN THAT CASE . .. a treatment which is effective against all three will be indicated for cuts, abrasions, burns, scalds, boils and most inflammatory skin infections 1

THIS IS THE TREATMENT

ANTIPEOL Cutaneous Vaccine Ointment contains the sterile vaccine filtrates of the three micro-organisms mentioned. The filtrates destroy the a'ctual micro-organisms and at the same time act as a local immuniser against re-infection. This is a

purely biological action and there is no damage to delicate tissues.

RAPID HEALING is further expedited by the ointment base of proved efficiency. For burns and scalds, ANTIPEOL has special advantages. It is microbicide and non-adhesive. Therefore dressings do not have to be changed every day.

AND HERE IS THE PROOF.

Antipeol Ointment is proving and reproving itself every day in dozens of surgeries, clinics, hospitals and homes. Letters from the medical and nursing profession bear convincing testimony to its effectiveness.

THERE is the logical argument for including ANTIPEOL Ointment in every First Aid kit. As a logical person, why not send for full details and a clinical sample ?

antipeol

cutaneous vaCCIne ointment

Produced by the makers of: ENTEROFAGOS for intestinal complaints; RHINO-ANTIPEOL for nasopharynx infections; OPHTHALMO-ANTIPEOL for ocular infections; DETENSYL for reducing arterial tension.

MEDICO-BIOLOGICAL LABORATORIES LTD., CARGREEN RD., SOUTH NORWOOD, S.E.2S

First Aid & Nursing

Competition

5

8 10 12 12

THE Grand Prior's Trophy Competitions -the' Blue Riband' of the St. John Ambulance Association competition yeartook place at the Central Hail, London, on 18th November, and were won by the National Fire Brigades Great Yarmouth team (men's competition) and the St. John Ambulance Brigade , Palmer's Green (women's competition).

In the men's contest the first three teams were separated by only I! marks; the Fire Brigade's team winning first place from the National Police (Metropolitan L Division) team by one mark, and the British Railways, London Transport (Railways), Bristol D.O.S .O. team coming third, only t mark behind the police. The final results are given below.

Palmer's Green Nursing Division, who won the women's competition, were newcomers to the contest. They had a comfortable margin over the British Electricity Ambulance Centre, Mid Sussex, who came second, and the Ministry of Supply, Storage Depot, Elstow, who took third place.

MEN

1. National Fire Brigades (Great Yarmouth) 292t

2. National Police (Metropolitan L Division) 29It

3. British Railways & London Transport (Railways), (Bristol D.O .S. O.) 291

4. Miners National First Aid Competition (Markham Main Colliery)

5. The St. John Ambulance Br igade (Wolverton)

6. British Transport Commission Police (Liverpool Street)

7. British Electricity Ambulance Centre (Worthing)

8. General Post Office (S.B.D. Acton)

9. Gas Industry (South-Eastern Gas Board)

to. National Road Passenger Transport Ambulance Association (Plymouth)

11. Ministry of Supply (Wind scale Works)

WOMEN

J. The St. John Ambulance Brigade (palmer's Green)

2. British Electricity Ambulance Centre (Mid Sussex)

3. Ministry of Supply (Storage Depot, E1stow)

4. National Road Passenger Transport Ambulance (Chiswick L.T.E.)

5. British Railways & London Transport Railways (Broadway L.T.E.)

6. Ger.eral Post Office (Belfast T.M.O.)

;

We aU our reaber.s' ; l a ;men!' ((bri.s'tma.s'

The Earl of Atblone presents the Silver Bowl to Palmer's Gleen S.l.A.B. Nursing Team

AFTER an interlude in which first aid was discussed, we return in this article to the subject of 'How to keep fit.' Keeping fit depends on observing a number of rules of health some of which have already been des cribed.

Care of the Bowels

The motions or stools which are passed contain waste products which have been produced within the body, and also the indigestible debris of food. Regularity of the bowels is essential since otherwise harmful substances are liable to be absorbed into the bloodstream and set up a mild form of toxaemia with symptoms such as lack of energy, loss of appetite, a muddy complexion and a furred tongue.

The dangers of constipation, however, are often exaggerated and the modern tendency is not to regard anyone as constipated provided the bowels act adequately once in 48 hours. It is recognized that each individual has his own normal just as .the amount of sleep required vanes somewhat from person to person.

The care of the bowels is largely a question of diet, sufficient drink and adequate exercise. Foods which encourage regularity are those which contain bulk and roughage to stimulate the movement of the intestines. Green vegetables, salads, fruit and wholemeal cereals are of value while a certain amount of fat such as butter, margarine and olive oil helps to provide lubrication. Proprietory preparations such as KeUog's All-Bran, Lactic oats and have a high reputation as Simple and natural laxatives. It is an important rule to obey promptly the call of nature. Many cases of constipation date from failure to observe this rule and to allow a time each day for habit tlme, usually after breakfast.

Aperients and purgatives should be avoided whenever possible and

Keeping Fit-3

By A. D. Belilios, M.B., B.S. (Lond.), D.P.H. (Eng.)

should their need be felt medical advice should be sought since taking remedies may develop into an unnecessary habit. Some people believe in taking a regular purge each week but this practice is undesirable.

Care of the Skin

The skin is an essential organ of the body and possesses numerous functions. It protects the deeper tissues from injury and from infection with germs. It produces sweat which is an excretion containing a waste product called urea, traces of salts and water. Sweating is continuous throughout life although it is not always perceptible particularly when the body is inactive or the weather is cold.

In addition to removing waste products, sweating plays an important part in regulating the body temperature. When it evaporates from the surface, it cools the body, hence sweating is more profuse in hot weather and after exertion. It is estimated that about two pints of fluid are lost from the body each day by the sweat which is produced by special glands in the skin. As a result a very thin film of :vhitish powder, generally invisible, 1S left on the surface.

The skin also possesses sebaceous glands which secrete an oily substance called sebum. This is a lubricant and keeps the skin and hair in a soft and smooth condition unfortunately, however, it has disadvantage that it readily picks up dust and germs.

The care of the skin, therefore, is of utmost importance. Regular washmg and baths, using liberal quantities of hot water and soap, remove the thin film of waste products referred to above, keep the of the skin through whlch sweatmg occurs, and get rid of excess of sebum with the dirt and germs that it has collected. Moreover, the hot water and friction

stimulate the vitality of the skin making it less liable to develop boils, pimples and other skin conditions.

Particular care must be paid when washing, to parts of the body which sweat readily and to places from which sweat cannot easily evaporate. areas include the armpits, groms, the feet, and under the breasts in women. A little absorbent powder used in these situations is of value after they have been thoroughly washed and dried.

Special attention shoul d be paid to the hands and nails which should always be washed before taking food and also immediately after defaecation. Moreover should they become contaminated with chemical substances, dirt, etc., they should be washed as soon as possible afterwards. Some people have to undertake work with oils and various chemicals and cannot avoid dirty hands. Generally the skin accustoms itself to these substances and no harm results. Occasionally, howif the skin becomes sensitive, a dlsease called dermatitis occurs. This is to a large extent preventible by cleanliness and also, when possible, by wearing gloves or by smearing over the skin before work is begun a suitable protective cream. Dermatitis may also occur in women who use various chemicals such as soda in their domestic duties, and through many other causes.

Those whose hands tend to become rough can with advantage use a hand lotion after washing while the first signs of dermatitls-redness pimples, roughness and irritation: call for medical advice without delay.

The care of the skin includes, of course, prompt first aid. for any injury, however small; it will be appreciated that a wound may be contaminated with germs present on the patient's skin quite apart from outside sources.

FIRST AID & NURSING, NOV. /DEC. 1952

Care of the Nose

The nose is the first organ of the respiratory system. Its functions are to warm, moisten and filter air which enters the body. It is also the organ of smell and gives tone to the voice. Care of the nose, therefore, consists essentially in making sure that it is used for the purpose for which it is intended, since many troubles result from breathing through the mouth instead of through the nose.

Nose-breathing cannot be satisfactory unless the nostrils are kept clear and this involves regular use of the pocket handkerchief to remove the natural secretion which tends to accumulate. Nose blowing should never be too forcible particularly if the individual is suffering from a cold or similar infection. Too violent blowing . may, in certain circumstances, spread infection to the ears. Since the nasal secretion contains germs, handkerchiefs should be frequently changed and never lent or borrowed.

Breathing through the nose is a natural process and should normally begin immediately after birth and continue throughout life. Sometimes, however, a mild degree of obstruction within the nostrils causes the habit of mouth breathing which must then be corrected by training.

Obstruction to nose breathing can be due to many causes. Enlarged adenoids - masses of lymphoid tissues in the throat at the back of the organ-may have to be removed in childhood while the partition between the nostrils (nasal septum) may not be centrally placed and hence cause obstruction of one nostril. Sometimes the difficulty results from a broken nose where the first-aider has omitted to send the patient to a doctor. Medical advice should always be sought if there is difficulty in breathing through the nose.

Some people overdo nasal hygiene by using douches, sniffing water up their noses and using drops. These practices should only be undertaken on medical advice since normally the upper parts of the nose are free from living germs; hence in a healthy person the procedures mentioned may only have the harmful effects of carrying infection up the organ.

First Aid Quiz

you can learn a lot .from a A!d Quiz. Write down your answers to each of followmg questIons WIthout referring to any books. Turn to page 7 and gIve yourself two marks for each correct answer. When there are two parts to a question allow one mark for each. FOR

I-MEDICAL

Set by Dr. A. D. Belilios

l. What is , fissured' .fracture and why is it important?

2. In a spramed ankle, if keeping the bandage wet with cold water ceased to give comfort, what would you do ?

3. In what first aid condition does an aura' occur and what is it ?

4. To what points would you direct attention when maintaining observation on a case of concussion ?

5. What is a Colles's fracture?

6. How should the doses of antidotes be reduced for children ?

7. What is meant by the term' spasm' ?

8. Why are there numerous openings in the base of the skull ?

9. What is incontinence' ?

10. Where is the Jugular vein ?

11. What is a brush burn ?

12. In what conditions is it forbidden to give an emetic in poisoning?

II-NURSING

Set by Agnes Pavey, S.R.N.

1. What do you understand by the recumbent position' ?

2. A patient is to be nursed in a sitting position. Give four simple measures to prevent him from slipping down in the bed.

3. How might you make a dose of castor oil palata ble , (a) for a child, (b) for an adult ?

4. What would you do if you gave a wrong medicine to a patient?

5. In what position should a baby be bottle-fed, and why?

6. What is the strength of normal' saline? Why is it called normal?

7. What are the two main points of difference between a clinical thermometer and any other thermometer ?

8. What is the normal respiration-pulse ratio?

9. What is the difference between a ' medical' and a ' surgical' fomentation?

10. What age group has the greatest need for vitamin D, and why? How mayan adequate supply be obtained?

11. What is the other substance necessary for bone and teeth formation ? and how is its supply assured ?

12. What is the difference between a symptom' and a sign' of an illness?

ill-EVERY FIRST-AIDER SHOULD KNOW-

Set by F. A. Trott, Ambulance Secretary, Southern Region British Railways

1. Should a first-aider re-dress an injury?

2. Wh at are the factors concerned in the production of shock ?

3. The patient is suffering from concussion-face is very pale-what is the correct position for head and shoulders?

4. How many bones are there in the spine?

5. Where does the absorption of the food take place ?

6. Which should receive the first attention shock or bleeding?

7. Would you cover a cold compress to fix it ?

8. How many thicknesses of flannel are needed to make a hot compress ?

9. How often should a constrictive bandage be released?

10. How may water be made sterile?

11. What injuries are most hkely to cause toxic shock ?

12. Is alcohol a stimulant?

By AGNES PAVEY, S.R.N.

Development of Child Care in B,·itain-5

Dr. Bowman Stephenson and the National Children's Homes and Orphanages

T HE great Methodist Foundation

now known as The National Children's Homes and Orphanages is the third largest organization of its kind in Britain, accommodating nearly 5,000 children. Like most other voluntary organizations, it commenced in a very small way by the individual work of one man who was neither wealthy nor important, as the world estimates such values. He was Dr. Thomas Bowman Stephenson, a young Methodist minister who, 84 years ago, was working in a poor area in South Lambeth. He saw little children in a condi tion that caused him to write : , There they were, ragged, shoeless, filthy, their faces pinched with hunger, and premature wretchedness staring out of their too bright eyes; and I began to feel that now my time had come. Here were my poor little brothers and sisters sold to hunger and the devil, and 1 could not be free of their blood if I did not try to save some of them.'

With the help of two friendsFrancis Horner and Alfred MagerDr. Stephenson opened a house in Lambeth to shelter a few homeless children in 1869. A well-wisher gave him £100 and another lent him a donkey to deliver the wood that was chopped by the boys; and with these very meagre assets there started a work that was to extend and endure as a pioneer of enlightened methods in child care. The family soon outgrew its original accommodation and, in I8}], Dr. Stephenson moved the Home to Bethnal Green, and in the following year a redundant public house at Edgworth, on the fringe of the Yorkshire Moors, was acquired as a Farm House for London boys, where they could live in bracing air and be trained to work on the land. Later, a Branch Home was opened in Ontario for boys who wanted a life among the open spaces of a new country; and as the years went by further homes were started · in different parts of

England, some of which were for physically handicapped children. In 1878, Dr. Stephenson started an 'Industrial School at Gravesend, for the social reclamation of children who had been brought before the Courts for breaking the law. This school later removed to Farnborough, where it now houses 106 boys. It was the first of what have become known as 'Approved Schools.'

Training for Child Care

From the first Dr. Stephenson recognized the importance of specia lized training for child care, and as early as 1872 he founded a training department in connection with his Homes. In his Report for 1873 he says that ten men and nine women were undergoing training. Some of his observations are as relevant to-day as they were at that time. He said: 'The value of the Training Department of our work becomes increasingly apparent. The great difficulty in our enterprise has been to secure officers who are suited for this most difficult task.' He stresses the moral and spiritual qualities needed, and continues: , And second only to this is needed a complete and habitual self-control, together with a quick eye for peculiarities of temperament; and almost boundless patience; and a loving sympathy which no perversity, or wilfulness, or ingratitude on the part of the children can tire out. Therefore, it is a huge mistake to suppose that anybody who may have proved incompetent in any other walk of life but who can wash a child's face or sew a button on a child's dress is fit for such work as ours. Of all departments of educational work there is none which makes a greater demand upon the highest moral qualities ; nor is there any in which the breadth and refinement which mental culture alone can give may be used to better advantage.'

At the present time, three different kinds of training are sponsored by the Society for those who accept the vocational outlook and are suitably

qualified. First, there is N ursel y Nurse training extending over two years at six of the branches for babies and for the under-fives. At Birmingham and at Alverstoke there are hostels for Cadets who are not old enough for the Sisterhood training, but who are taking a preparatory course. There are approximately forty Cadets at these two centres. The rl1ain training, for which the minimum age is 18, is given at two Colleges for adult staff-Stephenson Hall, Highbury, London, an d Princess Alice College, Sutton Coldfield. A Home Office grant is available for these courses, which are in preparation for the National Certificate in the residential care of children. At HighbUlY, all the students are candidates for the Sisterhood Order, whilst at Sutton Coldfield both men and women students are received.

Many students of child care from overseas as well as from this country visit these Colleges and the various Branches of the organization for study purposes, and during last year the Principal went to Wash ington, at the invitation of President Truman, to discuss with leaders of child care in the States the contribution the National Children's Homes and Orphanages is able to offer in this sphere of training.

The Work in Modern Times

The greatest development has occurred during this century. In 1912, there were thirteen branches, there are now forty. The Society undertakes to train and supervise the children under its care up to the age of 16, and then to place them in .suitable employment, or to continue their education and training; but after they leave the Homes they are still supervised and helped in every way that is desirable and consistent with their standing as responsible citizens.

Reception and Placement

Except for the very young babies, all the children who are received have undergone experiences which have resulted not only in physical but in mental and moral trauma. The child's individual fears and difficulties must be assessed and his behaviour problems studied. So he first goes to a branch that specializes in this study, and then his placement is decided upon. For babies it may

FIRST AID & NURSING, NOV. DEC. 1952

be that adoption is the best course. The Home's own Registered Adoption Society has arranged the successful legal adoption of some 2,000 children into private homes, but it never advises adoption if there is any hope that the mother may one day re-assume responsibility for her child.

Boarding-out

For Some children the best solution is that they should be boarded-out in a suitable foster home where the conditions, although greatly bettered, are not too far removed from the life they have previously known. A very high standard is required in the foster parents and very careful supervision is maintained.

Small Houses and Flats

Little houses have been built at Birmingham and larger houses have been adapted as fiats, where a real home life can be given to ' families' of six to ten children of both sexes and varying ages. Each family has its own 'Mother,' the home is furnished and equipped like the ordinary family home; and the presence of toddlers, junior and senior school children, and even a baby, is good for the development of all the children.

Branch Homes

For some children, particularly the difficult or ' problem' children, this is the best choice. They mix freely with the children of the neighbourhood at school and form natural friendships. They are encouraged to invite their special friends to their house and they are, in turn, invited to the houses of their friends. These friends are not always children, for adults often enjoy a friendship with one of the children, and even invite them to their own homes during school holidays or include them in a holiday party.

Special Homes and Hospitals

These include two sanatona for tuberculous children, two hostels for diabetic children and a Branch for cripples and those needing orthopaedic care. A recent is a Branch for educatlOnally retarded children, who may have had broken schooling but who are not necessarily of low intelligence. They need more individual teaching (continued in column 2)

News from British Railways

London Midland Region

ON the 7th October at the N.U.R. Social Club, Deane Road, Liverpool, LongService ambulance awards were presented by Mr. D. S. Inman, District Goods Superintendent, Liverpool.

The Chairman was Mr. W. H. Oates, Assistant District Goods Superintendent, who was supported by Mr. C. J. Rogers, District Operating Superintendent, Liverpool Central; Mr. G. Whipp, Goods Agent, Park Lane; Mr. S. Pratt, Chief Claims Clerk; and Mr. H. C. Healey, Regional Ambulance Secretary.

A packed hall was admirably entertained by well-known local artists under the direction of Jimmy Couton.

* * *

A social evening in connection with the presentation of awards for 1950 / 51 in the Wigan area was held on Thursday, 16th October at the Central Labour Club.

and help than could be given at an ordinary school.

Approved Schools

There are now four for boys accommodating 383, and one for 40 girls. These are approved and inspected by the Home Office, which makes a 50 p.c. grant towards the cost of maintenance.

Opportunities Overseas

In recent years Australia has been the focus of the Home's migration policy. Shortly before the war the Northcote Farm Schools in Australia received a group of boys from various Branches. In 1948 the Principal, the Rev. J. H. Litten, visited Australia to investigate the prospects for the reception of further parties. During 1950, 53 boys and 29 girls emigrated and are now resident in Methodist Children's Homes in Sydney, Melbourne, Adelaide and Perth; and to each of these centres a ' Sister' from the Homes in England has gone. Mr. Litten who has now retired, is living 'near Sydney and is watching the interests of this new and important development. A very careful selection is made from the many boys who would like to go, and the consent of parents or guardians is obtained where these exist and are known. The cost of travelling has been borne by the Australian Government, which has also given grants towards equipment.

M.r. J. S. Gavin, Station Master, Wigan, preSIded and the awards were presented by Mr. O. Banister, Divisional Operating Supenntendent, M.B.E., Manchester, who was supported by a number of railway officers.

North-Eastern Region

A rather small but unusual party recently travelled from Norham (Northumberland) to Bridgwater (Somerset). An ambulance the family- invalid father, mother, MIchael age 7, whose legs were in plaster casts and fixed at an angle of 30 0 and his sister Margaret age 4-from Norham to Newcastle, where they joined the 12.45 p.m. Bristol train.

A compartment was fitted with boards across the seats for Michael to rest his legs on as the plaster casts were too wide apart to enable him to sit on the seat sideways. Meals were served in the compartment. On arrival at Bristol they were met by ambulance and taken to Bridgwater.

For the special arrangements British Railways North-Eastern Region have received a letter of appreciation which says :-

We were able to do our journey from Newcastle to Bristol last Wednesday in great ease and comfort thanks to the admirable arrangements you made for us. Everything went smoothly-the ambulance men were all that we could ask for at both ends of the railway journey and the refreshment car staff did us well. But most of all we are indebted to you for your most efficient and courteous planning and we should like you to know how grateful we all were. Best wishes and many thanks.'

Western Region

BIRMI GRAM DISTRICT held their annual smoking concert and presentation of loogservice awards under the Chairmanship of Mr. R. F. Wilson, District Engineer, who was supported by Brigadier M. Hayne, C.B.E., County Commissioner, St. John Ambulance Brigade, Birmingham County. and Dr. D. J. Nichol, M.C., Chairman, St. John Ambulance Association.

Mr. R. P. Davis presented long-service awards to 105 members, and in doing so made reference to the unfortunate decrease in membership, and referred to the of constant and continual propagatIOn of the movement among the staff, in order to secure and retain new members.

Brigadier Hayne the, to the winning teams in thIS year s competitions, and took the opportumty of referring to the sustained support the St. John Ambulance Brigade had received from the railway Divisions in Birmingham, oI?e of which-the Birmingham Division-was this year celebrating Its 50th anniversary.

Reference was made to the Impendmg retirement of the Chairman, Mr. R. F. Wilson, and the meeting an expression of thanks to hlITl hiS long and valued services to the first aid movement in the Birmingham district.

Bed Cross Nems I'

O NE of the resolutions passed at the recent 18th International Conference was as follows :-

, The Conference recognIzmg the superiority of the Holgar Nielsen of Artificial Respiration over the majorIty of other similar methods, particularly in respect of pulmonary yentila!ion, of execution and simphclty of InstructIOn recommends that the Holgar Nielsen Method of Artificial Respiration be adopted as soon as feasible, for general in struction of Red Cross personnel: that this should not exclude, however, the teaching of other methods of artificial respiration for use in specia l circumstances and conditions.'

* At a recent Executive Committee Meeting, General Hawes reported on the splendid work done by the Middlesex Branch at the time of the rail disaster, at Harrow and Wealdstone. He said the Matron of the Edgware General Hospital in a letter thanking the County Director fOT the help given by nursing members said that those who had done their ho sp ital training were particularly valuable.

* * *

Members from Cornwall 9, 28 and 112 were present at the weekly meeting of the Cornish Speedway at Par Moor St. Austell, on the 16th September, when a flying display was given by a helicopter of the R.A.F. This went off successfully at the beginning of the e vening, but during the interval, when it was descending in darkness into the centre of the stadium by the light of its own searchlight and four flares on the ground, it crashed into the car park on coaches parked there. It fortunately missed the crowd, but casualties were caused by flying debris. The M.O of Cornwall /28 Detachment was on duty and was quickly on the scene, where he was joined by another doctor. Stretchers carried by men of Cornwall / 9, who were in the centre of the track for possible casualties among the speedway riders, immediately rushed across, followed by other Detachment members with spare stretchers. The seriously injured patients included a man with no visible injury, later found to have a ruptured heart; a man with his right arm severed above the wrist, and the co-pilot of the machine, severely cut about the face who was subsequently found to have a fractured sku ll. After quick first aid treatment, the first two patients were taken to the Royal Cornwall Infirmary, Truro, where one of them died, and the other had hi s arm amputated, and the third to St. Austell Hospital where he also died. Other cases take!'! to St. Austell Hospital included a girl, detaIr:ed as a qutlry fractured pelvis case, but the next day ; a man with a deep C?ut, WhICh was stitched; a young girl suffenng from severe shock, who was taken to hospital, but was subsequently discharged and taken to her home near Liskeard , by Several cases suffering with mInor cuts and shock were dealt with quickly and efficiently, and all patients were away from the scene of the accident in record time.

By JAMES WRIGHT, S.R.N., B.T.A., Nursing Officer, Millbay Amb. Div., Plymouth.

DISLO(;ATIONS

A DISLOCATION is a displacement of one or more bones at a joint. There is no actual bone injury, but the articulating ends of the bones are no longer in contact.

Causes of Dislocations

(a) Injury.

(b) Pathological causes, due to certain abnormal conditions producing destruction of the ligaments, e.g., Tuberculosis.

Varieties of Dislocations

(1) Simple. This is not associated with any wounds or other injuries.

(2) Compound. This type of dislocation is accompanied by a wound, thus allowing germs to gain access to the dislocation.

(3) Complicated. These include fracture-dislocations, and those dislocations associated with injury to blood vessels or nerves.

Signs and Symptoms

(a) Pain of a severe character at the affected joint.

(b) Loss of power in the limb.

(c) Fixity of the joint. · The limb cannot be moved at the joint either by th e patient or by the first-aider.

(d) Deformity of the limb. The limb assumes an unnatural position and appears misshapen at the joint.

(e) Swelling around the joint.

First Aid Treatment of Dislocations

Make no attempt to reduce a Dis loca tion.

In the case of a limb : When the accident occurs out of doors, steady the limb and support it in the most comfortable position, using padding where necessary in order to lessen the effects of jolting during transport.

When the patient is indoors, place the patient on a couch or bed in the position which gives most ease.

When the injury is painful, expose the joint and apply a cold compress. This will not give much relief unless carried out within a short time following the injury.

If an interval has occurred between the injury and treatment, apply a hot compress to relieve congestion and / or pain.

In the case of the lower ja w :

(i) Remove the patient's dentures if he wears them.

(ii) Afford support to the lower jaw.

Always obtain medical aid as soon as possible. Treat for shock.

Surgical Treatment of Dislocations

The dislocation will have to be reduced, either by manipulation or by extension. An anaesthetic is usu a lly necessary, firstly because it is often a painful process and secondly because the muscles ar ound the joint will have to be relaxed.

If the di slocation is a compound one, the wound leading to the seat of the dislocation will have to be closed by op era tion, as well as reduction of the di slocation itself.

When the dislocation is of the complicated variety, or is a longstanding dislocation, an open operation may be ne cessary, as besides reducing the dislocation, the damaged ligaments and other structures will have to be repaired.

Dislocation of Lower Jaw

A disloc atio n of the lower ja,-,,: usually occurs whilst the p at ient is yawning, but tooth extractions and other operations within the mouth have been known to be causes.

Signs and Symptoms

(a) The patient cannot close his mouth.

(b) Considerable pain is experienced.

(c) Salivation or dribbling' from the mouth is marked.

Treatment

Remove dentures, if any.

The doctor must first protect his thumbs by covering them with clean bandage or similar material. He then inserts them into the patient's mouth, one on each side over the back lower teeth or gums, and presses the lower jaw downwards and backwards. His fingers, which

FIRST

AID & NURSING, NOV./DEC 1952

are placed under the front of the jaw outside, pull upwards and forwards, thus levering the jaw into its normal position.

Dislocation of the Shoulder

The shoulder is the most common site for a dislocation to occur. It is usually caused by a fall on the elbow or- outstretched hand. A dislocation of the shoulder frequently recurs. The head of the humerus may be found in either of the following positions :-

(a) In front of the glenoid fossa of the scapula.

(b) Behind the glenoid fossa of the scapula.

(c) Below the glenoid fossa of the scapula. The glenoid fossa is the cavity on the outer border of the scapula, into which the head of the humerus fits, in the formation of the shoulder joint. A prominent sign is the flattened appearance of the outer border of the shoulder, together with the outward displacement of the elbow.

Treatment

(a) Kocker's method which aims at making the head of the humerus retrace its path by means of manipulation, or, (b) Extension of the arm by traction.

Suitable exercises should be encouraged as soon as possible, by a qualified person. Passive movements and massage should not be carried out.

With elderly people, it may be some time before active movement is possible.

Dislocation of the Elbow

A dislocation of the elbow is more common with young people than with the old.

There is usually a backward displacement which is reco!?nized by the typical deformIty. It IS not uncommon for a dislocation of the elbow to be associated with a fracture of the ulna.

Treatment

This is carried out either by means of traction of the fore-arm or by flexion over the doctor's knee. After the dislocation is reduced, it is very important that no rorcible movement of the joint is carned out.

Dislocation of the Hip

As great force is necessary to cause a dislocation of the hip this type of dislocation is rare. The head of the

femur is usually found either in front of the socket in the hip bone or behind the socket in the hip bone. This socket is known as the acetabulum (a-se-tab-yu-lum). A dislocation of the hip is caused by some severe form of violence when the legs are apart.

Treatment

(a) Powerful extension by traction to the hip, or,

(b) Kocker's form of manipUlation which is performed in three

movements, with the patient lying on his back with the knee bent.

(1) Lift the thigh upwards.

(2) Bend it outwards.

(3) Roll it outwards.

Both these methods are performed under an anaesthetic.

Serious complications may arise if an attempt is made by an inexperienced person, to reduce a dislocation, therefore first-aiders must never go beyond their first-aid treatment.

First Aid Quiz: Answers

(see page 3)

I -ME DICAL

1. When the bone is 'cracked' but not completely broken. Very important because the only positive sign of a fracture may be tenderness.

2. Take the bandage off and re-apply it.

3. Epilepsy. It is a. premonition experienced by many patIents that they are going to have a fit.

4. Signs of compression such as SIOWillg of the pul se, increasing of unconsciousness unequal pupIls, face becoming flushed, etc.

5. A fracture of the lower end of the radius.

-

6. Half dose for children between 2 and

8. Quarter do se for those 2.

7. Sudden and involuntary actIOns .of muscles working out of harmony WIth others. Thus Strychnine by producing spasm of the respiratory. muscles may cause death from asphYXIa. Asthma IS due to spasm of the muscular coats of the bronchi.

8. For the passage of blood vessels and nerves.

9. Loss of control of the bladder or rectum whereby the patient passes urine or motions involuntarily. Incontinence of urine may occur in epilepsy.

10. In the neck. It is the main vein.

11. A burn caused by friction, e .g., by contact with a revolving wheel.

12. When the lips or mouth are burnt or In the case of unconsciousness.

II-NU RSING

1. Lying flat on the back one pillow usually being allowed for t,he head.. ,

2. (1) Place pillows in an fashion, thus supportillg the elbows.

(2) Place an air ring under the

(3) Supply a foot-rest-a sandbag IS suitable for this.

(4) Raise the foot of the bed on 4 or 6-in. blocks.

3. (a) Beat it into very hot milk, when It forms an emulsion and is undetectable.

(b) Put a little fruit juice or brandy 1ll a medicine glass, pour the oil on to this and add rr:ore fruIt juice or brandy. The patIent must swallow this in one gulp.

4. Report the mistake immediately and ask for instructions.

5. With the head and shoulders raised and supported, and with teat pointing slightly downwards m(;lUth. This is the natural positIOn ill WhICh a mother holds her baby for breast feeding.

6. 0.9 p.c. common salt in water, is about one teaspoonful to the Pillt. It is called' normal' because it is the same density as essential body fluids.

7. The clinical thermometer is graded only between 95 and 1I0 OF., and it is self-registering.

8. One respiration to fO\lr

9. The medical fomentatIOn IS applied to unbroken skin and therefore need not be sterik. The surgical fomentation is applied to a wound, so that it .must .be completely sterile and be applied wIth the' no-touch' technique.

10. Babies and growing children; because it is needed for bone and teeth formation. The three sources of supply are animal fats cod and halibut liver oil, and of the skin to

11. Calcium or lime salts. ThIS IS abundantly present in milk, which is the natural food of the very young. Children under five are supplied with milk at a reduced price, whilst the over-fives are given it at school.

12. A symptom is an unpleasant such as a headache or a pam , the patient experiences, but whIch IS not apparent to another persop. A is something unusual WhICh IS notIced about a patient, such as a. change of colour, twitching, or a qUickened or irregular pulse;. or. that the doctor finds upon exammatIOn.

III- EVERY FIRST-AIDER SHOULD KNOW-

1. No.

2. Injury, emotion, medical emergencIes.

3. Raised and supported.

4. Thirty-three..

5. In the small mtestlOes.

6. Bleeding if severe.

7. No.

8. Three.

9. Every 20 minutes.

10. By boiling f

11. Crushing, effects of blast, fractures 0 large bones and severe burns or scalds.

12. Yes,

NOTES TOPICAL

FIRST AlDERS & NfJRSES

National Panel of Blood Donors

As research into blood grouping and technology advances the number of distinguishable types of blood grows larger, and more clas.sification into subdivisions of the mam groups becomes necess a ry. In most cases, only the main and the Rhesus groups need to be matched between donor and recipient ; but sometimes a patient is found to have such a rare type of blood th a t a country-wide search for a suita ble donor has had to be m a de, a nd that has often involved a serious delay in giving the tr a nsfusion. The establishment of the Nation a l Panel of nearly 2,000 donors, each of whose blood has been cla ssified down to the fines t subdivi s ion of his particular group , should overcome the difficulty of finding a donor when a recipient ca n tolerate a blood only when it completely matche s his own rare type.

With t he new Service, ea ch of the t wel ve Region a l Centres of the N a tion a l Blood Tran sfusion Service will keep a p a nel of a ll the donors in its region who h av e volunteered to gi ve blood in a n emer ge ncy. So a lso will corre sponding centres in Scotl a nd 'a nd N orthern Ireland.

T his will en a bl e a donor of a particul a r type of blood to be found without del a y, and the Director of the Region will a rr a nge to procure a nd disp a tch the blood to the hospital or house where it is needed.

In the event of there being no suitable donor in his Region the Director will consult the Nation al Panel and arrange for the blood to be obtained from a donor in another Region. Each Regional Transfusion Centre will be responsible for keeping its panel up to date by registering a new donor for every donor who resigns;

Britain has always held a leading position in Blood Transfusion Service, and in no other country in the world has an organization com-

parable to the newly established National Panel of Blood Donors been formed.

A Village VVorkshop for Crippled Girls

Some years ago Miss J. V. L. Brown took a crippled girl into her own home and taught her the art of producing hand-printed fabrics by a process which she herself had learned whilst in India. From that small beginning has grown the organization known as the Yateley Textile Printers, Ltd., Yateley, Hampshire, whose new workshops, specially designed to meet the difficulties of severely crippled girls, were opened early this autumn by the Duke of Wellington, who said that the assembly had met to mark the realization of a dream and to do honour to some of the finest craftswomen in England.

The workshops are most modern in design. They have a covered loggia where wheel chairs can be parked, and non-slip floors so that crutches can safely be used. Benches are of heights suitable for those who must sit at their work and also for those who are un able to bend. The plant is specially adapted for the relief of strain in the operator.

Yateley Textile Printers is entirely devoted to the training and employment of crippled girls and Miss Brown is now acting as Principal of the establishment. Some thirty girls are being trained or are employed there. The workshops produce hand printed fabrics and garments made from them, every stage in the process being carried out by the girls themselves. They draw their own designs, make the blocks, mix the dyes, print the fabrics, and cut and make up the garments, which include dresses, skirts, aprons and belts. They also make table linen, curtains and bedspread s All the designs are original and many of the colour effects are most beautiful. The goods are on show and for sale in the Yateley

showrooms and are a lso sold in shops in various p a rts ofthe country.

The org 8. nization is recognized by the Ministry of Labour and National Service as one which exists for the resettlement of girls who are so severely dis a bled that they can be employed only under specially adapted conditions. Both the Ministry and the Nuffield Trust have mad e grants towards the building and equipment of the new workshops, but voluntary subscriptions are still needed to augment the general fin "l n ces , for the industry is not entirely self-supporting a nd considerable expense i s incurred during the two-year tr a ining period.

Toy Making by Crippled Girls at the VVoodlark VVorkshop

This is the result of another voluntary effort to g ive seriously disabled girls a n opportunity to become ea rning citizens whilst living in a sheltered community A few years a go , Colonel a nd Mr s. Martin Strover s t a rted th e workshop in a hutted camp n ea r F a rnham, in Surrey, in order to t each a n interesting and artistic craft to girls who could not particip a te in the life and work of an ordin a ry industry. Only six girls a re in resid en ce at the present time , but there i s a long list of applicant s aw a iting the hoped-for extension of accommod a tion and facilities.

The bedroom s, sitting-rooms and workshop are surrounde d by lo vely g ardens. The toys m a d e ind ude anima ls , sa iling bo a t s, cut-out alphabets , dolls' houses a nd furniture, trucks and horses and carts They are charmingly designed and attractively painted. They are sold to shops at commercial rates , but the workshop still depends upon voluntary help although the girls do receive mainten a nce grants from the Government. Mrs. Martin Strover acts as Honorary Secretary of this happy little community but one of the crippled girls has become the workshop forewoman, a job she carries out with ze st and efficiency whilst still sharing in the toy making.

BACK NUMBERS

The Editor cordially thanks all those readers who have sent back numbers of this journal for tbe years 1940 /45. Our files are now complete and no more copies are required.

Where 'your training is needed

You ARE TRAINED in first aid and nursing, and may have worked in hospital. But unless you are a member of the N.H.S.R . how will your local hospital know that it will be able to count on you in the event of war - how can it organise the first aid and nursing teams now , as it must do? That is why the hospital wants you to join no w

The Reserve has been formed to provide men and women already trained and organised in units for first aid and nursing duties in the event of war. It is the only war-time reserve for first aid and nursing you can join to help your local hospital. Do you know about the special concessions for "efficient members" of the St. John Ambulance Brigade and British Red Cross Society which shorten hospital training and extend the recruiunent age?

It would be a terrible thing if a sudden emergency found your hospital's Casualty Services unorganised and unprepared through lack of trained personnel. Ask your Area Officer about joining the

FfRST AID & NURSING, NOV. DEC. 1952

queries

Answered by Dr. A. D. Belilios, M.B., B.S. (Land.), D.P.H. (Eng.)

E. W. (Edgware) writes

:-

We are unable to arrive at a definite conclusion concerning the following treatments.

Would you therefore be so kind as to give us the benefit of your advice on these matters.

(1) Treatment offracture of thigh or leg, when the patient has to be carried over rough or uneven ground, and it may be necessary to use a splint for additional immobilization.

After adopting Rules 1 to 4, we are instructed to apply a splint of adequate length on outer side of injured limb. Then apply the bandages mentioned in Rules 5 and 6 in the same order round the splint and tie them off over the splint.

The question is, has the splint to be secured round the feet with an extra bandage or left unsecured, thus using 5 bandages and not 4 as per illustration?

(2) When both legs are fractured and no assistance available. Rule 5 states apply bandages round both limbs in the order shown in Fig. 105. As this figure shows three splints, we are unable to agree concerning the number of splints required. I personally teach that only the middle splint is to be used and the outside splints are omitted.

Please inform us which of us is correct.

Answer

(1) If you work strictly in accordance with pages 144 and 145 of the Book, only four bandages are required but I must refer you to the last paragraph on page 17 of the S.l.A.A. Manual.

(2) I agree with you. Fig. 105 gives you the order in which the bandages should be applied.

* * *

Matthews

wntes :-

(Quebec, Canada)

We have been interested in Questions and Answers for years, and can truly say they have been

very instructive to our Brigade members, and now we have a question regarding the fractured patella. We cannot see why the uninjured leg is elevated and tied by figure 8 round both feet, it is not very comfortable for the patient. We would be very pleased to know the advantages there are in the new method.

Also, in fracture of the spine, are the pads placed under the calves regardless of where the fracture occurs, or only in case of fracture of the cervical region.

Answer

How nice to have a question from Canada. Our greetings to you.

(1) The advantages of the new method are (a) that the uninjured limb gives greater support to that which has been affected and (b) relaxation of muscles is easier in the injured limb if those of the opposite side are also at rest.

(2) In all cases.

* * *

I. B. (Preston) writes

The 40th Edition of the S.J.A.A. Manual mentions on page 94 squeezing an antiseptic cream on to a wound before applying a dressing. When should this be done and can you recommend a suitable cream.

Answer

Officially an antiseptic cream can be applied in any circumstances. It should certainly be used for all cases when there is likely to be delay before medical services can be obtained except when there is profuse bleeding which is often more easily controlled by a dry dressing. Dettol cream is popular with the medical profession. * * *

F. H. (Wandsworth) writes :-

At a sports meeting a man was hit on the eye with a tennis ball. I could not see any sign of injury and applied a cold compress to prevent a black eye. Now I hear he is attending a hospital and has nearly lost his sight. Could I have prevented this ?

Answer

You do not say whether you sent him to his doctor. If you failed to

The Editor, First Aid & Nursing. DEAR SIR,

In your edition of Sept./Oct. 1952 of First Aid & Nursing, Dr. A. D. Belilios in answering a Reader's Query on page 12 concerning the prevention of travel sickness in children makes reference to two proprietary preparations, namely' Avomine ' and' Kwells.'

As a practising pharmacist, may I make one or two observations on this.

With regard to 'Avomine,' this is listed in Schedule 4 of the Pharmacy & Poisons Act and therefore cannot be purchased other than on the prescription of a medical practitioner.

In the case of ' K wells,' the manufacturers specifically state that for children under 7 these tablets should be taken' as prescribed by a doctor.'

Neither of these points are made clear in the reply to your correspondent, namely that: (a) he will not be able to obtain Avomine other than on prescription and (b) K wells should only be given to children under 7 under a doctor's supervision.

After having made the foregoing observations, I would like to pay tribute to the valuable assistance which is rendered to all first-aiders by Dr. A. D. Belilios in answering their many queries and giving us his greatly valued opinions.

I am, Yours faithfully, DESMOND E. COBHAM, M.P.S.

BATH.

take this step, the answer to your question unfortunately may be yes.' Blows on the eye can be treacherous injuries since the delicate coats such as the retina within the organ may be injured although there are no external signs. Serious symptoms such as defective vision, may not develop until later.

R. L. G. (Kingston-on-Thames)

writes :-

One of the girls ;n our office gets frequent headaches which she calfs Migraine. What is this and what can I do for it ?

Answer This common complaint takes the form of severe headaches sometimes affecting only one side of the head (continued on page 14)

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IT PAYS TO ST ANDARDISE

Xnl8S Competition

Editor's Report

* First C,·osswoI·d No.2

Compiled by w. A. Potter

T

HE number of entries for the competition was rather a disappointment. We expected readers to be bursting with good stories about their experiences at Christmastime but if they are they must be reluctant or too modest to see them in print!

The number of entries in verse was comparatively good; on the other hand only one entry was received for the sketch competition, and in the circumstances no award is being made.

Another competItIOn is being prepared for a future issue; jf any reader has an idea on the subject we should be pleased to hear from him.

Results: 1st prize of two guineas to 'Essex S.B.St.J.' whose story is printed below, 2nd prize of one guinea to Miss S. Martin, Todmorden, whose light-hearted verse is also published. Mrs. Dorothy Pattemore (Crewkerne) and Div Supt. Ivor H. Timms (Birmingham, 7) are highly commended. Better luck next time!

CHRISTMAS DAY 1935

The day was cold and foggy, the fireside being the most comfortable place. Dinner was served at 2 p.m. and in the middle of it a banging on the wall. Ilea ve my dinner to see what the trouble is and find my neighbour's young son choking. The correct treatment is applied with satisfactory results, followed by a flow of tears, and so back to finish my dinner.

After, the usual nap and tea. Soon after I had commenced my tea, another banging on the wall, round again to see what is the trouble and find it far worse this time for the father is on a couch vomitting haemorrhage, usual signs and symptoms.

Now the fun started; phoned to a London hospital (where he had been a patient) for instructions, was informed that I would be told later. At 7.30 p.m. message received, patient must be brought to the London hospital without delay; phoned ambulance, this would arrive in 30 minutes changed into uniform, made for the accommodation of the three children as their mother was coming to London with her husband.

The ambulance arrived and we loaded up and off we went for one of the worst trips I have had. Visibility about 10 yards a.nd 40 miles to go. Had to stop two or three times because of condition of patient.

(continued overleaf)

.DDODOfJODODODO.

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• EJOOOOOOOOOOOO.

act now

16. Serious kind of fracture

17. Common cause of Biliary Coric

20. I bit a tonic for this drug

21. Copious sudden bleeding

23. Brandy corn, or hemp

25. The fever cannot be measles

28. Exterminate

29. Musical anatomical structure

30. Quinsy, for example? Or it

(2,4) (9) (5) might mean the office bore (4,2,3,4)

DOWN

2. The universal one is Group 'A B ' (9)

3. Dexterou s (6)

7. Punished at schoo I? (5)

8. Drugs first used by Dom ack in 1935 (13)

9. Soap does this (6, 3, 4)

14. Contained in radioactive seeds (5)

15. Pal in ? It's clear (5)

18. Sharp paroxysmal nerve pain... (9)

19. Superficial skin injury produced by a brain so muddled (8)

22. 'I must to the seas again' (' Sea Fever ') (2, 4)

24. The play begins with a little doctor ...

Minor

PATENT "PORTLAND"

AMBULANCE GEAR

The Gear lllustrated(A.B.C.D.) carries two stretchers on one side of Ambulance, leaving other side clear for sitting patients.

The UP AND DOWN action is quick and easy for loading or unloading.

A. Shows the two stretchers in position.

B. Shows the top stretcher lowered ready for loading.

C. Illustrates the same Gear with the top stretcher frame hinged down for use when only one stretcher case is carried,

D. Shows the same position as in "c' only with cushions and back rest fitted for convalescent cases.

Where Ambulances are required to carry four beds two Gears are fitted, one on EITHER. SIDE, and the same advantages apply as described above.

full cotalogue of Ambulance Equipment No. 7A will be sent on request

TeJegrophic Address :-

GREAT PORTLAND ST., LONDON, W.1 Pbone.' Langbam 1049. KARVAUD, WESDO LONDON

Gastric Disorders

•

L cases of minor ga tric disorder, it is a matter of common sense to shun the probable cause but one of e.\.perience to treat the symptom. BI oDoL Powder a wcll-recognised correcti\ e which brings prompt relief.

26. Not in company, please!

27. Net found in time sheets

(5) (4) (4) (Solution next issue)

SOLUTION TO CROSSWORD No. 1

ACROSS 1, First aid classes; 10, odour' 11 operation; 12 trains; 13, severe: 16' swim.; 17, principles; 20, do not 21, l,lmb; 23, on spot; 25, very; 28, nounshed ; 29, onset; 31, fangs of snakes.

DOWN 2, Isolation; 3, spring; 4, atom; 5,

duel; 6, leaves it; 7, sp ine ; 8, contused wound; 9, insensibility; 14, trial; 15, untie; 18, laity; 19, stooping; 22, femora; 24, sputa; 26, s hoo; 27, adds; 30, see.

(There was a printer's error in 28 across, the clue of which should have read' House rind' cared for and fed (nourished).)

Consisting of bismuth, magnesium and sodium bicarbonate, BISoDoL is ;l finely di\ id e u p;llatable powder which pcedily neutralises excess acid and soothe - irritated membranes.

The inclusion of diast;lse assists in the rcduction or' starch and the oil of peppermint I I t fla\ ourm'g ae-ent but also as a u'\erul present acts not on y as a p easan '-'

Professi onal samples if BrSoDoL together with litcl'JtlIrc, will aJaJ0 be sent upon request to member5 o( 1hz NurSing Prcfession, free if charge.

CHRISTMAS DAY, 1935 (continued/rampage 12)

Nearing London the fog thickened and we were lost. But we had a change of luck for a motor cyclist led us most of the way. Good! He left us in Lea Bridge Road. In Essex Road lost again, and just avoided running over a drunk in the road, we pulled up to have a look at him and his language was blue and our names mud. At last he noticed who we were. Where were we going? We told him Euston Road, and to our surprise he told us that he lived there.

H was now past 11 p.m., we got him up in the driver's cabin with door open, driver's mate holding him, and it or not he could see better than our driver and took us straight to our destination without mishap. But what a Cockney he was, aged about 60.

When we arrived I assisted to get him down and thanked him, when down he went,'flat out. As we unloaded our patient a policeman arrived and I informed him of our troubles, he said he knew the old boy, but would go and see his sergeant and be back later. On returning, I found the policeman and sergeant in hall, and told them what a help he had been to us. The sergeant gave us his address, so another stretcher case, and with a porter as a guide, took the old boy about 200 yards to his home and what a reception his old lady gave him. We arrived home about 4 a.m. Boxing Morning. Glad to report patient recovered after operation on spleen. r never did finish my Christmas tea; the only thing I got was a severe chill.

Shall I ever forget the foggy Christmas ] 935 ? No ! But service was done. I often wonder what happened to the old boy , for his home was blitzed in ]94l.

, Essex S.B.St.J.'

JUST SUPPOSING

Supposing Santa's whiskers , Caught fire on Christmas Eve. Suppose he tripped and broke a bone. Could I, his pain relieve?

If he should have a nose bleed, Or he slipped and cracked his head, Or caught his finger in the door, Would, then, my face be red?

I'd better read my little book, Bu t one thing I declare, I'd treat him as he would my gifts, And handle him with care.'

Miss s. Martin, 4 Strines Street, Walsden, Todmorden, Lanes.

ANOTHER CLASS HOWLER

It was question time in my Cadet class. Margaret was looking very bored with the proceedings and I decided to ask her one last question to justify her attendance before dismissing the class. So I asked her how she would deal with a case of severe bleeding. I am afraid the class broke up in disorder when she replied, with a fine disregard for grammar, ' I'd put one of them there tabernacles on it.'

FIRST AID & NURSING, NOV./DEC. 1952

QUERIES (continued/rom page 10)

an d often accompanied by other symptoms such as nausea, vomiting, giddiness or mistiness of sight. Prevention and treatment is essentially a matter for a doctor and all the first-aider can do is to provide rest in a quiet darkened room, seeing that the patient takes those remedies which the doctor has prescribed.

* * • F. R. (Manchester) writes What examination should be made of factory lvorkers who use lead in their occupation?

Answer

Each worker must be examined by the Appointed Factory Doctor once in every four weeks. Symptoms of poisoning due to absorption of lead include anaemia, digestive disturbances including constipation and occasionally a blue line forms between the teeth and the gums. In a severe case, severe abdominal pain -lead colic may occur. Nowadays, frequent blood tests undertaken by an expert, demonstrate excessive absorption in an early stage and before true symptoms occur.

The Army looks to

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FIRST AID HANDBOOKS

ANATOMICAL DIAGRAMS AND CHARTS FOR LECTURES

H.

A Sil11]Jle relief for ch ildren' S strauLS and sprcnns

The vasodilatation and hyperaemia resulting froni the application of ' Algipan' Balm to minor injuries where the skin is unbroken is rapidly followed by relief of pain.

In 'Algi pan,' the powerful vasodilator Histamine has been combined with Methyl Nicotinate and is thus able to penetrate to subcutaneous levels. Here, it promotes an increased flow of blood to the inj ured tissues, assists in the removal of exudates and imparts a warm subjective feeling of comfort.

Bland, soothing, readily absorbed and free from oily re sidue, 'Algipan' is a comforting balm that will not harm delicate skins and is ideal for the treatment of the minor tissue injuries so common to children.

For the relief of paIn 'Algipan'

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A HANDBOOK OF

ELEMENTARY NURSING

Arthur D. Belilios, M.B., B.S., D.P.H., and Dorothea Duncan-Johnstone, S.R.N.

This handbook provides, in simple language and without elaborate technicalities, an introduction to the principles and proced ures which underlie the science of nursing. These are based on recognized hospital procedure, and are described in a simple manner so that they can be readily understood.

The second part of the book is devoted to a brief description of the more common diseases, with general notes on the nursing required in each case, and the whole thus forms a comprehensive volume of reference and guidance.

With 314 pages and 57 drawings, 7s.6d. Postage 6d.

HANDBOOK OF FIRST AID & BANDAGING

Arthur D. Belilios, M B., B.S., D.P.H., D. K. Mulvany, M.B., F R.C.S., and Katharine F. Armstrong, S.R .N., S.C.M.

The most comprehensi ve and up-to-date book on the subject, giving full detail s of the first-aid treatment of medical emergencies as well as of injuries and accidents.

Third Edition.

With 520 pages and 244 drawings.

Postage 6d. 6s.

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ELEMENTARY ANATOMY & PHYSIOLOGY

A handy, compact manual which gives a complete outline of the anatomy and physiologyofthe human body. 'A most straightforward, reliable little book.'The Nursing Times

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Name

Efficient FIRST AID

Please send me l................ copy j ies of A Handbook of Elementary Nursing copy j ies of Elementary Anatomy and Physiology for which I enclose remittance of

Address

f.... ........ copy / ies of First Aid and Bandaging

FA/452

Arthur D. Belilios, M.B., B.S., D.P.H., D. K. Mulvany, M.B., F.R.C.S., and Katharine F. Armstrong, S.R.N., S.C.M.

The u nit is complete with water storage, electric power and all essential equipment for the purpose. It has been designee. in two sections to obta in greater scope, manceuvrability and better distribution of weight to enable it to cope with rough and unmade roads and wooden bridges which exist in the territory in which it will work, The units have also been designed to work under extremely high temperatures ranging from 90 to 130 fah renheit so that normal film development temperatures can be mai ntai ned.

One section houses the electric power unit and complete facilities for developing, washing and drying X-Ray films ranging from 35 mm. miniature to the large 17" X 14 radiography, i.e., Dark Room

The other section functions as an X-Ray room complete with mass miniature X-Ray apparatus for taki ng films of the chest, and incorp orates a separate control room and the Doctor 's Room for the projection and examination of films, i.e., the X-Ray Room.

YOU ARE INVITED TO APPLY FOR FULL DETAILS OF MOBILE MEDICAL UNITS, AMBULANCES, ETC., BUILT TO YOUR PARTICULAR REQUIREMENTS FOR SERVICE IN ANY PART OF THE WORLD

Then you will follow this point-by-point argument and reach the same conclusions as so many doctors, nurses, hospitals and clinics have done.

DO YOU AGREE ... that the causes of most skin infections are the common strains of STAPHYLOCOCCI, STREPTOCOCCI and B. PYOCYANEUS ?

IN THAT CASE . a treatment which is effective against all three will be indicated for cuts, abrasions, burns, scalds, boils and most inflammatory skin infections?

THIS IS THE TREATMENT

ANTIPEOL Cutaneous Vaccine Ointment contains the sterile vaccine filtrates of the three micro-organisms mentioned. The filtrates destroy the actual micro-organisms and at the same time act as a local immuniser against re-infection. This is a

purely biological action and there is no damage to delicate tissues.

RAPID HEALING is further expedited by the ointment base of proved efficiency. For burns and scalds, ANTIPEOL has special advantages. It is microbicide and non-adhesive. Therefore dressings do not have to be changed every day.

AND HERE IS THE PROOF.

Antipeol Ointment is proving and reproving itself every day in dozens of surgeries, clinics, hospitals and homes. Letters from the medical and nursing profession bear convincing testimony to its effectiveness.

THERE is the logical argument for including A NTIPEOL Ointment in every First Aid kit. As a logical person, why not send for full details and a clinical sample?

antipeol

cutaneous vacczne ointment

Produced by the makers of: ENTEROFAGOS

intestinal complaints; RHINO-ANTIPEOL for nasopharynx infections; OPHTHALMO-ANTIPEOL for ocular infections; DETENSYL for reducing arterial tension. MEDICO-BIOLOGICAL

7 Development of Child Care 8 Health Service." 9

New Books 9

Crossword 10

Readers' Queries It

Ministry of S.,pply

THE second annual presentation of First Aid and Home Nursing awards for London Headquarters Offices was recently held at the Ministry of Supply, Adelphi Buildings, London , W C.2. The awards were presented by Sir Archibald Rowlands, G.C.B., M.B.E., President of the Centre, introduced by Mr. H. R. Camp , C.B., Centre Chairman. Sir Lewis B. Hutchinson, K.B.E., C.B., Vice-President of the Centre, was also present together with many Heads of Headquarters branches.

In addition to the 132 awards for presentation to men and women who had passed examinations in First Aid and Home Nursing, there was a shield, presented by the Welfare Section for competition between tearns from Headquarters Offices, which had been won this year by the Chessington women's team, and a Ministry of Supply Ambulance Centre Certificate of Merit awarded to a Miss K. R. Fawssett in recognition of outstanding first aid rendered by her following an accident in the canteen at Chessington.

Mr. Camp congratulated the recipients on their very fine achievement and for giving up so much of their time to becoming proficient in First Aid and Home Nursing. He did not think it was necessary to urge them to maintain their efficiency and to increase it, but he did ask his listeners to persuade their first aid colleagues to join the Centre. He thanked Sir Archibald Rowlands for the great interest he had

Ambula"ee Centre

shown in the organization and for so kindly coming along to make the presentation.

Sir Archibald Rowland s said he regarded it as a great honour to be invited to present the awards and he took the opportunity of saying on behalf of the Minister and on his own behalf, how much was owed to Mr. Camp and the Ministry of Supply Ambulance Centre Committee for their great interest in establishing what he believed to be the best first aid organization in any Government Department.

Dr. J. H. Chambers , Principal Medical Officer, on behalf of Dr. N. Langdon Lloyd, Chief Medical Officer who was unable to be present, passed a vote of thanks to Mr. Camp for his presence and for his continued interest in the Ambulance Centre.

Dr. Chambers spoke of the growing interest in first aid amongst all sections of the Ministry. The Ministry of Supply Ambulance Centre, although a young Centre, had done a considerable amount of work, not only in Headquarters Offices but in most of the outstation establishments; in addition to providing a large number of new first aid personnel it had also encouraged those in possession of first aid awards to come forward and requalify for further awards.

Dr. Chambers also paid tribute (0 the Centre Secretary, Mr. L. G. Barrington, for his work in increasing the activities of the Centre and for the excellent organization of that afternoon's function.

a

If you are logical person .•.

of at Ministry of Supply (Left to right) Mr. L. G. Barrington (First Aid Training Officer, SIr ArchIbald (PreSident of the Centre) Mr R R. Camp, C.B. (Chairman), and Sir LeWI S B Hutchinson, K.B E (Vice-PreSident).

Hygiene

I N recent issues, some of the more important rules to be observed in keeping fit have been briefly described. Thus we have considered the value of exercise, rest, fresh air, ventilation, together with subjects such as the care of the teeth, bowels, etc. There remain a few similar points to consider in this the concluding article of the series, but before doing so it is only fair to mention that we have not dealt with two large subjects which markedly influence keeping fit, namely, food and diet' and 'mental hygiene.'

The former is usually discussed in lectures and text books on Elementary Nursing while the latter belongs to the realm of ' Everyday Psychology.' A course oflectures on this subject will probably be given at the Wimbledon Technical College, Gladstone Road, Wimbledon, on Thursday evenings after Easter.

Care of the Ears

This consists solely of keeping clean that part of the ear which is readily accessible. Any impairment of hearing caused, for example, by wax should be dealt with by a doctor. It is dangerous for those without experience to tamper with the ear since they may damage the delicate drum or injure the lining of the ear channel. 'Picking' the ears for example, with match-sticks, etc., may result in small abrasions and lead to boils which are most painful. Ear-ache, running ears and other complaints all call for medical aid without delay.

Care of the Eyes

This is a very big subject and cannot be fully discussed in an article of this kind since it brings in many problems such as the choice of the correct amount and type of light suitable for work of various kinds, the avoidance of glare and the selection of suitable print for reading, etc.

How to Keep Fit-4

By A. D. Belilios, M.B., B.S. (Lond.), D.P.H. (Eng.)

Good light is of course essential when the eyes are being used for purposes such as reading, sewing, etc., and working in shadows should be avoided. When, for example, working at a desk the light should come from the left so that no shadow from the hands or other object is cast over the paper or work. Much trouble and suffering results from what is commonly called , eyestrain.' The patient complains of headaches, redness of the whites of the eye, styes, fatigue, and general discomfort. These symptoms call for medical advice and the doctor will often recommend an examination of the eyes in case glasses are necessary. A very ' high percentage of headaches are due to the need for glasses.

Periodical examination of the eyes is particularly desirable in children since faulty sight develops so gradually that it is generally only recognized by special tests. Unrecognized defective vision may be the cause of backwardness at school. Squinting -one or both eyes out of truecalls for immediate medical advice since in the absence of treatment, usually by glasses, the squinting eye may become permanently defective or 'lazy.'

Many normal adults require glasses for reading when they reach the age of between 40 and 45, this being caused by the gradual deterioration of the muscles of accommodation, i.e., those which enable the eye to focus print efficiently at a distance of about 12 in. from the head. Those who neglect to take to glasses as become older find that they have to hold print further and further away from their heads until ultimately their arms are not long enough to obtain a satisfactory focus!

If the above commonsense rules are observed, the eyes usually look after themselves satisfactorily. They are well protected from injury and

adequately flushed out by the invisible tears which flow over the front of the eyeball and drain into the nose. Hence bathing the eyes and the lise of eye baths are generally unnecessary and should only be undertaken on medical advice.

Should at any time symptoms or signs suggesting a fault of the eyes develop, medical advice should never be delayed since it is so easy for the untrained to miss a serious disease such as an ulcer, inflammation of the iris, etc., which in their early stages may not seem to be more serious than a minor ailment such as a foreign body in the eye.

Television fans will be relieved to learn that recently the B.M.A. in their journal made a statement to the effect that Television caused no harmful effects to the eyes.

Avoiding Harmful Substances

Certain substances known to be harmful to the human body should be avoided, or, if taken, used with discretion. The two most important of these are tobacco and alcohol.

Tobacco contains an extremely poisonous substance called nicotine a few drops of which taken by the mouth may cause death in a susceptible individual. There is considerable evidence that smoking is a harmful habit, particularly when inhalinK is practised. It may cause catarrh in the throat (pharyngitis) the usual cause of the well-known smoker's cough, which may lead on to increased susceptibility to tracheitis, laryngitis and bronchitis. Moreover, recent medical research suggests that cancer of the lung occurs much more frequently in the heavy smoker than in the light or non-smoker.

There is also evidence that oversmoking has an adverse effect on the blood-vessels and may in fact contribute to hardening of the arteries (arteriosclerosis) and other complaints. Many who sm9ke do not appreciate the extent of their habit.

FIRST AID & NURSING, JAN. /FE B. 1953

It has been estimated that a heavy smoker may easily exceed a 40-hour week in his consumption of tobacco. Those who work in factories will understand what this means since if they are using substances known to be harmful to the body such as lead an d chrome they have to be examined at regular intervals by a doctor to make certain that they are not suffering from ill-effects. No such precautions are observed by smokers!

SHOCK

I N spite of a wider appreciation of the effects of shock, we still see accident cases not adequately treated before adIlfission to hospital. This article considers what happens to the body workings in this common clinical state, which arises in cases of injury, surgical operations, emotional upsets and in some cases of disease. With these changes which take place in the body, and mind, one must appreciate the importance of its treatment.

What is Shock?

Depression of the cardio-vascular system leading to circulatory failure with a fall in blood pressure.

What Happens in the Body ?

(a) The circulatory centre which is situated at the base of the brain becomes depressed and the heart rate increases, but with less power.

(b) Capillaries dilate and the fluid part of the blood (plasma) escapes into the tissues from their vessels, leaving cells of the blood concentrated. Therefore the blood volume decreases and the blood pressure falls.

(e) Kidney function becomes depressed, this being due to the fall in blood pressure and therefore less urine is secreted.

(d) Toxic substances accumulate in the tissues which depress the nerve centres and heart muscle.

Types of Shock

(1) Primary Shoclc.- This occurs at the time of injury and is a simple condition of collapse to fainting. Due to emotional stimuli or severe pain, a psychological factor plays a big part in this type of shock. The condition may terminate in recovery, or develop into a secondary shock,

So far as alcohol is concerned it is probably not as harmful as tobacco provided it is not taken to excess when it sets up pharyngitis, disturbances of the digestion and in some cases extremely serious complaints. Nevertheless, it must be recognized that alcohol is a drug and must be considered a narcotic poison. Taken in small doses, it gives a feeling of well-being and lessens reserve and shyness; it also lessens ability to make rapid and

By John E. Smith, S.R.N.

and in some cases death may occur.

(2) Secondary Shock. - This usually occurs some hours after injury or operation, due to absorption of toxic substances from damaged tissue.

Shock is a temporary and reversible state at first and treatment must be given urgently. Children and elderly people react badly to shock.

Signs and Symptoms

These may vary from a feeling of faintness to severe collapse.

Faee.-Usually pale with no expression.

Skin.-Cold and clammy and there may be cyanosis (blueness) of lips, ears, nose and nails.

Pulse.-Rapid and weak but may be irregular. In cases of severe haemorrhage it may be absent at the wrist. The pulse is an important guide in shock.

Eyes.-Sunken and still. Pupils dilated but react to light. The longer the pupils remain dilated the more severe the condition.

Respiratiol1.-Slow and shallow and may be sighing, and in cases of severe external or in ternal haemorrhage, air hunger may be present.

Temperature.-Subnormal.

Mouth.-Dry and patient complains of thirst.

Incontinence of urine and faeces may occur. The patient may be restless leading to syncope and coma.

Treatment

Once this condition has occurred, do nothing to aggravate it. Rough handling must be avoided.

(1) Reassura71ce.-This is important and can be administered whilst other treatment is being given.

3 accurate decisions and impairs mental judgement.

While it is essential to understand the disadvantages of both alcohol and tobacco, it is important in this life not to be an extremist. There can be no doubt that taking alcohol and tobacco plays Slome part in promoting social intercourse which in itself is an important factor in keeping fit. Nevertheless, their use in a normal, well-adjusted individual for this purpose should, strictly speaking, be unnecessary.

(2) Warmth.-Cover with blankets, but overheating must be avoided as this will cause loss of valuable body fluid. Not only must the patient be covered with blankets, but a blanket must be placed underneath the patient. When using hot water bottles, great care must be taken not to burn the patient. Therefore, they are best placed outside the blankets.

(3) Fresh Alr.-Undo all tight clothing at neck, chest and waist. Always remove false teeth.

(4) Examination of head, chest, abdomen, pelvis, arms and legs should be carried out quickly. Control haemorrhage and cover wounds and temporary splinting to fractures.

(5) Elevation of foot of stretcher, or bed, if no head injury is present. This helps to get blood to vital centres.

(6) Fluids. - If the patient is conscious and there is no abdominal wound or internal haemorrhage give small amounts of fluids, e.g., sweet tea or coffee. If given in large amounts it may cause vomiting.

(7) Oxygen. - If there is cyanosis of lips, ears or nails, give oxygen if available.

Always find how the accident occurred and record the time. Do not allow your attention to be focussed on one obvious injury, when other more serious injuries may be less obvious.

Hospital Treatment includes the above, with the addition of blood transfusion, plasma, saline or saline and glucose by intra-venous drip. Morphia is also given.

Urgent operative treatment may be necessary in cases of abdominal injury and head injury with intracranial haemorrhage. The bloodpressure is taken every ten to fifteen minutes in severe cases.

Always remember SJock is a killer.

for th-Eastern Region

MEMBERS of the British Hull District Ambulance Council ha ve presented an Illuminated ,Address t.o Mr. H. A. Marshall in recogmtlOn of his fifty years in the Ambulance Movement. The presentation was made by Mr. H. A. Short, Chief Regional Officer, York.

Mr. H. A. Marshall commenced his activities with the First Aid Movement in May 1903 and has the very fine. record. of having been continuously assocJated Wlth first aid organizations for half a century. He has retired from his railway work but still takes a very active part in the Hull Dock Engineer's Ambulance <?f which he was the founder. The class IS still the largest in the Hull district and no less than 1 900 awards have been gained by its during its forty years' existence.

His services to the Ambulance Movement were recognized by the Order of St. John in his appointment as a Serving Brother of the Order in 1929.

Western Region

The presentation of one Class 1 award (clock with an appropriate engraved silver plate and framed certificate), and elevcn Class 2 awards (framed certificates) was recently made by Mr. K, W. C. Grand, Chief Regional Officcr.

Doctor H. H. Cavendish Fuller, Chief Medical Officer, Railway Executive, was

BritishRailways

pl:esent, together with a number of Chief Officers of the Western Region.

A vote of thanks to Mr Grand was proposed by Mr. G. Matthews Operating Superintendent.

Many tributes to the work of Mr. J. H. Tippett for the Plymouth Division Ambulance Movement were paid at a presentation ceremony to mark his retirement from the position of District Secretary

The presentation-a radio set-was made by Mr. C. F. E. Harvey , District Traffic Superintendent, on behalf of all members of the District at the annual presentation of first aid awards to Plymouth North Road and Millbay Docks Ambulance Classes.

Mr. Harvey said that in his 39 years in the Movement, 16 of them as District Secretary, Mr. Tippett had rendered 'enormous service.'

Dr. R. Howarth, Class Lecturer, declared that Mr. Tippett had been indefatigable in staging competitions, while Mr. A. W. Tully, who succeeds Mr. Tippett as Secretary, said that he had upheld the Ambulance Movement in Plymouth for a number of years. Tributes were also paid on behalf of Class Secretaries from many parts of Devon and Cornwall.

In reply Mr. Tippett said that ambulance wo rk was to him a labour of love and he had enjoyed every moment of it. The Ambulance Movement was continuing to flourish in the West of England.

News from St. John

'pROBABLY the biggest job the St. John Ambulance Brigade has undertaken' was how Col. G. F. Page, D.S.O., Commissioner No. 1 District, described the task of St. John during the Coronation when proposing the Toast of the East London Division at the annual dinner and ball on 10th January of No. 30 Ambulance and No. 76 Nursing Divisions. He said that approximately 100 first aid posts would have to be maintained which would require between 7,000 and 8,000 first-aiders.

, The Queen is going to drive round South and East London on subsequent days,' he went on, and we shall have plenty to do.

I am most encouraged by your liveliness and energy and am sure we shall put on the biggest St. John occasion we have ever had.'

Members and guests were received by Mrs. Lionel tie Rothschild and Mr. Leopold de Rothschild, Vice-President, who subsequently proposed the toast of' The Brigade.' Div!. Supt. Mrs. Robinson proposed the 'Guests,' and the reply was made by the Mayor of Stepney, Councillor A. D. Bermel.

Welwyn Garden City

At the annual meeting of the Welwyn Garden City Ambulance Division, Secretary

L. Blake reported that the 1'8 members had between them put in 1,486 hour s on public duty, 224 hours in the ho spita l car service, and 76 hours for medical comforts.

Divl. Supt. E. A. Rusch told members that 1952 had been an extremely satisfactory year, a great improvement on two years ago. The medical comforts depot had done extremely well, loaning 200 articles.

Stressing the need for recruitment, Mr. Rusch said that he had already made arrangements for the Brigade to be represente d at the next welcoming party for new tenants in the Great and Little Ganett area to be held shortly at Ludwick House, and suggested that leaflets might also be issued.

Preston Pjoneer's Death

We regret to report the death of Mr. Amos Howard, an ex-Inspector of the Preston Borough Police, who was also a South African veteran and a former Superintendent of the Preston Corps of the SL John Ambulance Brigade. He was 87. Mr. Howard joined the Preston Police in 1883 and was appointed inspector in 1903.

During the South African war he raised drafts for the Royal Army Medical Corps

THE EDITOR, , FlRST AID & NURSING,' 32 FINSBURY SQUARE, LONDON, E.C.2.

Dear Sir,

As a regular reader of First Aid & Nursing I would like to thank you for the great amount of help 1 receive by reading First Aid & Nursing. The articles are most valuable. I have read with much profit the First Aid Quiz in the Nov./Dec. issue but I am wondering if some of your readers may not be rather misled by the answer given to one of his questions in the admirable Quiz by Mr. F. A. Trott.

To his question 'Is alcohol a stimulant? ' the answer' Yes' without any qualification may be misleading. In' Alcohol, its Action on the Human Organism,' issued by the Medical Research Council and published by Her Majesty's Stationery Office, we read (page 42) , the direct effect of alcohol upon the nervou s system is, in all stages and upon all parts of the system, to depress or suspend its functions; that it is, in short, from first to last a narcotic drug.' They point out, in other parts of their report, that many of the apparently stimulating effects are really on account of its narcotic effects on the higher nervous centres.

Yours faithfully, P. L. DANI EL. NORTIIAMP TON.

and became sergeant-major to the hospital contingent of the Rhodesian Field Force. On his return he enrolled a local bearer company of the Brigade. He was also local secretary of the Royal Humane Society and a serving brother of the Order of St. John.

Derbyshire Cadets' Success

IT has been a very successful year for members of the Derby Nursing Cadet Division in the Cadet arts competition, which is open to all Cadet members of the Brigade.

The Cadet Music Cup for besL composition for any instrument(s), was won by Glenda Wilkins (pianoforte), and the Cadet Author's Cup for best short sLory or play, was won by Barbara Speakman for her s tory called' HalIow'een.' Margaret Cocker and Mary Branthwaite also of the Derby Nursing Cadet Division, were cOlllmended for their entries for this Cup. Barbara Speakman was highly commended for her entry called 'The Storm' in the Cadet Painter's Cup and was mentioned in respect of her entry called Rooftops.'

New in Ambulance Design

AN entirely new design in ambulances, which has many unique features, has just been completed by Pilchers of Merton for the Home Service Department of The British Red Cross and Order of St. John Joint Ambulance Committee. It incorporates a new low loading top stretcher gear which enables two orderlies to load and elevate patients without any discom-

fort, the smooth action gear eliminating any shock or jolts. The wide centre gangway provides space for three wheel chairs and these can be loaded very easily with the ramp and winch incorporated in the bodywork. Adequate heating and ventilation are provided.

The arrangement of the stretchercarrying equipment allows for the greatest flexibility in accommoda-

tion, as the following alternative capacity shows: (a) four stretcher and four sitting patients (five stretcher cases in an emergency); (b) two stretcher and eight sitting patients; (c) sixteen sitting patients. The cab seats three attendants. Adequate provision has been made for storing stretchers, blankets, medical supplies, etc., and the stretcher gear is designed to take British and American stretchers. Built on an Austin 2-ton long wheel-base chassis, the Pilchers' 'G.P.' ambulance can equally well be mounted on Commer, Bedford or Ford chassis of similar type. The rear doors, when closed, conceal the folding steps and slide-in ramp. The unladen weight is about 3 tons.

The makers claim that this new ambulance is ideal for hospital use at home or abroad, especially where cases from isolated villages have to be collected for conveyance to a central hospital, as the general purpose arrangement of its accommodation offers facilities for carrying a number of patients under many different circumstances. In this country, its possibilities are obvious for inter-hospital conveyance.

TOPICAL N OTES FOR FIRST AlDERS & NURSES

Civil Defence Reserre

The Minister of Health (Mr. Ian :\1 acleo d) recently reported upon the progress of Civil Defence. He said that recruiting in the Ambulance Section was better than in other sections of the Civil Defence Corps and that the peace-time target had now been reached but the ational Hospital Service Reserve had only 29,000 towards the 100,000 needed. If only one in every 200 women joined the Reserve the peace-time Service would be adequate. The training as an auxiliary member involved the giving up of only 24 hours of leisure for 12 weeks, followed by a short experience of hospital work, but the knowledge gained would prove an invaluable asset throughout life; for every woman is called upon to nurse the sick in her own home and to give aid in minor accidents. When disasters, such as the Lynmouth flood, the Harrow train accident and the recent gale and flood havoc occur, the possession of knowledge and skHl by organized voluntary workers is of inestimable value. A ratio of members of the Reserve per 1,000 of the population shows that Wales heads the list with Tewcastle as a fairly good second, then the numbers fall off, until Birmingham shows only a quarter of the Newcastle tOial and one-sixth of the ratio for Wales. Tn order to aid recruitment a film has been made by the Oxford University E x perimental Film Group enti t led' Just in Case.' It presents the story of a business girl undergoing her training. The scenes concerning her hospital experience were filmed at the Radcliffe Infirmary without any interruption of the ordinary hospital routine, and this gives a very honest picture of hospital life. The film runs for 32 minutes and it may be purcb::tsed from the Oxford Regional Hospital Board \ (price £25) but at present there are no arrangements for it to be loaned; which appears a little unfortunate in view of the need for stimulating recruitment.

The Fight Against Poliomyelitis

The Infantile Paralysis Fellowship, which was founded in 1939, has as its chief concern the welfare of nearly 8,000 disabled members, but the second of its objects has been the energetic pursuit of research into the causes, prevention and treatment of poliomyeLtis, and also into methods of rehabilitation of those disabled by its ravages. This researcb was held up during the war years and it has been very restricted by lack of money since then. A National Fund for Researcb was officially maugurated on 17th December, 1952, at a Council Meeting at the Mansion House attended by the Lord Mayor. This is the first time that a private organization bas been. !ormed to raise money for poliomyelltls research, but the money will be spent only on the advice of medical experts, many of whom are Vice-Presidents or Council members of the Fund. Great care will be taken not to overlap but to supplement any other research projects, both here

and abroad. The establishment of tbe Fund has the approval of the Ministry of Health althougb it is completely outside the ational Health Service.

A New Form of Insulin

When insulin was first introduced, in 1921, it was given i,n a soluble form 20 to 30 minutes before each meal, so tbat a minimum of three injections a day were necessary. In 1935 it was discovered that insulin would combine witb a monoprotamine and that the resulting compound would be broken down very slowly in tbe body, its action extending over a much longer period than tbat of soluble insulin, It was, bowever, too unstable to put on the market. Two years later it was shown that it could be rendered cbemically stable by the addition of a small amount of zinc, and as zinc protamine insulin it was issued commercially in 1937. Its action is not apparent for at least three bours after injection, so that a dose of soluble insulin is needed to cover this time. The insulin is gradually released from its combination with protamine over a period of about 24 bours. Thus it is possible to obtain a fairly constant liberation of insulin into the circulation with only two injections a day. In 1939, globin insulin was prepared in research laboratories but i t was not available commercially in this country until 1943. Its action commences within two hours after admini s t;-ation and its maximum effect is reached between the sixth and eighth hour. Tbus, it is intermediate in the duration of its action between soluble insulin and zinc protamine insulin. A new form of insulin, known as 'Lente,' bas now been prepared by a group of workers at tbe ovo Laboratories in Copenhagen. It bas recently been tested in Britain on eleven patients in King's College Hospital, London , and bas been found to control the blood sugar for at least 24 hours, this gradual action being achieved by the addition of an acetate' buffer' witb a small amount of zinc. It would seem, therefore, that when Lente can be made available for general use tbe sufferers from diabetes for whom it is found suitable will need to give themselves only one injection a day, instead of at least two.

The First Eye Bank

Following the legislation introduced in the last Parliamentary session regarding the supply of corneas for grafting purposes, an , eye bank' is to be organized at the Queen Victoria Hospital, East Grinstead, Sussex. The Tunbridge Wells Hospital Management Committee bave agreed to the provision of six eye containers, at a cost of £51, for use in tbe scheme. It may be remembered that tbe Corneal Grafting Bill was sponsored by Member of Parliament for Tunbridge Wells, it being a Private Member's Bill, so that it is interesting to note that the enthusiasm in tbat constituency has had a practical outcome.

FIRST AID & NURSING, JA 'FEB. 1953

Tuberculosis Educational Institute Refresher Courses

Refresher Courses have been arranged to take place at the Medical School, St. Thomas's Hospital, from 14th-17th April, 1953, inclusi\ e. Tbe Course for doctors i on ' Radiology in tbe Treatment of Tuberculosis.' That for nurses, health visitor, social workers and administrators is on 'Domiciliary Treatment of Tuberculosis." and the programme arranged is most interesting. It includes the present position regarding B.C.G. vaccination in children, the new drugs, treatment without sanatorium, the work of the tuberculosis health visitor, the place of surgery in the treatment of tuberculosis, home tuition, especially of cbildren of school age, and the organization and practice of domiciliary occupational tberapy. In addition to the lectures, arrangements have been made for small parties to visit various chest clinics in London. The fee for this Course is only one guinea. Tickets for single lectures are not available, but tickets for the Course are transferable. Members of the Courses may use the Students' Club for lunch and teathe approximate cost of a three-course lunch being 2s. 6d., and coffee may be obtained during the morning session. Those attending the Courses are asked to notify the Secretary when enrolling of their wish to use tbese facilities. The fees are payable in advance to the Secretary, Tuberculosis Educational Institute, Tavistock House orth, Tavistock Square, London, W.C.I. The tickets may be cancelled and the fees refunded until one week prior to the commencement of the Course but not after that time. With all these facilities and the \ery small fee it is to be hoped that as many students as the accommodation can take will avail tbemselves of this wonderful opportunity.

Institute of Certified Ambulance Personnel

The fol,owing were successful in the Examinations of the Institute held in October 1952, in London and Halifax.

Final Exantination

C. James, Nortbwich; A. W. Price, Lydbrook; W. H. A. Smith, ottingbam W. Turnley, Nottingham.

Preliminary Examination

C. K. Ashwin, Didcot; A. R. Bernard, London; A. G. Blower, Norwich; A. A. Cleland, Leeds; C. R. Dipper, Havering ; Mrs. E. Dodd, Huddersfield; T. Ellis, Birmingbam; J. W. Fitton, Halifax; D. E. Gillard, London; E. G. Giraud, Rochester; F. G. Glover, Norwich; W. R. Griffen, London; M. R. Grimbley, R.A.F. Hospital, Bucks; D. G. Hanson, Halifax

1. Hanson, Halifax; L. Hanson, Halifax; H. K. Hayward, Norwich; D. A. Howarth, Colne; Mrs. C. Richmond, EIland; A. Robertshaw, Halifax; N. F. Russell, Didcot; E. Spring, Halifax; M. Templeton, Glasgow.

In the Final Examination the first place was gained by Mr. W. H. A. Smith and in the Preliminary Examination by Mr. W. Fitton.

FIRST AID & NURSING, JA T. FEB. 1953

Develop,ne"t of CI.ild Cn·,-e i,,, B,-itain-6

THEentr'y of 34 teams for the Sister Hutcbrngs Cup Competition was a record one, and five district competitions were held to select the nine teams to take par:t in the Final, which took place at Chisw]ck ';Yorks on 29tb ovember 1952.

First place was obtained by the Manor House team led by Mr. G. Foley with a total of marks, wbilst tbe runner -up were last year's winners, Chiswick (leader, Mr. J. Barnes), \,\1tb 164 marks.

Vauxhall A' team (leader, T. Clift) were a close tbird witb 163 marks and Dorkin" (leader, R. Edwards) fourth with 157 t

Total possible marks were 200. Other teams taking part were Peckham 'B: Hammersmith, Baker Street, Charlton and Dunton Green' A.'

Tbe competition was judged by Dr. G. Bousfield. County Surgeon, S.J.A.B., and Deputy Principal Medical Officer, S.l.A.A and Mr. L. G. Barrington, Ambulance Secretary, Ministry of Supply, whilst tbe presentation of the Cup and Prizes was made by Mr. 1. W. Wicks, Works Manager (Buses and Coaches), Cbiswick.

The competition for the Webb Trophy took place at tbe Ambulance Hall, Baker Street Station, on 20th No\"ember.

This is an individual competition for women members of the Centre and consists of a practical and oral test.

The winner was Miss A. Middleton. of the Dra\ving Office, Chiswick Works, who obtained 10 mark out of a possible 150, being followed by Mrs. V. Davies, also from Chiswick Works, witb 98 marks. Miss L. Duckett of the Schedules Office. Broadway, was third with 95 marks, and Mr P. Heins of tbe Food Production Centre, Croydon, was fourth with 91 marks.

The presentation of first aid awards was held at the Porchester Hall, London. W.2. on 17th December 1952, and was accompanied by a dance, social and cabaret.

The presentation was made by Lord Williams, part-time member of the London Transport Executive, and Lady Williams, who were introduced by the Centre Chairman, Mr. Alex. J. Webb, C. St. lohn. General Superintendent (Staff and Training) Railways. About 350 out of some 900 awards gained during the first half of J952 were presented to members. and were followed by special awards.

The first competition for the Wenl\\orth Trophy was held at the Ambulance Hall, Baker Street Station, on 6th December. This is a new trophy which has kindly been donated by Mr. C. M. Wentworth. Divisional Superintendent, Railways, for competition amongst individual members of the No. 1 (Central) District.

Eleven members took pal"t in the compel ition, the winner being Miss E. Hunt of the Staff Office, Broadway, with a total of 85} marks out of a maximum of 120. Second, Mr. P. Dowling of the Steam Running, Neasden, with 83t, followed by Mr. W. H. Butler of Lots Road Generating Station, with 78t marks.

ONE of the mo t colourful and magnetic personalitie in the field of philanthropy 10 the second half of the nineteenth century was urely Thomas lohn Barnardo. H( family was of Spanish origin. Some of it members migrated to France and, a generation or two later. to Germany. li\mg at Frankfurt and Hamburg for about 200 years. The father of Tom Barnardo spent some year in travelling and finally settled in Dublin, becoming a naturalized British subject. He married a woman of great strength of character and deep religious convictions, wbo belonged to an old Quaker family tbat had settled in Ireland. Their son was born in Dublin in During hi adolescent year he was a voracious reader, especially of seriou literature which included the work of Voltaire. Rou seau and other agnostic philosopbers of that period: but, in 1862, be wa caught up in a remarkable religious revival that spread to Dublin from or them Ireland. He had already entered bu iness, and from that time be took an acti, e part in Church activities, in the work of a Dublin Ragged School, and in visiting and assisting the sick and aged poor. He detennined to become a rnis ionary to China and. being advi ed that a medical qualification would be of great help in such work, he came to London in 1866 and entered the London Hospital a a medical lodging in two rooms in a quiet house at the back of the ho pita!.

The Donkey Stable in Hope Street

Shortly after commencing his studentship Tom Barnardo wa helping in a Ragged School in Ernest Street, Stepney; but a little later he and a few fellow students opened one of their own in an old shed in Hope Place. Stepney, wbich they rented for 2s. 6d. a week. It had formerly been a table for costerrnongers' donkeys. The student cleaned and wbitewashed tbe rafters, lin1ewashed the walls, and obtained lamps, eats and books. At first the scbool was opened on two nights a week and on Sundays, two of the little band of helpers being in cbarge on each week night and all being present on Sundays. As soon as the doors were opened the place became filled with ragged, dirty and hungry-looking boys. It was winter, and one evening a small urchin of ten begged to be allowed to stay all night as he had no parents and no home. Bamardo did not, at first. believe him and asked where he had slept the night before. He said in the Hay Market at Whitechapel and that there were lots of bomeless boys who slept there. Barnardo took him to his own lodging and gave hin1 some hot coffee and food: and then asked about his life. The boy, whose name was Jin1 Jarvis, told a pitiable story of orphanage and destitution and said that many boys were in the ame plight. Still incredulous, Barnardo asked lin1 to take him to a place where boys could be een lying out in the· streets all nigh.t, and shortly after midnight Jin1 took him to the old Rag Market, where a number of destitute boys from about nine to fourteen years of age

were sleeping on an iron roof of a shed clad in the most inadequate of rags and huddled together for warmth. The young medical student was appalled bv the di .cO\ ery but felt powerless to do anythmg to belp Just then. He found Jim a home with a motherly woman who lived near hi mvo an? he frequent I} went out at rught, wlth Jlm as his guide. and \\a often surrounded by a group of pitiably friendless, homeles and hungry children. Gradually. he found homes fo-r about fifteen or ixteen of the most destitute but he had ery little money or influence: Soon after this, a mi sonary conference was held at the Agricultural Hall, Islington. As an intending mis ionary. Barnardo had been im ited and \Va sitting quite near the platform. 'Some of the speakers had been delayed and the chairman was in a difficulty, o he begged Bamardo to tell the audience omething of his Ragged School work in the East End. Reluctantly, Barnardo got to hi feet and, after a he itating tart. he began to tell of the terrible plight of homeless children in the miserable quarters of the East End, his talk gaining in fervour and eamestnes as he warmed to bis ubject. Hi audience was deeply impressed for, although interested in foreign missions, hi hearers had little idea of the desperate need of those near at hand.

Lord Shaftesbury Become Jilterested

A report of the meeting appeared in the press and gave rise to considerable correspondence. rany doubted Barnardo's \ eracity. but be knew nothing about that as he did not see the report or the correspondence at tbe tin1e. About a week later he received an invitation to dinner from Lord Shaftesbury. who wanted to know a good deal more about these home Ie children, and asked Barnardo to take him to one of the 'resorts.· They went to Billingsgate where they found a large number of' empties' covered with enormous tarpaulins but there was no sign of homeless boys. Barnardo found a place where two tarpaulins oyerlapped and began to investigate. He drew out a small boy who thought be had been caught by t he police. but who readily agreed to rou e the other who were sleeping uuder the tarpaulin Seventy-tbree forlorn chi ldren. clad in \rilely smellrng rag with no head or feet covering, tumbled out. Barnardo remembered a coffee hop that was open all night and Lord Shafte bury took the whole company there. filling it twice. He wa , however, deeply impressed by the proof he bad received that Barnardo's statements were not exaggerated and he declared that ., All London shall know of this."

Extension of the Work at Stepney

The donkey table became hopele 51) inadequate to accommodate the children who came to it and, in 1867, Barnardo issued an appeal for funds in a religious magazine. A urn of £90 wa sub cribed. Tbe only commodiou place that cOtlld be ecured

s was a large room attached to a public house-the King's Arms-in the Mile End Road, but having a separate entrance.

When it had been made ready he and his friends with the scholars of their Ragged School: paraded the streets singing hymns and carrying banners bearing an invitation to the meeting in the King's Arms Assembly Room. The inaugural gathering included a free tea to over 2,000 rough and ragged boys and girls.

In a very short time a change of landlords occurred at the King's Arms and Barnardo's tenancy was abruptly tenninated. Then he had a serious illness which incapacitated him for about two months. When he was able to resume his work he hired a somewhat unpromising room in Bale Street, Stepney, where under great difficulties he continued his work among the children and also held mission services for adults on Sunday evenings. In such a rough locality as Stepney his efforts were not altogether popular and on several occasions he was set upon.' Once he sustained two fractured ribs, another time he received bruises and

black eyes and unplea ant 'practical jokes' were staged by the more unruly lads of the Ragged School but none of these incidents deterred blm or hiS helper.

The East End Juvenile Mission

In 1868 with the financial upport resulting his appeal, Barnardo ob!ained possession of two small houses opposite the donkey stable and gradually he acquired several adjoining houses, and then be proceeded to erect a Mission Hall. It was here that a Bootmaking and Repairing Shop was started and a certain amount of poor relief' was distributed and the whole of the activities in Hope Place were consolidated into the East End Juvenile Mi sion. Barnardo had now been in London for only two years and although, in addition to his medical studies, he had accomplished much, he longed to establish a Home for the more destitute of the children with whom he came into contact; but neither the money nor the opportunity were, as yet, forthcoming.

(to be conclL/ded)

How the Health Service Grows

A STEADY expansion of the ational Health Service in England and Wales is traced in the annual report of the Ministry of Health covering the 21 months from 1st April 1950 to 31st December 1951.

More Hospital Beds

The report shows that in 1950 and 1951, nearly 14,000 more hospital beds were brought into use, that the hospital nursing staff increased by over 13,000 and records a strengthening of the medical and ancillary staffs as well as the addition of much modern equipment and improvements in accommodation.

Over 3,250,000 patients were treated in hospitals last year, 173,000 more than in 1950 and 322,000 more than in 1949. Not only have more patients been enabled to receive treatment but, says the report, • individual patients have often been enabled to be treated better or more comfortably.'

Waiting lists for tuberculosis beds fell by 4,000 and patients were found beds more quickly, but the chronic elderly sick still remain a problem, and the shortage of beds in mental hospitals and mental deficiency institutions remains as intractable as ever.

The demand for dentures and spectacles fell sharply when charges amounting to about half the cost were introduced in May 1951. There was, however, no halt in the persistent rise in both the number and cost of doctors' prescriptions, which in number went up from 217,000,000 in 1950 to 228,000,000 in 1951, and in average cost from about 3s. Id. at the beginning of 1950 to about 3s. lId. each at the end of 1951.

Numbers were affected by the influenza epidemic last year, when, in January alone, there were nearly 29,000,000 prescriptions compared with about 19,000,000 in a normal January.

Local health authori ties' services all reported big increases in their work, the only contraction being in maternity and

New Books

B.R.C.S. First Aid Manual. Tenth Edition. B.R.C.S. Supply Dept., 14 Grosvenor Crescent, London, S.'V.l, price 46.

There are many good points in the tenth edition of the British Red Cross Society's First Aid Manual which has ju t been published. The authors are to be congratulated since the book i- well set out. nicely produced and written in a pleasant. easy style. It supplies an excellent training in first aid and devotes adequate space to common conditions uch as fainting, no ebleeding, abdominal pain, etc. The Holger ielsen method of artificial respiration, fully described in Appendix E, will from now onwards be the first choice in the B.R.C.S, instead of Schafer's method.

Where youI' training is needed

You ARE TRAINED in first aid and nursing, and may have \vorked in hospital. BlIl unless you are a member of the N.H.S.R., how will your 10cal hospital knO\'>' that it will be able to count on you in the event of \var - how can it organise the first aid and nursing teams 1I0 W, as it must do? That is why the hospital \vants you to join no w.

Join the

child welfare, due- partly to the falling birthrate, partly to the growing demand for hospital confinement, and partly also to an increase in the maternity medical services given by general practitioners.

Increase of Nursing Staff

Development of the hospital services is shown in the increase in whole-time nursing and midwifery staff (125.752 in 1949, 132,408 in 1950 and l36,210 in 1951) and in parttime staff (23,060 24,977 and 25 ,756).

Improvement was also shown in the numbers of domestic staff of hospitals, which increased by 2,122 whole-time and 3,684 part-time in 1951 to respective totals of 105,416 and 33,630.

There has been a steady increase, too, in the numbers of professional staff other than medical, dental or nursing. The expansion of rehabilitation and physiotherapy, which accelerate the patient's return to work, is hown in the figures for whole-time physiotherapists (2,814 in 1949, 2,916 in 1950 and 3,055 in 1951), occupational therapists (750, 883 and 929) and remedial gymnasts (131, 157 and 169).

Ambulance Service

Ambulances are continuing to receive more calls. In the year ending 31st March 1951, they carried 9,250,000 patients compared with just over 7,000,000 in the previous year, and the mileage increased from 79,000,000 to 89,000,000. Although the total calls on the service have been going UP. the average miles per patient have shown a steady reduction from 12 miles per patient in the second half of 1948 to 11 in 1949 and lOt in 1950. Better arrangements by the hospitals for the co-ordination of their calls and better organization of journeys by the local health authorities, the introduction of vehicles for carrying several out-patients at a time, and more economical operation of vehicles contributed to this result.

The B.R.C.S. still wisely retain alma t all the original pressure point and advocate their use as a temporary measure in stopping arterial breeding. Body splinting is recommended for fractures but ordinary splints may still be used when neces ary. Hence methods of applying the latter are described and well iIlu trated. There is a valuable chapter on ciyi] defence first aid with a section on atomic bomb explo ion : blast injuries and biological warfare are included.

The chapter on internal haemorrhage includes paragraphs on bruises. bleeding from the tongue, a tooth socket, nosebleeding, etc. Although theoretically it may be correct to consider these conditions a varieties of internal haemorrhage, many teachers of first aid would prefer to see them described under a different heading, and this particularly applies to cerebral haemorrhage despite the cross-reference in the chapter on unconsciousness.

The Syllabu of Instruction published at the end of the book shov,s how the course of training can be covered in nine lectures (compressed into six at the discretion of the lecturer). The B.R.C.S. would be well advised carefully to consider whether this number of lectures is adequate to meet tbe high standard of knowledge which this manual wisely sets up, bearing in mind that for many students first aid is their first introduction to a medical subject. And the wisdom of condoning a four-lecture course is debatable.

The B.R.C.S has produced an excellent first aid manual; it sells for the amazingly low price of 4 / 6 and is a good investment for all first-aiders whatever their creed.

'First Aid Competitions and Casualty Make-up' by Major A. C. White-Knox, St. John Ambulance Association Stores Dept. , St. John's Gate, ClerkenweU, London, KC.l, price 1/ 6, postage 3d.

This excellent little book is a valuable contribution to first aid literature. It is written not only for first-aiders and competitors but also for judges, whether they be doctors or laymen And judges have to study competition work just as much as first-aiders-a point that is often forgotten!

The Reserve has been formed to provide men and women already trained and organised in units for first aid and nursing duties in the event of war. It is the only war-time reserve for first aid and nursing you can join to help your local hospital. Do you know about the special concessions for "efficient members" of the St. John Ambulance Brigade and Briti sh Red Cross Society which shorten hospital training and extend the recruitment age?

It would be a terrible thing if a sudden emergency found your hospital's Casualty Services ul10rganised and unprepared through lack of trained personnel. Ask your Area Officer about joining the 11070.

BY ft.\J.

Aid for tl.e Brigade

MITCHELL LTD.

1953 PRICE LIST

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OVERCOAT..... £10 7 6

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OVERCOAT........... ............ ......... £5 13 5 ill Superfille Grey Cloth

CAPS........... 10 6 REgulatioll

Female Officers :-TUNIC and SKIRT , . from £12 5 0 (includes nne fitting)

Female Officers or Nurses :-OVERCOAT .............." £7 11 0

ALL DELIVERIES- 3 '4 WEEKS (;o,,'ractors P"blic to H.J.'I. · 601"pr",,,p,,f ""d efr.

NEW BOOKS-continued

The book deals with all aspects of the subject. There are chapters on the team hints for competItors and arrangmg a competition while, specially for judges, sections on drawing up tbe mark sheet, hints at competitions, etc. Of outstanding value is the chapter on casualty make-up. The book concludes with an appendix containing specimen mark-sheets.

Dr. White-Knox has generously given the reader the full benefit of his wide practical experience. The book is full of useful hints and wise dicta. Everyone should note tbat 'it takes as many years to make an expert first-aider as it does to make a good craftsman at any job.' The full appreciation of this statement would raise tbe standard of first aid to a high level.

To all those interested in first aid whether as judges, competitors or spectators, tbis book can be warmly recommended.

'Aids to Tuberculosis Nursing' by L. E. Houghton, M.A., M.D.(Cantab.), and T. Holmes Sellors, D.M., M.Ch.(Oxon.), F.R.C.S.CEng.) Fourth Edition. Bailliere, Tindall & Cox, 6/-. In few fields of medical work have there been more advances in recent years than in the treatment and general management of tuberculosis. The text of tbis book has been thoroughly revised for its fourth edition in order tbat it sbould be abreast of modem outlook and practice. It has about forty pages more tban the tbird edition, and these bave sufficed only because of condensation of subject matter that is included in general basic nursing and the re-writing of passages tbat might have been regarded as somewbat wordy or not absolutely necessary; with tbe result that the new edition is as concise and comprehensive as it is possible for it to be.

Tbe chapter on drug treatment has been extended to include azochloramide, thiosemicarbazone, para-amino-salicyllic acid and isonicotinic acid hydrazide, whilst additional notes on the use of penicillin, streptomycin and the older sulphonamides have been added, and also recent observations on drug sensitivity. With regard to surgical treatment, cavernostomy is mentioned as an alternative form of cavity drainage, and plombage as an alternative to thoracoplasty. More space is given to excision of lung, in view of the increasing use of this operation; and a recently introduced procedure---decortication of the pleura-is described. More detail is given of mass radiography, together with some statistical facts and figures.

The therapeutic value of bed-rest is explained from the physiological angle and more detail is given with regard to general precautions to prevent the spread of infection. The group of X-ray photographs and explanatory pen and ink drawings at the end of the book now include two additions showing extensive bilateral lesions before and after streptomycin treatment. Throughout the book the authors show a very sympathetic understanding of the patients' difficulties, and give excellent advice to the nurse in relation to the patient.

A.E.P.

Compiled by W. A. Potter

BDDODOEJODODODOB

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ACROSS

1. Supports and rests the upper limb (5, 3, 5)

10. Decisively defeats (5)

]

1. Drug to evacuate the bowel is pure outside (9)

12. Much sought for by the alchemists (6)

13. Introduce Pathogenic Bacteria (6)

16. Girl of your eye (4)

17. Its excitation results in muscular action

20. They return tissue fluid to the blood stream

21. At once, as on the prescription

23. The clue is hidden here

25. Antidote is dilute vinegar or lemon juice, if available

28. Bone which might be near colon

29. Essential to Life

30. These organs produce Cortisone, and all dangers, too

DOWN

2. Light metal which may be Llsed as silver' paper

3. Analgesia often used in Midwifery

4. Essential part of scalp sutures

5. Take note of this apostle

6. Knowledge

7. Discordant sound

8. Found in 9 and 14

9. Between Mitral and Aortic valves ...

14. Gives origin. to Coronary arteries

15. Found in beef or cereal

18. Rescinded

19. V.I.P. in the' Health Team'

22 Sir Toby Belch was her uncle (Twelft h Night)

24. Step which upsets trade

26. Ann runs up and down making something of little value

27. Cosy

(Solution next issue)

SOLUTION TO CROSSWORD No. 2

1,

2, Recipient; 3, adroit; 4, fear; 5 , rude; 6, humanity ; 7, caned; 8, sulphonamides; 9, cleans the hand; 14 radon 15 , plain; 18, neuralgic; 19, abrasion 22, go down; 24, drama ; 26, yawn 27, mesh.

A NEW FIRST AID FILM FOR YOUTH

'HELP' is a brilliantly produced film designed to introduce children to First Aid. Here is an interesting and often exciting lesson in pictures that young people can easily understand and remember. Help teaches them the · principles of First Aid in a way that they will enjoy, and leaves them with a real enthusiasm for its subject. 'Help' can be obtained on free loan by schoo ls, the

J muor Red Cross and all youth organizations. It is a ] 6mm. sound film that lasts ] 3 minutes. 'Help' has been seen and approved by leading authorities and can be obtained from :

The Film Librarian.

Sound-Services Ltd .• 169 King ,t on Rd. London. S.W.19

Th e Public Relations Dept., T J. Smi th & Nephew Ltd., Neptune Street Hull

T. J. Smith & Nephew Limited, manufacturers of Elastoplast and Elastocrep e

THE INSTITUTE OF CERTIFIED AMBULANCE PERSONNEL MEMBERSHIP OF THIS INSTITUTE IS NOW OPEN TO ALL THOSE WHO HOLD A RECOGNISED FIRST AlD CERTIFICATE

PROFESSIONAL EXAMINATION

The next examinations of the Institute will be held in April 1953

PRELIMINARY-Saturday, 11th April, London. The examinations will also be held in one or more other centres according to appllcations received. Written paper on Anatomy, Physiology and Hygiene. Oral.

FINAL-Saturday, 25th April, London. Written paper on Principles of First Aid, Transport of the Injured; and choice of Emergency Obstetrics, or First Aid in Coal Mines, or First Aid in Industry. Oral and Practical.

CLOSING DATE for entry, on form available from the Secretary, 1st March, 1953.

For particulars, Syllabus (2(6), Previous Test Papers (6d), apply to THE SECRETARY, I.C.A.P., 61 Cheapside, London, E.C.2

FIRST AID:General Rules

Examination

Fractu res

Dislocations Sprains

Wounds

Hc.emorrhage

Types of Bandages

Splints

Shock

Artificial

Lifting T ransporti ng, etc .• etc.

HOUSEHOLD PHYSICIAN ( UP-TO-DATE

)

NEW EDITION

Describes in simple language, with helpful coloured plates and diagrams

The COMPLAINTS OF MEN, WOMEN AND CHILDREN

Their Cause, Treatment and Cure

A few of the Subjects treated:

First Aid What to Do in Emergenc ies , Influenza. Colds etc.

Measles, Mumps, Cat arrh

Corns and Warts

Physical Culture, Self Defence

Treatment for all Skin Dise ases

The Lungs, Pleu risy Hygiene, Anatomy, Pharmacy

Fevers, Bl adder, Kidneys Pregnancy, Childbirth Home Remedies, Diet

MOVABLE MODELS OF

HUNDREDS OF TESTIMONIALS " I am deiighted with' The Household PhysiCian,' and as I am an Ambulance man, I can appreciate them to their fullest extent."

"Being a Nurse it is of great help to me."

Principles of Nursing PRESCRIPTIONS

Eye, Ear, Nose 375 proved remedies

Throat, Liver MOTHER AND CHILD

Chest, the Heart teaching pictures

Stomach. Duodenum BEAUTY TREATMENT

Teeth. the Muscles how to bring out your best points

Child Welfare SELF DEFENCE

Homceopathy, Arthritis what to do if attacked

Neu rasthen ia

Rheumatism, Poisoning COMPLETE INDEX

Patent Medicines enables you to find Glossary. etc .• etc. instantly what you require THE HUMAN BODY-hundreds of illustrations

Male and Female

COUPON FOR ATTRACTIVE BOOKLET or write To VIRTUE & Co., Ltd., (F.A. Dept.) 9 , 11 Gray's Inn Road, London, W.C.I

Plea,e send me free booklet on THE HOUSEHOLD PHYSICIAN without any obligation [0 purchase this form in unsealed envelop •. stamped 1!d

ADDRESS

Treat for shock; 10, ulcer; 11, ahdominal; 12, pepsin; 13, an idea; 16, open; 17, gallstones; 20, antibiotic; 21, gush; 23, Indian; 25, no rash; 28, eradicate_; 29, organ; 30, pain in the neck.

, Percy (Swindon) writes :-

I \Vas ca11ed to the scene of an accident to render first aid to a motorcyclist who had been in a collision

lI'ith a heavl' lorn

He was 0)il1g 011 his left side in th e road, )tIith his right leg in a circle, ll'ith a double fractured femur alld double fractured fibula and tibia, lI'ith his knee joint out of proportion. He also had afracturedfore-ann, but he !Vas conscious, and it lVas pouring down lI'ith rain.

Was I justified in straightening the leg and applying splints before moving the patient and transporting him to hospital?

Answer

I am not quite clear as to what you mean by , double fracture' but in any case the modern tendency is not to use splints except in special circumstances, e.g., carrying the patient for a long distance over uneven ground, delay in obtaining medical facilities, etc. Despite this, I personally would not object to your treatment provided it did not cause delay in transporting the patient to hospital.

G. M. (Edwardsville) writes :-

J would like yo ur help, please, to decide a controversy ll'hich has arisen among our members.

In the general treatment of wounds accompanied by severe haemorrhage, Rule 9, page 98, states.' ' Bandag e the pads firmly in posi{;on. When a foreign body or projecting broken bone is present in a wound it may b e advantageous to apply the bandage diagonally to prevent pressure on the foreign body or projecting broken bone.'

I \Vould greatly appreciate an explanation hOl v the diagonal bandage should be applied and where it should be tied, seeing we have faced this problem in competition.

We shall greatly appreciate your advise.

Answer

The actual method of application does not matter so long as the

queries

Answered by Dr. A. D. Belilios, M.B., B.S. (Lond.), D.P.H. (Eng.)

bandage makes adequate pressure on the pads to stop the bleeding, but does not make direct pressure over the site of the foreign body or projecting broken bone.

T. M. (Folkestone) writes

One of m y friends is suffering from Glandular Fever. This is a nell ' disease to me. Can you tell me s omething about it ?

Answer

This infectious ailment is more common than usually supposed. It generally attacks young adults and begins suddenly with a sore throat, high temperature and the usual symptoms and signs of fever. The characteristic feature is enlargement of lymphatic glands in the neck, armpits, groins and other places in the body.

M. J. (Wandsworth) writes

Over Xmas, I looked after some children lvhile their parents Ivent out for the day. Soon after they had gone the baby boy aged 12 months started screaming and looked pale. He drew his legs up to his stomach like many babies who have wind. I noticed a little blood on his nappy so I thought he must have indigestion. J gave him a ' teaspoonful of castor oil and some gripe water. The parents called in a doctor when the y returned and the baby was taken to hospital and had an ' operation. The doctor seemed annoyed and alarmed but else' could J have done ?

Answer

I am afraid you dropped not one but a whole hod of bricks. The case was obviously right outside your scope hence (1) you should have sent for a doctor immediately (2) you should not have given castor oil or gripe water without medical advice. The baby was probably suffering from an intussusception which means 'telescoping of the intestines.' Delay in professional treatment might have been fatal.

J. G. B. (Hampstead) writes :In a fracture of the pelvis, 11'e are {old to lvarn the patient not to pass ll'ater if he can avoid it. What is the reason fo/' this advic e ?

Answer

In this injury there is a possibility that the bladder or urethra may have been injured or even torn. In this event, micturition might aggravate the injury or even cause the urine to enter the tissues of the pelvis rather than leave the body in the normal way.

H. M. S. (Leeds) writes

I wandel' If you could settle all argument for us. One of our Division stales that it is quite unnecessary to apply a large arm sling in cases of broken ribs when the patient is going to be kept lying down. He says he has noticed that it is not done 011 patients he has seen in hospitals. Most of us prefer to believe the text book but in viell' of his statement about hospitals, we are a little confused.

Answer

Definitely apply a sling in all cases. In hospitals, patients with broken ribs are treated by firmly strapping the chest with strong adhesive plaster so that the fragments do not move to any marked extent with the muscles of the arm. This cannot be attained with broad bandages. You cannot compare hospital and first aid methods.

H. M (Eastbourne) writes :-

One of the workers in my factory injured his hand. As there was tenderness over the carpus, 1 treated him for a crushed hand and sent hiJn to hospital. But he was X-rayed and told there was no fracture. A (elv weeks luter as he still complained of pain, his doctor again sent him to hospital. TMs time the X-ray sholved a fracture of one of his carpal bones. Can you explain this, please?

Answer Fractures of some of the carpal bones do not always show up in X-rays taken soon after the accident. The X-ray appearances of a fracture may develop later, hence, as in this case, the need for a further examination.

A Minor

PATENT "PORTLAND"

AMBULANCE GEAR

The Gear IIlustrated(A.B.C.D.) carries two stretchers on one side of Ambulance, leaving other side clear for sitting patients.

The UP AND DOWN action is qUick and easy for loading or unloading.

A. Shows the two stretchers in positi 0n.

B. Shows the top stretcher lowered ready for loading.

C. illustrates the same Gear WIth the top stretcher frdme hinged down for use when only one stretcher case is carried

D. Shows the same position as in "C' only with cushions and back r est titted for convalescent cases.

Where Ambulances are required to car ry fou r bed s two Gears are fitted. one on EITHER SIDE. and the same advantages apply as described above.

full catalogue of Ambulance. Equipment No. 7A will be sent on request.

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Gastric Disorders

• • •

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Consisting of bismuth, magnesium and so<1 ium bicarbonate, Bl oOoL is J. finely eli, icleJ p.lbtable PU\\ Jer \\hi ch speec1il)' neutrali cs excess acid anJ soothe irritated membranes.

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Prifcssional samples if BISODOL together II ith literature, will glaJij' be sent upon request to members of 1hz NurSing Prifession, free if -

M. E. F. (Dublin) writes In a fractured femur, why does the foot lie rolled on to its outer side and what is the cause of the shortening up to 3 in.

Answer

The weight of the limb is the cause of the foot rolling over while shortening is produced by the pull of the muscles on the lower fragments and, since the thigh muscles are very powerful, the shortening may be marked.

M. S. (Great Yarmouth) writes :J often notice in the newspapers that someone or other is suffering from a ' virus infection.' What is this complaint?

Answer

Any disease caused by a germ ca n be called an infection. A virus is a minute germ which cannot be identified by the usual methods ; often it can only be seen by an ultra microscope even if it can be seen at all. The well-known influenza is an example of a virus infection, so is the common cold.

C. N. (Southampton) writes Recently whilst training my team

for a first aid competition I gave them the fol1owing test :-

, Whilst 011 mobile patrol at 10.45 one night you observe a crowd assembled outside a certain public house, on investigation you find a fight has taken place and one man is l)'ing injured il1 the road, he is unconscious, Act.

'The patient has received the foll01ving injuries: (1) Complicated fracture of ribs on right side involving the lung; (2) fracture of lower jaw (both sides); and (3) concussion.'

Follo.wing the completion of the test there ivas considerable discussion between us as to the best method to adopt in transporting the patient to hospital on a stretcher, whether it lvould be best to transport him face down because of the fractured lower jaw (both sides), or supine position with body inclined to right side because of the complicated fracture of rib " or on his back with head and shoulders raised because of the concussion.

J shall be grateful if you will kindly give us your valued opinion in this matter, stating :-

Miscellaneous Advertisements

FJRST AID & NURSING, JAN.jFEB. 1953

(1) Which is the best method to adopt in transporting the patient on a stretcher?

(2) The reason why it is the best to transport him so ?

(3) Which do you consider is the most important and serious injury?

Answer

The answer to your questions depends on the relative severity of the conditions at the time of attending the patient, hence it is impossible to be dogmatic in a problem of this kind. Since broken ribs with lung injury has been diagnosed in an unconscious patient, his injury must be considered serious. Lying on the back with the head and shoulders raised and the body inclined towards the right would cover both the broken ribs and the concussion and also provide for possible compression later developing. The head should be turned to the right and continuous observation maintained for incipient asphyxia due to tongue or other cause. Incidentally, I would not have been surprised to have heard that you yourself were suffering from similar injuries for setting such a test !

The Army looks to you to look after the Army!

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Dental (flY

A sinl]Jle relief for children's strains and sprCLLns

The vasodilatation and hyperaemia resulting from the applicalion of 'Algipan' Balm to minor injuries -where the skin is unbroken is rapidly followed by relief of pain.

In 'Algi pan,' the powerful vasodilator Histamine has been combined with Methyl Nicotinate and is thus able to penetrate to subcutaneous levels. Here, it promotes an increased flow of blood to the injured tissues, assists in the removal of exudates and imparts a warm subjective feeling of comfort.

Bland, soothing, readily absorbed and free from oily resid ue, 'Algipan ' is a comforting balm that will not harm delicate skins and is ideal for the treatment of the minor tissue injuries so common to children.

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We shall be pleased to send full details upon request.

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A HANDBOOK OF ELEMENTARY NURSING

Arthur D. Belilios, B.S. D.P.H. and Dorothea Duncan-Johnstone, S.R.N.

This handbook provides, in simple language and without elaborate technicalities an introduction to the principles and procedures which underlie the science of nursing These are based on recognized ho s pital procedure, and are described in a simple manner so that they can be readily understood.

The second part of the book is devoted to a brief description of the more common diseases , with general notes 0n the n ur s ing required in each case, and the whole thus forms a comprehensive volume o f reference and guidance.

With 314 pages and 57 drawings, 7s.6d. Po stage 6d.

HANDBOOK OF FIRST AID & BANDAGING

150-162 EDGWARE ROAD, LONDON, W.2 , BAILLI ERE'S ELEME NTARY NURSING HANDBOOKS

ELEMENTARY ANATOMY & PHYSIOLOGY

Arthur D. Belilios, M B. B.S., D.P H., D. K. Mulvany, M.B., F.R .C .S. and Katharine F. Armstrong, S.R.N. S. C .M.

The most comprehensive and up-to-date bOok on the subject giving full details of the first-aid treatment of medical emergencies as well as of injuries and accidents.

Third Edition.

With 520 pages and 244 drawings. Postage 6d 6s.

DALE, REYNOLDS & CO. LTD. 32 Finsbury Square London EC2

A handy compact manual which gives a complete outline of the anatomy and physiology of the human body. 'A

Arthur D. Belilios, M.B., B.S. D.P.H. D. K. Mulvany, M.B ., F R. C .S., and Katharine F. Armstrong, S.R. N., S. C .M.

IRST AID &: NU SING

DYSMEN RRU<EA

The unit is complete with water storage, electric power and all essential equipment for the purpose. It has been designed in two sections to obtain greater scope, manreuvrability and better distribution of weight to enable it to cope with rough and unmade roads and wooden bridges which exist in the territory in which it will work, The units have also been designed to work under extremely high temperatures ranging from 90 to 130 fah ren heit so that normal film development temperatu res can be maintained.

One section houses the electric power unit and complete facilities for developing, washing and drying X-Ray films ranging from 35 mm. miniature to the large 17" X 14" radiography, i.e., Dark Room.

The other section functions as an X-Ray room complete with mass miniature X-Ray apparatus for taking films of the chest, and incorporates a separate control room a nd the Doctor's Room for the projection and examination of films, i.e., the X-Ray Room.

YOU ARE INVITED TO APPLY FOR FUll DETAilS OF MOBilE MEDICAL UNITS, AMBULANCES, ETC., BUILT TO YOUR PARTICULAR REQUIREMENTS FOR SERVICE IN ANY PART OF THE WORLD

ARE the stars in their courses any more mysterious than the recurnng cycle of the menses? As regularly and predictably as the phases of the moon , the average uterus sheds its endometrium every twentyeight days and the average woman experiences discomfort, pain and depression . Measurable relief from these symptoms of dysmenorrhrea may safely be obtained at every period with ANADIN tab1ets. Anadin combines the benefits of two pain-relie ving compounds with those of two mild stimulants . Anadin is not habit forming and is quite safe for self-administration by the patient in the prescribed dosage.

Two to four tablets, according to severity of symptoms, repeated every four hours as required

you

,

•••

•.. Then you will follow this point-by-point argument and reach the same conclusions as so many doctors, nurses, hospitals and clinics have done.

DO YOU AGREE ... that the causes of most skin infections are the common strains of STAPHYLOCOCCI, STREPTOCOCCI and B. PYOCYANEUS ?

IN THAT CASE . a treatment which is effective against all three will be indicated for cuts, abrasions, burns, scalds, boils and most inflammatory skin infections?

THIS IS THE TREATMENT . . .

ANTIPEOL Cutaneous Vaccine Ointment contains the sterile vaccine filtrates of the three micro-organisms mentioned. The filtrates destroy the actual micro-organisms and at the same time act as a local immuniser against re-infection. This is a

purely biological action and there is no damage to delicate tissues.

RAPID HEALING is further expedited by the ointment base of proved efficiency. For burns and scalds, ANTIPEOL has special advantages. It is microbicide and non-adhesive. Therefore dressings do not have to be changed every day.

AND HERE IS THE PROOF.

Antipeol Ointment is proving and reproving itself every day in dozens of surgeries, clinics, hospitals and homes. Letters from the medical and nursing profession bear convincing testimony to its effectiveness.

THERE is the logical argument for including ANTIPEOL Ointment in every First Aid kit. As a logical person, why not send for full details and a clinical sample ?

antipeol

cutaneous vaCCIne ointment

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First Aid & Nursing

March/April 1953 * In this Issue

It was their big moment!

First Aid on Public Duty 2 Books 3

Coronation Duties 4

,Britjsh Railways 6 Report from Essex 6

Police Contest... 7

First Aid on Building Site s 8

Topical Notes. 10

Readers' Queries 12

First Aider's Crossword 14

Cadet John Fisher, 14 of Copse Farm

Oving, Sussex, had his big moment when h; was presented with a Cup for gallantry at the recent St. John Cadet Competitions at Central Hall, London.

John, who is a member of the Chichester Cadet Division, went to the aid of his father when he had been attacked by a bull. Mr. Fisher managed to crawl under a wire fence and the enraged bull was making attempts to get to him when John arrived on the scene. He sent a farm worker for first aid equipment and to phone for an ambulance, and then pulled his father clear, gave first aid, and got him away

The presenta tion was made by Brig.General R. L. S. Williamson, of the

Embassy, and the Cup, for the bravest Cadet,' was given by the U.S. 8th Army Air Force.

* *

Twelve years old Cadet Pamela May had her big moment on Thursday (16th April ) when she presented a bouquet to Lady Woolton on the occasion of the European Premiere of Walt Disney's 'Peter Pan,' in aid of the British Red Cross Society, at the Leicester Square Theatre, London. In the picture she

York Carriage & Wagon No. 1 ambulance team which for nine consecutive years has won the York District of the North-Eastern Railway Centre, St. John Ambulance Association, Competition Challenge Shield. The team are: left to right, H. Shippey, J. Taylor, P. Jackson, J. Shanks, G. H. Parker, Captain. Behind are Mr. H. M. Lattimer (left), District Operating Superintendent, York, who presented the Shield, and Mr. H. R. Charlton, Regional Ambulance Secretary.

is practising with the Duchess of Marlborough, Chairman of the Premiere Committee, B.R.C.S.

Pamela was to have made her curtsy to the Duke and Duchess of Gloucester and Prince William, but the period of Court mourning prevented a Royal attendance.

Pamela was chosen from 100,000 junior members because of her outstanding service at the time of the r(;cellt floods. Her own home was flooded to a depth of 4 ft. She helped to clear the mess there and then reported to Canning Town Hall where she helped to sort out clothing for the flood victims. The premiere is being attended by many celebrities, Walt Disney among them.

If

are a logical

It was thei,. big moment!

A number of readers have asked for an article dealing with first aid for conditions likely to be met when on public duties for occasions such as the Coronation. The answer, of course, is that the first-aider must be prepared for any emergency ranging from a sprained toe to a dangerous lunatic! And here is a moral, too; all first-aiders who hope to do duty at the various functions to be held this year, should go into immediate training, revising their text-books until their knowledge is well above that of examination standard.

First aid on public duty

By A. D. Belilios M.B., B.S. (Lond.), D.P.H. (Eng.)

A FlRST-AIDER on duty is always in a position of considerable responsibility; the public rightly expect a high standard of efficiency not only in all practical measures he undertakes but particularly in his good judgment. The latter cannot be learnt entirely from books since it is acquired by thought and common sense. It includes deciding when to refer patients to hospital or to their own homes, and also when to leave out deliberately recognised steps in first aid. When, for example, hospitals are near at hand and ambulance services most efficient, it is good judgment to reduce first aid to bare essentials and to arrange for immediate removal.

The appearance and demeanour of the first-aider are of great importance. He must be neat and tidy; above all, his hands must be clean and his nails well trimmed. His manner must be placid and sincere. In almost every case reassurance of the patient or his relatives is essential. This, however, must be done in a tactful and sincere manner-not just' gabbled off' as is often heard in competitions.

The responsibility of the firstaider does not end when he has completed his first aid treatment. Indeed, it never ends at all unless he provides for the future of his patient and for any complications that may arise. Hence, in most cases, it is wise to conclude the interview by advising the patient to consult his own doctor. An example will make the of this advice clear. A first-aider, without difficulty, may successfully remove a piece of grit from the eye. But he cannot say for certain that the foreign body has not the cornea in which case

ulceration can follow with permanent impairment of sight. The first-aider, therefore, would be gravely failing in his duty unless he provided for this possible complication by advising the patient to see his own doctor, at any rate if the discomfort persisted after a few hours.

I t is scarcely necessary to emphasize the need for the treatment of shock which is present in so many casualties. Not only is it essential for the patient but nowadays the public know enough about first aid to criticize first-aiders who do not give it efficiently. Once again, however, the amount of treatment given depends on the availability of ambulances and the proximity to hospital.

The remainder of this article gives brief notes on first aid treatment for the following conditions : faints, epilepsy, apoplexy, infantile convulsions, concussion, wounds, fractures, foreign bodies in the eye. At this stage, the wise first-aider will stop reading, get a pencil and paper and write down without referring to any book, the treatment he himself would give for the conditions mentioned. Then compare with the text and see how much has been left out by the reader, and indeed by the author!

Faints

Whenever possible, get the patient lying down with the head and shoulders low and the feet raised ; keep the head turned to one side. Undo tight clothing and ensure an adequate supply of fresh air; fanning the face will help in this respect; supply blankets but do not overheat. Remove to shelter in recumbent posture.

On return to consciousness- or sooner if facilities permit, confirm that the faint is not caused by a more serious condition such as bleeding from a varicose vein, commencing miscarriage, etc. If the faint is uncomplicated, give 'drinks in sips, of plain water, sugared tea or coffee. If the day is hot, salt and water (half a teaspoonful to the pint) is a good drink. Sal volatile (dose, one teaspoonful in water) may be given and smelling salts used.

Keep the patient under careful observation particularly his pulse and colour. Recovery should be relatively quick; if prolonged unconsciousness or relapse-medical opinion essential.

If the faint occurs on a crowded stand and it is impossible to remove the patient recumbent, place the patient's head between his knees after undoing the collar and tie.

Epilepsy

Make no attempt to move the patient during the fit. Quickly prepare a gag to place between the teeth; it is worth while having one or two wedge-shaped wooden gags in first aid kit. If there is a gap between the teeth, insert gag during the first stage of the fit so that its position can be quickly adjusted when the convulsions begin. The object of the gag is to prevent the tongue and cheeks being bitten during the second stage; often it cannot be inserted until then. Ease the gag in gently between the teeth; clumsy handling may cause harm. Remember that the first stage of the fit only lasts about a minute hence there is not usually time to do much more than prepare the gag.

FIRST AID & NURSING, MARCH/APRIL 1953

Support the head to prevent injury during the fit; otherwise make no attempt to control the convulsions. Undo tight clothing if time allows, and ensure fresh air. On recovery remove ·recumbent to shelter. Examine for injuries sustained by fall and apply first aid if necessary. Encourage sleep but maintain observation remembering the possibility of recurrent fits and complications such as automatism. Removal to hospital is generally advisable if the fit recurs.

Cerebral Haemorrhage-Apoplexy

Removal to hospital is essential when on public duty but careful and gentle handling of patient most desirable at all stages. Raise and suitably support head and shoulders. Keep head turned towards affected side if known (the eyes often turn towards the affected side). Remove and preserve false teeth; keep mouth as dryas possible by wiping away saliva with cotton wool. Warmth to body by blankets. Tight clothing undone.

Infantile Convulsions

Hot bath treatment is impracticable on public duty. Recumbent posture-head to one side. Wrap child in warm blanket; cold compress on top of head. Reassure parents. When fit over, remove to hospital for cause to be ascertained, and possibly for a medicine to be given since recurrence always a possibility. Simple drinks on recovery can be given. Usual principles re fresh air, etc.

Concussion

Recumbent: head and shoulders raised, face to one side. Warmth to body. Cold compresses to head. Usual principles re fresh air and clothing. Sips of water on return to consciousness. Hospital; continuous observation maintained until case handed over. Bowl at hand since vomiting common.

Wounds-Minor

These are wounds for which a patient would not normally consult a doctor. They include small cuts, scratches and abrasions. Since thorough cleansing is usually impossible on public duty, if the wound is dirty, hospital is essential. Cleanse

owl!- with antiseptic. Apply antIseptIc cream and dressing, bandage firmly.

Wounds-Major and Intermediate

These are all wounds for which medical attention sooner or later is essential. In first aid, the sooner the better. They include all large wounds of any variety, punctured wounds, the small cuts which require stltchmg; also all wounds accompanied by more than slight haemorrhage. When hospital facilities are likely to be available within reasonable time, restrict first aid to bare essentials, such as stopping bleeding , removal of foreign bodies, and covering with a temporary dressing. A full knowledge of the general treatment of wounds and methods of stopping bleeding is not possible in this article.

Fractures

Too big a subject to be dealt with satisfactorily in this article. Follow the general principles for the treatment of fractures with particular emphasis on immediate support of the injured limb. Use body splinting rather than splints. Even if the distance to shelter is only very short, and it is not possible to treat the fracture on the spot, ensure that steady support is supplied during transport. Remember always to prevent and treat shock.

Foreign Body in Eye

A common ailment. Practise this on your friends until you are perfect: stand behind the patient who should be comfortably seated with his head thrown backwards and supported 011 the first-aider's chest. Examine under the lower eyelid by drawing it downwards towards the cheek while the patient looks upwards. If not discovered in this situation, either by the matchstick method or by using the forefinger as a lever (practical demonstration desirable) evert the upper eyelid. Remove foreign body from either situation with the twisted-up corner of a pocket handkerchief or a wisp of cotton wool, previously dampened Instil drops of castor oil or liquid paraffin. If foreign body not found or seen on cornea, doctor or hospital essential. Temporary pad and bandage desirable.

Bookshelf

This atlas cannot fail to give the student a good understanding of the structure of the body. The drawings have both beauty and <l;cc:uracy, and one of the large figures has hftm.g parts to show the position of all the mternal. organs, including a pregnant uterus neanng full term. There is an extensive key to all the drawings and thirty pages of explanatory text, which is an admirable precis of the whole subject of anatomy and physiology that leaves out nothing of importance to a student taking a first course in these subjects. The atlas can be warmly recommended, not only to n':lrses .and physiotherapists, but also to Flrst AId and Home Nursing students and all members of the National Hospital Nursing Reserve.-A. E. P., S.R,N., D.N. (Lond.1

Transport

Always a problem on public duty particularly when there are crowds' is the method of transport to adopted. Handseats are only suitable for a limited number of injuries and in any case can only be used for short distances and for patients who are light.

The fore-and-aft carry has the advantage that it does not require much width of space, but otherwise has little to commend it particularly since the majority of casualties in a crowd may be anticipated to be unconscious cases for whom the method is unsuitable for obvious reasons.

When there is sufficient width, the old human stretcher can be very useful and there is much to be said for bringing it back into first aid. Nevertheless, the majority of unconscious cases require stretcher transport and in this connection it should be noted that crowds are generally very co-operative in making space when sudden illness occurs. Further economy in space is obtained by the use of carrying chairs.

This article began by exhorting first-aiders likely to be privileged to be employed on public duty during festive seasons to practise and revise. It can well be concluded in a similar vein since the public will be quick to notice any inefficiency in transport.

3

of Female Anatomy, Fourth EdltLon, revIsed by Katherine Armstrong S.R.N., S.C.M., D.N.CLond.) Coloured plates by Douglas Kidd, M.M.A.A. Size 17 in. by 9} in., price 8/ 6.

Coronation duties

DetaiJs of first aid facilities on Coronation Day-the largest public duty ever undertaken in London-have just been released. Some 8,500 St. John and Red Cross men and women will be on duty on or near the route, while the greatest privilege goes to twenty-five St. John men and women and five Red Cross women who will be inside the Abbey during the Coronation service manning the five first aid posts there. They, together with ten Sisters from the Westminster Hospital group, ten nurses from the Services, nine civilian doctors and fourteen Service doctors, have been selected by a committee headed by Sir Horace Evans, the Queen's physician, for this important duty.

F IRST AiD arrangements for the Coronation are being organized by the London County Council (who are responsible for ambulance arrangements in the London area), the Metropolitan Police, St. John and the British Red Cross Society. For the special duty inside Westminster Ab bey the Earl Marshal asked a committee headed by Sir Horace Evans to make the arrangements. A leading part in organizing these facilities is being taken by Mr. H. E. Harding, Orthopaedic Surgeon at Westminster Hospital. That hospital has always supplied doctors and nurses for special duty inside the Abbey on these big occasions, and will again be responsible for selecting personnel for the first aid posts , although the doctors and nurses are coming from all parts and not merely from the Westminster group.

M r. Harding tells us that there are to be five first aid posts on Coronation Day in the near vicinity of the Abbey although not actually inside. The doctors, nurses and ambulance men will, however, take up positions inside. Mr. Harding will be in control, and the organization will follow closely the pattern which was found so successful in ] 937 on the occasion of the Coronation of King George VI.

Personnel inside the Abbey will be: Ten Sisters from the Westminster group; ten nurses from the Services (Navy, Army and Air Force); five nurses from St. John

(Ass. Dis. Supt. Mrs. Nellie Matthews, Div. Off. Miss Betty Chariton, Nurses Miss Nora Lane, Miss Margery Slate, and Miss Jean Wintersgill); five from the British Red Cross Society (M r s. E. Carnegy Arbuthnot (London) , Miss Barabel MacIver (Anglesey), Mrs. W. Wood (Isle of Man); Mrs . B. McAnally (N. Ireland) and Mrs. Alison Grant (Scotland); twenty St. John Ambulance Brigade men and twenty-three doctors.

Four of the St. Jalm nurses are members of the Palmers Green Division team which last year won the Grand Prior's Trophy, the premier first aid award, and Mrs. Nellie Matthews, who is in charge, comes from Hendon. The twenty men include members of the teams which came first, second and third in the Brigade First Aid Competitions last year. They are the Wolverton Division, Bucks, the Worthing Division, Sussex, and the Shrewsbury Division, Shropshire. The rest of the men come from London. Their names are: Area Staff Officer J. J. A. Cameron (Officer-in-Charge), Sgt. E. J. Ratliff, Pte. S. Crouse, Pte. A. B. Savill, Pte. J. Melville, Pte. R. Ockenden, Pte. A. R. Pickworth , Cpl. F. Simons (all from Central Area) ; Sgt. W. Richardson, Pte. R. Bennett, Pte. L. Billingham , Pte. H. Green, (Wolverton Division) ; Div. Off. W. H. Virgoe, Pte. C. W. Charlton, Pte . F. Long, . Pte. G. MCCourty (W orthing Division); County

omcer E. L. Price, Pte. T. Sandford, Pte. F. Jones, Pte. D. Manning (Shrewsbury Division).

In charge of the St. John first aid duties on the Coronation route is Colonel Geoffrey Page, No. I District Commissioner, who is cooperating with the Metropolitan Police. Superintendent C. E. Bowler is Col. Page's chief of staff. There will be some 7,000 St. John members on the route, and of these 5,000 come from London and the remainder from all parts of the cou ntry. Members are to work as teams under their own officers.

The route extends about 61 miles, and there are to be over 100 first aid posts Dressing stations will be situated in side streets behind the route. Half of the St. John personnel will be on duty from 5 a.m., the remainder come on duty at 7 a.m. Members will carry first aid haversacks and filled water bottles, coats according to weather.

be on duty in Westminste,· Abbey

The names of the doctors who will attend in the Abbey have not been published; it is understood that nine will be civilian doctors and the remainder will come from the Services. Sir Horace Evans, the Queen's physician, will be in attendance.

The B.C.R.S. will be responsible for that sector of the route lying between the Achilles statue and Marble Arch, in Hyde Park. There will be nine ambulance stations, and seven dressing stations and about 1,500 members, from all parts of the country, will be on duty. A skeleton staff will be on duty from 8.45 p.m. on Monday, 1st June, and at midnight the first women members will come on duty. Personnel will be at full strength at 7 a.m. on 2nd June.

AU ambulance duties will be controlled by the Sector Commander from a Sector HQ., and each station will be in charge of a Station Commander, in the case of dressing stations this officer will be a County Medical Officer. The Red Cross have instructed that all officers and members should have undergone first aid refresher instruction, and all men personnel should be practised in stretcher drill, especially handling of cases out of crowds and high stands, and the Llse of carrying sheets.

The Red Cross and St. John are to share a first aid post in the forecourt of Bucki ngham Palace. Cadets from both organizations will be on duty at many posts, and some will act as messengers and runners. A Police control point is being established at Scotland Yard.

Duties on the route will continue until about two hours after the procession has passed, but first aid posts near Buckingham Palace and the Embankment (for the firework display) will operate until midnight.

What casualties might be expected on this great occasion? We have asked a number of authorities this question, and opinion is that most cases will be sickness and faintness due to long standing, inadequate meals excitement, and so on. As usual : we can expect casualties from people who really ought not to attend, elderly people and the very young, and even some in ill-health who take a chance on such an important day, and who can blame them?

The weather will, of course, play an important part. If it is cold and wet (and it can be in June) there will be much more work. But we all hope that it will be a sunny, warm day to cheer the waiting crowds and to bless the; Queen ,

Five Red Cross Commandants-from London, Scotland, Northern Ireland , Wales, and the Isle of Man-will be on dut) in Westminster Abbey on Coronation Day. They are:

Mrs. E. Carnegy Arbuthnot, Commandant County of London 442. She joined the Westminster Division in 1938, and saw service in First Aid Posts and the Mobile Unit in London during the war. Holds the Red Cross Distinguisbed War Service Certificate.

Mrs. B. McAnally, Commandant of Belfast /54 and a Life Member of the Society. First enlisted in 1938 and was appointed Commandant of Belfast /54 in 1940. Was on first aid duty in Belfast during the war. Went to Canada in 1946, and on her return in 1947 rejoined the Society, when she was engaged on welfare work. Reappointed Commandant of Belfast, 54 in 1952.

Miss Barabel MacIver, Commandant of Anglesey 6. Was a V.A.D. in India during the war, later with the Royal

Mrs. W. Wood, Commandant of Isle of Man /2. First joined the Red Cross in October 1949 was appointed Assistant Commandant in October 1951, and in the following October was appointed Commandant. Is a member of the N.H.S.R.

Mrs. Alison L. Grant, Commandant of Dumbarton. Is a B.R.C.S. Instructor, General Instructor, Home Office and Casualties Union Instructor. 'Vas with the Mobile J'Jlood Withdrawal Unit during the war.

Mrs. E. Carnegy Arbuthnot, London.

FIRST AID & NURSING, MARCH/APRIL 1953.

Mrs. B. McAnally, N. Ireland.

Mrs. Barabel MacIver, Anglesey.

Mrs. W. Wood, Isle of Man.

British Bail",ays

WESTERN REGION

Women's First Aid Competition

THIS competition was held at Old Oak Common Hostel, London, and the following is the result :-

1. Newton Abbot (Florence M. Lean Cup and prizes) 29H

2. Swindon (Mabel A. Potter Cup and prizes) 246

3. Bristol o. 2 (prizes) 238

4. Bristol No. 1 23n

5. Paddington

6. Swansea 216t Doctor E. J. Selby was the adjudicator in the team test and Doctor A. H. Jones in the individual tests. The trophies and prizes were presented by Mrs. Grand.

The Newton Abbot team have qualified to compete in the British Railways and London Transport (Railways) Competition for Women which is being arranged by the St. John Ambulance Association at the Central Hall, Westminster, S.W.l, on Thursday, 21st May, 1953.

British Transport Commission Police First Aid Competition-1953

The South-Western Area Eliminating Competition was held at Old Oak Common Hostel, and the following is the result :-

lv/aximlll71 No. of Marks 400 Dover... 315

Exeter 304 Cardiff General 303 Brighton 296

The adjudicators were Doctor F. H. Taylor, of London, and Doctor C. T. ewnham, Western Region Medical Officer.

Mr W. W. Wood, Chief of Police, South-Western Area, presided at the presentation of prizes which took place at the tern1ination of the contest, and was supported by Mr. W. B. Richards, Chief who presented the prizes, the adJudIcators, Mr. S. G. Ward, Assistant Regional Staff Officer, Mr. E. C. Brashier Assi!>tant Chief of Police, Mr. P. Anstey: ReglOnal Ambulance Secretary, and Mr. J. A. Martin, Assistant Regional Ambulance Secretary.

The Dover team will represent the SouthWestern Area in the National Competition organIZed by the St. John Ambulance Association which is being held at the Central Hall, Westminster, on 21st May.

Paddington

Mr. W. T. Geden, Station Master Paddington, presided at the presentation of first aid awards to members of the London 'A' District of the Western Region. He was supported by Mr. K. W. C. Grand Chief Office,r, who presented the t;ophies and prIZes gamed at the recent District and also a number of long serVIce efficIency awards. The presentation of. class was made by Mr. N. H. Bnant, Dlstnct Operating Superintendent. Other Officers present included Mr. G. Matthews, Operating Superintendent, Mr. C. Furber, Commercial Superintendent, Mr. R. Burgoyne, Regional Staff Officer and Doctor C. T. Newnham, Regional Officer.

F IR ST A ID D URING T HE FLOODS

R epor t from Essex

THE Essex coastal areas suffered severe flooding accompanied by serious loss of life on Sunday, 1st February. In many respects the worst hit area in the Essex Region was Jaywick, near CIacton-on-Sea, where 37 lives were lost and approximately 700 persons were rendered homeless.

(The Canvey Island area is in o. 1 District.)

In the Harwich area the homeless was about 3,000 but the loss of life was small, the great danger in this area was due to the breakdown of the sewerage arrangements.

The Commissioner for Essex, Dr. J. T. Whitley, O.B.E., M.B., Ch.B., on receiving the news of the disaster, at once went to Jaywick, and later to Harwich. He was prominent in organizing the relief work at Harwich and expressed his great satisfaction to all concerned at both places at the manner in which they were carrying out a very difficult task. He was accompanied by County Staff Officer Miss W. K. Argent.

The County Nursing Superintendent, Mrs. E. Smellie, M.B.E., who resides in Colchester, was one of t11e early ones in action at Clacton and grl' at credit is due to her for her work in the early stages at both Clacton and Har.vicb. Mrs. Smellie since recorded many duty hours at both towns and has been a great help in obtaining many urgent articles for use of the homeless. Many very favourable comments have been passed regarding her services in these two areas.

The first news of the disaster was received at County Headquarters at 10.30 a.m. on Sunday morning, this was at once passed on to the County Duty Officer, Mr. W. R. Unwin, who promptly mobilized 15 members of the Chelmsford Ambulance and Nursing Divisions and arranged for their transport to the Jaywick area, a distance of over 40 miles, which they reached soon after lunch.

The Duty Officer accompanied this party, and on arnval all were soon very busy assisting the Clacton Nursing Division in housing the homeless and attending to their wants at the seven hotels which had been taken over by the local authorities. This party put in app:-oximately 200 duty hours, eight members staying all night at Clacton on duty. Their assistance was much appreciated by the Local Nursing Superintendent.

The County Headquarters at Chelmsford have had a busy time receiving and allocating clothing, bedding, etc., for the victims of the flood, van loads being received from many areas. Meritorious service was rendered at the Essex Headquarters by County Staff Officers Miss W. K. Argent and Mr. J. S. Smith who spent many hours on this important work.

Also, mention should be made of the work which has been carried out by County Staff Officer Mrs. Wakeland Smith who has been responsible for the distribution of bedding, etc., for the Joint St. John Ambulance and British Red Cross at Canvey

Island, assisted by other St. John Auxiliaries from the Hospital Library Department. Without doubt the work performed by the Brigade in Essex has been of a very high standard and a credit to all concerned.

Clacton-on- Sea Ambulance Divis ion

This Division, under the charge of Div. Supt. H. F. Fancett, was called upon to assist at Jaywick in the early hours of Sunday, and together with its ambulances was soon assisting in both the rescue and transport of the victims at Jaywick. The Division was later joined by Supt. R. H, Weavers and members of the Walton-onNaze Divisions together with their ambulances. All members toiled for long periods under very trying conditions, working with the Police, C.D. Firemen, County Council Ambulances, Salvation Army and many others.

Many cases were treated on the spot and it was not before late on Sunday night that they were able to relax.

Great credit is due to both Supts. Fancett and Weavers and the members of the C1acton and Walton Divisions for the meritorious manner in which they upheld the tradition of The Order.'

Harwich Ambulance and Nursing Diyisions

At Harwich the floods caused few casualities but tbe welfare work to be carried out was tremendoLls.

A large portion of this fell upon Di\,. Supt. Mr. B. L. Bowden and members of the Harwich Divisions, who performed a task of great magnitude. They were called upon in the early hours of Sunday when the floods broke through and caused about 3,000 persons to be rendered homeless.

It is almost impossible to state fully the work which members of this Division carried out in the first 48 hours, both rescue and transport were the foremost tasks, to be followed later by the housing of the victims at the Army Transit Camp at Dovercourt.

Here, once again, the County Supt. Mrs. E. Smellie, was of great assistance. Members of the Colchester Divisions have been assisting with the work at the Transit Camp under Div. Supt. I. M. Evans, over 300 hours of duty being performed in the period 1st to 14th February.

The welfare work at the Transit Camp may have to be continued for a long period due to the damage to the sewerage system. Manningtree, Braintree and Wivenhoe Divisions are assisting.

Many fine compliments have been passed by variOLlS civic heads regarding the work done by members of the Brigade in this area.

Clacton -o n-Sea N ursing Division

Special mention should be made of the splendid work which has been carried out by Div. Supt. Mrs. S. Chipperfield and the members of this Division,

FIRST AID & NUR SING, MARCH/APR TL 1953

Here the main task was the reception of the homeless and settling them in at one of the seven hotels which had been taken over by the local Council, this entailed a great amoun.t of labour, treating for exposure, supplymg changes of clothing, etc" redressings and assisting the old folk of whom there were many. About 700 persons were covered in this operation, the babies in arms proved to be one of the most difficult to cope with, but the D ivision by making calls on various shops in the town on Sunday were able to obtain the necessary articles.

Some of the members were on the job for over 36 hours without a break, they were assisted by members of the Chelmsford Ambulance and ursing Divisions.

Later in the week it was decided to take over the Valley Farm Caravan Camp to house the homele s, here once again Supt. Mrs. E. Chipperfield and her members have carried out a wonderful job, being in sole charge of the camp since, this has proved '0( to be a great strain on the members of the Division but they are carrying on in a magnificent manner.

Once again the Divisions at Chelmsford have assisted by supplying members to relieve the CIacton personnel at week-ends and the local Division is very grateful for this help.

Burn ham-on -Cro uch Divisions

These Divisions were called out very early on Sunday morning and while the ursing Division assisted the flooded people on the river front the Ambulance men joined in the work on the sea wall.

On Monday morning they were again called at 2 a.m. to prepare for the evacuees from Foulness Island. Two Ambulance men with Divisional Surgeon Dr. Wilson went over on to the flooded island and the ambulances stood by taking the refugees from the boats. At the Rest Centres the ursing Division worked all day feeding babies, dogs, cats and looking after the refugees who ,"vere housed in the two Royal Yacht Clubs and Salvation Army H,Q. The next day they helped with their removal to a rest centre at Gt. Wakering, and as the refugees were now in o. 1 District the task of the Burnham Divisions was deemed to be completed. Supt. Mr. H. Whife and his members, both ambulance and nursing, have carried out their tasks here in a very creditable manner.

Manningtree Ambula nce a nd Nursing Diyisiolls

These Divisions, under Supt. W. Foster, were engaged in the rescue and evacuation of persons whose homes had been flooded at Manningtree.

They were called out very early on Sunday and while the Ambulance men were assisting in rescue work the ursing members were engaged in the reception of the homeless.

A large amount of work was carried out at the Division Headquarters, drying out bedding, clothing, etc., which has been sa lvaged from the damaged houses, thi task was carried out over a number of days.

Ma r coni- Che lmsford A mb ula nce Divis ion Two ambulances and seven members of the Marconi Division were among those who assisted with the rescue work and evacuation of Canvey Island.

(contin/led at foot of next coli/11m)

High S t "nda,- d in Police Contest

T HERE was a narrow finish in the Police ational First Aid Competition, held at the Porchester Hall, London, on 26th Febru<l:ry. L Divisiof', Metropolitan Police, and CIty of London 'A' team scored the same total number of marks but as L Division were awarded two ma'rks more in the individual tests they were the winners and retain the Pim Trophy for another year: The City of London team retain the Police Review Cup for runners-up.

Sir Harold Scott. Metropolitan Police C?mmissioner, and Captain H. P. Griffiths, CIty of London Acting Commissioner, were present to see their teams receive trophies from Lord Lloyd, Under-Secretary, Home Office, and the Chancellor of the Order of St. John, Lt.-General ·Sir Henry Pownall, presided at the ceremony.

A tribute to the high standard of the teams was paid by Dr. K. P. Duncan, Brighton, who judged the individual tests. I have never judged a competition with a higher average standard,' he declared, and

Vo luntary

Miss Pat Hor\lsby-Smith, Parliamentary Secretary to the Ministry of Health, praised the voluntary spirit which is now devoted to the wel fare of patients, when she opened the CO:lference on Picture and Book Libraries and Music in Hospitals organized by the British Red Cross Society. the Order of St. John and the Council for Music in Hospitals at the Welcome Research Institution, London.

The advent of the ational Health Service, she said, although it had relieved hospitals and as ociate voluntary organizations of the onerous task of raising large sums of money for hospital construction and maintenance, had not eliminated the need for voluntary work. On the contrary, it had made it possible for \oluntary organizations and workers to concentrate more on that field of activity in which their efforts

They were called out by the Home Service Ambulance Headquarters before lunch on Sund 1Y morning with instructions to proceed to Canvey lsland. There they set up operations in the Island's Secondary School and later moved to the Fire Station where conditions were found to be more favourable. They continued with this work until late on Sunday night. The Division was in charge of Mr. C. Bedwell.

* FL O RENCE NIGHTINGALE'S HOME

The home of Florence l ightingaleEmbley Park Gardens, near Romsey, Hampshire, vill be open to the public in aid of Red Cross funds on Sunday, 17th May, from 2,30-6.30 p.m,

went on to say that he was not surprised that there had been a tie for first place. '1 could not have told the difference between the first three teams with any certainty. The standard of discipline and team-work was extraordinarily high throughout.'

Lord Lloyd said that they were emerging from a se\'ere winter of disaster and tragedy. In these times we realize how invaluable it is to have those who can give skilful and immediate assistance to the afflicted.' Placing of the teams was as follows maximum marks 400 -

1. Metropolitan Police (' L 'Div.) 35 H

2. City of London Pol ice' A' . 351!

3 West Sussex Constabulary 3421

4. Birmingham City Police o. 1 332-

5. Grimsby Borough Police 313

6. Royal Ulster Constabulary 322.1-

7. Glamorgan Constabulary -0 I 322-

8. Devon Constabulary... 318

9. Edinburgh City Police. 307

10. Liverpool City Police' B 292 !

11 Bradford City Police' B

in Hospitals

were most effective-the welfare of the patients.

The Order of St. John and the British Red Cross Society had always been in the forefront of acti vities promoting the welfare of hospit a p a tients and they , along with the Counc l for Music in Hospitals. proyided for patients many valuable services of occupation a , entertainment and educational value.

TOPICAL NOTES

(collfinlled from pag e 10)

that the person i an epileptic and gi\'es information as to ho\\. he should be treated if he has an attack. His name and home addre s are in cribed on the badge. The British Epilepsy Association which has its headquarters in Victoria Street, London. S.\".!, maintains a close touch with the ational Epilepsy League of America, and this is in\'aluable for the exchange of information as research progresses British Children in Danish Sanatoria

During last year, fifty children who \,ere suffering from tuberculo is were sent to a Danish sanatorium for several months' treatment. under a scheme inaugurated by the Anglo-Danish Society and the British Association for the Prevention of Tuberculosis. They were recei\ ed at the airport by Princess Anne of Denmark. who welcomed them on behalf of the Danish people rvlany of them have now returned with their health restored and with \ ery happy memories of their Stay in Denmark. Before their return they were im ited to stay \\ ith Danish families for a few days, and they were delighted with the kindness they received. Sufficient funds have now been raised by the societies concerned to enable 100 children to go during J 953. and the first party left by chartered 'plane on 19th March for Vordingborg Sanatorium.

First aid on building sites

IN a recent issue we commented on the need for first aid facilities on building sites, seeing that the building industry is by its nature more hazardous than factory work. Readers who are interested in setting up first aid on sites will find the matter dealt with in a new publication from the Ministry of Labour and National Service entitled • Welfare Arrangements on Building Sites' (Stationery Office, price 9d.)

It is pointed out that beside the risk of minor injury from cuts and scratches there is a special risk of serious injury being caused by falling from a height or by falling materials. But experience shows that it is not always a severe accident that in the end proves most serious. Neglect or inefficient treatment of an injury apparently trivial may cost a worker the loss of a limb, an eye, or even his life.

It is therefore especially important that in the case of building sites there should be adequate arrangements for the promp.t first aid treatment of all injuries. Where more than 10 persons are employed at a site the requirements of Building Regulation 80 are obligatory. First aid boxes or cases of the appropriate standard are required to be provided and should be suitably located with regard to the distribution of the men. Such boxes or cases can be obtained complete and ready for use from most chemists but it is desirable to specify Factories Act Standard B or Standard C respectively.

WATER HEATER

D

If more than 25 men are employed every box or case must be in charge of a responsible person capable of giving first aid treatment. One such person may be in charge of more than one box or case but he must be readily available and his name must be plainly indicated in a prominent place near the box or case. At sites where the number employed is substantial the setting up of a definite first aid post is strongly recommended.

Serious consequences may result from the unskilful handling and carrying of men who have fallen from a height and received severe injury. On or in the immediate vicinity of building sites where more than 100 persons are employed an ambulance with a suitable stretcher or stretchers is obligatory unless definite arrangements have been made in advance to obtain one promptly from a hospital or other place to which telephonic communication is readily available.

On large sites the provision of a properly equipped ambulance room should receive consideration, and this is specially important where the site is an isolated one. Building Regulation 80 (5) makes obligatory in certain circumstances the provision of an ambulance room equipped at least up to the standard in the Building Operations (First Aid and Ambulance Room Equipment) Order 1948, and in charge of a qualified person.

EXAt11NATIOH LIGHT POINT

e.g. ANGLE POIIE

FOOT·BATH BATH HEATER DRESSINGS oBUCKET o CHAIR COUCH FOOTSTOOL

D

ALL-PURPOSE TROLLEY CURTAINED RECOVERYo ROOM CHAIR COUCH

DRESSII+GS (ABINET

FIRST AID & NURSING, MARCH/APRIL 1953 FOR EVERY LOCAL GOVERNMENT NEED

Useful information as to the organization of first aid services and ambulance rooms is given in Welfare Pamphlet No.4, entitled First Aid Services in Factories' published by the Stationery Office. Consultation with H.M. Medical Inspectors of factories is also advised where an ambulance room or relatively elaborate first aid services are in question.

The illustrations show the general lines in which ambulance rooms can be planned.

As a matter of interest, we append Regulation 80 of the Building (Safety, Health and Welfare) Regulations 1948, referred to above. It reads : -

First Aid, Ambulances and Ambulance Rooms REG. 80.-(1) With a view to making adequate provision for the prompt first aid treatment of all injuries likely to be sustained by persons employed during the course of operations to which these Regulations apply, the following requirements shall be observed.

(2) (a) In the case of a site where more than 10 persons are employed in operations to which these Regulations apply, a sufficient number of suitable first aid boxes or cases shall be available at or in the immediate vicinity of the site in a readily accessible position or positions while work is going on;

o

G DRESSINGS BUCKET II

o

Two suggestions for tbe layout of industrial first aid or rooms.

Twelve specialised types of vehicles - but all one make Bedford. Consider tile advantages of the One-Make fleet in terms of s implified maintenance and spare parts s tocking, together with interchangeability of drivers and mechanics. And with Bedfords there are the further advantages of low initial cost, low

running cost, readily available spare parts, and nation-wide Square Deal Service. With a range of chassis covering all loads from 10 cwts. to 10 tons, there is a Bedford for every local Government need. Full particulars from your local Bedford dealer, or write direct to the Municipal Vehicle DepL Vauxhall Motors Ltd., Luton, Beds.

PAYS TO STANDARDISE 0

(b) In the case of a site where more than 100 persons are employed in operations to which these Regu lations apply , there shall be provided and available at or in the immediate vicinity of the site a properly constructed ambulance with a suitab le stretcher or stretchers ; Provided that sub-paragraph ( b) shall not apply if specific arrangements have been made for obtaining an ambulance and stretcher promptly, when required, from a hospital or other place to which telephonic communication from the site, or from a place in the immediate vicinity of the site, is readily available.

(3) Every first aid box or case provided for the purposes of this Regulation shall :-

(a ) Con tain at least such equipment and materials as may be prescribed;

(b) Be distinct vely marked ' FIRST AID ;

(

c) Be placed under the charge of a responsible per son who in the case of a site where more than 25 persons are employed shall be capable of gi ving first aid treatment , who while in charge of the box or case shall be readily available when the box or case is liable to be needed and who se name shall be p lainly indicated in a prominent place near the box or case .

(4) Nothing except appliances or r equisites for first aid shall be kept in a first aid box or ca se.

(5) In the following cases, namely :-

(a) In the case of a site where more than 500 persons are intended to be or have been employed at a nyone time in operations to which these Regulations apply and the number so employed is for the time being more than 250, and

(b ) Jn the case of a s ite at which more than 250 persons are intended to be or have been so employed and which is more than 10 miles from a hospital and at which the number so employed is for the time being more than 100, there shall be provided and maintained in good order and in a clean condition a properly constructed ambulance room with equipment at least up to such standard as may be p r escribed. The room shall be u sed only for purpo ses of reatment and res t and shall be in charge of a suitably qualified per son who shall always be readily a vailable during working hours and a record shall be kept of all cases of accident or sickness treated at the room.

(6) For the purposes of Regulation 80 numbers employed shall be reckoned according to the largest number at work at anyone time.

Equipment of Ambulance Rooms

The Building Operations First Aid Order states that the equipment of an ambulance room for the purpose of paragraph

(5) of RegulatIon 80 of the Regulations shall be at least up to the following standard namely : (i) a glazed sink with hot and cold water always available; (ii) a table with top (iii) means for sterilizing (IV) a supply of suitable dressmgs, .bandages and splints ; (v) a couch; (VI) a stretcher; (vii) blankets and hot water bottles; and (viii) a foot-bath

TOPICAL NOTES

FIRS T AmERS & FOR NURSES

Coron ation Duties in the Abbey

It is a proud privilege of the D ean of the Westminster Hospital Medical School to be responsible for a ll arrangements for the provision of first aid in Westminster Abbey during such great occasions as the Coronation of a Sovereign. Such arrangements for 2nd June are now well under way. The personnel will include ten State Registered nurses , five Red Cross Commandants and three SL. John Ambulance nurses. Departing somewhat from previous precedence, not all the State Registered nurses are from the Westminster Hospital on this occasion, for each of the three Nursing Services of the Crown will also be represented The British Red Cross Society have chosen their team on a national basisone Commandant from England, one from Scotland, one from Wales , one from Northern Ireland and one from the Isle of Man. At the Coronation of King George VI fjrst aid stations were set up in different parts of the Abbey , but at given times the teams which manned them moved from one to another, so that each ha d an opportunity to view the magnificem ceremony from various vantage points It has not yet been announced whether a similar plan will be followed on 2nd June.

More People Nursed in their Own Homes

The Queen's Institute O f District Nursing has recently published a Report on its work during ] 952. In London alone Queen's Nurses paid 1,676,429 visits, which were 126,000 more than in the previous year. Of this increase, 20,000 visits were made in December as a result of the fog.

The Institute was founded in 1888 by money collected as the Women's Jubilee Offering to Queen Victoria, and it was she who directed that it should be devoted to the extension and development of district nursing. The fund had reached £70 000 and it produced interest amounting to' £2 000. The organization was known, for as Victon a 's J ubilee Nursing

By Its Charter granted in 1889, It connected with St. Katherine s Royal Hospital, Regent's Park, which had been founded and endowed by Queen Matilda the Consort of Stephen in the 12th century ; the Queens of England becoming its Patrons during the intervening centuries. A Supplemental Charter, granted by Edward VII in 1904, terminated the association of the with St. Katherine's, and g a ve permISSIOn for part of its i ncome to be applied to the training of midwives. Under a revised Charter, granted in 1928 the name of Institu teo changed to , Queen's of Dlstnct Nursing ,' for this was to be more suitable, as the relgnmg Queen or Queen-Mother has a!ways been its Patron. The Institute has SInce been governed by a Council nominated,

or approved, bJ:' Her late Majesty, Queen Mary a certam number of its members being appointed directly by her.

The qualifications required of a Queen's Nurse are on the same general lines as when the Institute was founded although they have advanced. with the scientific development of the tImes. State Registration is n ow the basic requirement , augmented by SIX months special training, with courses of on and Child Welfa re SOCIal EconomIcs , Tuberculosis and other subjects relative to district nursing. The Institute has now over 9000 nurses twothirds of whom are als; State Midwives Since 1947, male nurses h av e been accepted for Queen's training. About 200 have now qualified and they are proving a great asset to the Institute, particul a rly in the. of m a le p a tients when hea vy lrftmg IS mvolved The Institute a cts as a n and e xecutive centre in negotiations With Go vernment Departments and in connection with national insurance assistance schemes, family allowances , the ca re of old people the employ ment of disabled persons and m the w?rk of v olunt a ry agencies, such ?s the probatIOn officer. 1t is now a st a tutory lllstead ?f a voluntary org a n iza tion , but 10 p C of ItS costs mu s t still be r a ised from voluntary sources

About Epilepsy

Both in this country a nd in America the problem of helping tho se h a ndi ca pped by epilepsy to take their pr o p e r pl ace in the community as wage-earning and responsible citizens has received much attention in recl?nt years. With th e help of modern drugs, ep ile pti cs ca n no w ltve normal life. For a lon g time , phenobarbItone w a s prescribed fo r most c ases of epilepsy Th e newer phen y toin' does not produce the drowsiness th a usu a lly follo ws the taking of phenobarbitone and it is particul?rly effective in g rand 11101 , although It often mcreases the frequency and duration of p e tit mal attacks. On th e other hand , tridone is almost a s specific in the controi of p e tit mal.

Epileptics now have a Society of their own- the British Epileps y Association , WhICh founded III 1950 with the objects of furthenng research into epilepsy, helping the sufferers and bringing the true facts abou the condition before the gener a l public so that secrecy may be o vercome and the stigma which was attached , in the past, to the dIsease m a y be a voided The social aspects of the work of the Association includes the provision of an advisory service and the compilation of an inde x or available accommodation in hostels, homes and colonies where treatment may be given. Social clubs and centres have been established to give companionship and help , and all members of the Association carry a badge that indicates to police and ambulance men

(continu ed 0 11 pag e 7 )

A simple relief for children's strains and spraLns

The vasodil a tation and hyperaemia resulting from the application of ' Al gipan' Balm to minor injuries where the skin is unbroken is rapidly followed by relief of pain .

In 'Algipan,' the powerful vasodilator Histamine has been combined with Methyl Nicotinate and is th us able to penetrate to subcutaneous levels. Here, it promotes an increased flow of blood to the injured ti ss ues, assists in the removal of exud a te s and imparts a warm subjective feeling of comfort.

Bland, soo t hin g, readily absorbed and free from OilY. residue , 'Al g ipa n is a comforting b a lm that will not delic a te s kins a nd is ideal for the treatment of the mlOor ti ssue injurie s so common to children.

For the relief of paIn 'Algipan'

Aid f or the Brigade by B A RN ET T MITCHELL LTD.

19 53 PRICE LIST

Officers ;-

. .... .. ... . ......... . .. according to rank

IJ"iforn, Co"tr actors to H.M. 60Ver"'lIe"t ""d Public etc.

FrRST AID & NURSING, MARCH /APRIL 1953

F. C. (London, S.W.2) writes :-

In the S.J.A.B. Textbook we are told to use three splints (f both legs are fractured if assistance is available, but to use onl), the middle splint if no assistance is available, ret il1 the case of both Femurs beingjractured we should, presumab/., ' , use three splints whether lIIorking with oj' without assistance.

I have given this ruling some thought, but cannot understand ,vhy, if one person (alone) can use three splints in the one case, wily not use three in the other ?

I shall be very grateful for your explanation.

Answer

I suggest that the reason is that in the case of fractured femur, the two outside splints are well supported in position by the bandages round the chest, hips, and ankles (i.e., well away from the sites of fracture) before the other bandages are tied off. Hence there is little risk of the splints slipping, etc., during the remainder of the treatment. The same remarks would not hold good in the treatment of fracture of both legs.

* * *

R. J. G. (Lee) writes :-

A difference of opinion has arisen, regarding the order of use of the Constrictive Bandage as quoted on page 98, Rule 10 of' First Aid to the Injured.'

Am I correct in saying that: FiJ'st apply direct pressure, if this fails, place pad over wound and apply a firm bandage. Should blood seep through, appLy a further pad and bandage, once again blood seeps through, then apply the constrictive bandage afew inches above the wound, and should this fail apply pressure to the nearest pressure point.

I should like your comments on this subject. Many thanks for your co-operation .

Queries

Answered by Dr. A. D. Belilios, M.B., B.S. (Lond.), D.P.H. (Eng.)

Answer

I agree with your interpretation. You will appreciate that application of the constrictive bandage is a more permanent method of stopping the bleeding than using a pressure point where it is difficult to continue pressure during tr[1t"sport, and while doing other treatment.

* * >I<

R. G. (London, E.IO) writes :-

In the FIRST AID & NURSING Sept./ Oct. issue under' Report on Home Accidents,' if states holV materials for dressings may be steri/;::ed by baking. With pressure cookers getting into many homes it occurred to me that possibly they could be used as a substitute for an A ft oc/ave for the sterilization of dressings and instruments. I ask ifit )I'ould be as effective as baking as the pressure of 15 lb., at 11'hich they will opemte, produce a temperature of 262 o. The separators could be inverted and the bottom plate put Oil top to f orm a platform on which the dre::r:;;'1gs, etc., ma), he placed.

If you agree, I should like to knOll ) how long it lVould be necessary to maintain this temperature to ensure sterilization.

Answer

What a difficult question! I enlisted the aid of the National Pressure Cooker Company, and their Mrs. Richardsun has been most helpful. So far as instruments are concerned, five minutes at a pressure of 15 lb. is probably more than sufficient. Although dressings could also be sterilized , they would emerge slightly damp, and would have to be used immediately, since if stored damp they would go mouldy, and if dried they would be liable to re-infection.

Instructions for sterilizing instruments are given in Presto recipe books. It would appear, however, that there is room for [urthel' investigation of this subject.

F. H. (Dublin) writes :-

On page 143 of' First Aid to the Injured,' a Potts fracture is mentioned. The illustration (Fig. 99) suggests that this injury is a fractured tibia and fibula in the region of the ankle. Since the figure is not quite clear I should be glad for further i,?forma lion.

Answer

A Potts fracture is primarily an oblique fracture of the fibula about 2 in. above the ankle. It is often associated with a fracture through the lower end of the tibia.

C. R. E. (Torquay) writes :-

In our office of five, all except one got :flu recently. The lucky one told us that his doctor had given him injections to prevent the i11ness. Can you give us further information please?

Answer

Injections to prevent 'flu have given most promising results but further research is continuing. Three injections are given in the autumn and two boosting doses in January. The course can be reduced to two and one respectively. The injections protect against the two most common viruses causing 'flu but they must not be regarded as ] 00 p.c. certain.

:I:

N. V. J. (Slough) writes :-

A canteen worker in our factory stubbed her finger against a table, noticed a sharp pain and discovered that the last bone of her ring finger had become bent and she couldn't straighten it. l could straighten it easily but it kept on slipping dOH'n again when I let go. I told her to see her doctor but she hasn't come back to work. What was the probable injury and how should it be treated.

Answer

Almost certainly a torn tendon attached to the back of terminal phalanx of the finger. First aid should consist of applying a well padded splint to the palmar aspect of the finger, arranging the padding so that the affected part of the finger is bent in the direction opposite to that which it assumed after the accident.

PATENT "PORTL _ N..D"

AMBULANCE GEAR

The Gear IIlustrated(A.B.C.D.) carries two stretchers on one side c.f Ambulance. leaving other side clear for sitting patients.

The UP AND DOWN action is quick and easy for loading or unloading.

A. Shows the two stretchers in position.

B. Shows the top stretcher lowered ready for loading.

C. Illustrates the same Gear with the top stretcher frame hinged dewn use when only one stretcher case IS carried.

D. Shows the same position as in C only with cushions and back rest fitted for convalescent cases.

Where Ambulances are required to carry four beds two Gears are fitted, one on EITHER SIDE, and the same advantages apply as described above.

giues pletlsure bill that l1Jhich gives pain

MONTAlGNE

the truth of this is , alas, only too evidcnL to liable to indigestion. Fortunate iL is that in BiSoDoL Powder they have a faithful friend and ally, whose antacid properties are alway ready to hand. BiSoDoL, with its contcnL of Bismuth, Magnesium and Sodium bicarbonate , brings swift and soothing relief to the ga tric membrane, tiding the dyspeptic patient oyer his occasional dietary lapse.

First C,·osswoird No.4

Compiled by W. A. Potter

ACROSS

1. Its head becomes smaller at each turn

10. Hatred

11. Air gasped in a new way

12. Intimate acquaintance

13. Native instrument of two boys

16. Young hawk

17. Wound consists of ornamental fabric an d regulated allowance

20. Often precedes Arthritis

21. Cricket Final : England 162 and 299; AustraLia 271 and 190

23. To push the final result

25. Passes by the girls

28. It separates the abdomen and thorax

29. Squint

ACROSS

Large arm sling;

10,

(6,7)

(7,6) DOWN

3 Mental disorder

4 Important in 'twili<.;ht' vision

5. As well

6. Where to cut your Imen square to make triangular bandages

7. Concede an insect in end ...

8. Appearance of blood in Haematemesis..

9. But this disease is common here -even during the war

14. State one of the five senses

15. Bee around 51! Sb0w to be false

18. Your small one is milch longer than your large one !

19. Removed the rough . .. ..

22. Common site for dislocationespecially goalkee pt" S

24. Sarcastic allusion. Could it corne in ' a straight lalk'

26. Its continuation will aggravate shock

(So/ution next issue)

(9) (6) (4) (4) (8) (5) (6,7) (6,7) (5) (5) (9) (8) (6) (5) (4) (4)

R. C. M. (Wembley) writes I have just got a job in a factory where they make thermometers and am to look after the first aid. I hear mercury workers are liable to illness sometimes. What must I look for?

Answer

Congratulations on your new job. Fortunately, thanks to modern precautions in factories, workers are only rarely affected in these days but you must be suspicious of any of the following symptoms: (1) Nervous instability; (2) swelling, bleeding or even a. blue line on the gums; (3) movements of the fingers , eyebds or mouth; and (4) disturbances of digestion.

* :;: * J. C. F. (Southampton) writes In the treatment of a fractured pelvis we are told to lVarn the patient not to pass water if he can avoid it. What is the reason for this advice ?

Answer

If the neck of the bladder or the urethra has been torn as a complication, urine passed may not leave the body in the normal way but enter the fat under the skin in the region of the crutch or serious mishap called extravasation of urine.

Miscellaneous Advertisements

with remittance should be sent to F rst Aid & Nursing, 32 Finsbury Square, London, E.C.2. Rate 3d. per word minimum 4s. 6d. Trade Advertisements 4d. per word, minimum 6s. Box numbers I s. extra.

NurSing

the Army goes go the girls of Queen Alexandra's Royal Army

free - TICES II Oaklands Grove, London, W I2. HOLIDAYS. Excellent food, feather beds, H & C. bedrooms, reduction to S J.A.B. members and famjijes. Hunter, •Lynton,' Marine Rd Prestatyn, N. Wales, Phone 639. S JAB Badge Wall Shields 26s. 6d S.J.A .B. •• • • Gold Cased Crested Cuff Links 42s. Ideal presentation gifts. Medals and miniatures iI;nmediately; sew on ribbon bars, 9d. per ribbon; pm brooches covered Is. per ribbon Stamp for leaflets. Jeffery, Outfitter, St. Giles, Northampton. of open brigade first aid competitIOns III North or Midlands area requiring entrants communicate with W. Hall, 32 AJderley Road, Winnington, Northwich, Cheshire. FIRST AID & NURSING, MARCH /APRIL 1953 15 \ \ ,\ \%W

GARROULD'S for the Regulation Uniform for

OFFICERS

&

(Femaie only) OF THE ST. JOHN AMBULANCE BRIGADE F===================- Established over 100 years

We have specialised in the making of Nurses'. Uniforms for nearly 100 years and have a reputation for good quality materials and superb workmanship.

You can order your St. John Ambulance Uniform with confidence, knowing that every detail will be in accordance with regulations.

We shall be pleased to send full details upon request.

E. & R. GARROULD L TD.

150-162 EDGWARE ROAD, LONDON, W.2 ,

BAILLIERE BOOKS FOR FIRST AlDERS

A HANDBOOK OF ELEMENTARY NURSING

Arthur D. Belilios, M.B., B.S ., D.P.H., and Dorothea Duncan-Johnstone, S.R.N.

This handbook is the ideal guide for anyone who is called upon to carry out any form of emergency nursing. It describes in simple language the basic principles and procedures that underlie the science of nursing, and contains brief descriptions of the more common diseases, with general notes on the nursing required in each case. A complete chapter is devoted to the subject of home nursing, and the whole book provides for every first aider the essentials of nursing in a handy yet comprehensive form.

With 314 pages and 57 drawings, 7s. 6d.

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With 520 pages and 244 drawings. 65. DALE, REYNOLDS & CO. l TO.

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{ copy/ies of First Aid and Bandaging

Please send me copy/ies of A Handbook of Elementary Nursing copy/ies of Elementary Anatomy and Physiology

for which I enclose remittance of. (Postage 6d. extra per volume.) FIRST AID & NURSING, MARCH/APRIL 1953 THE HOUSE FOR HUMAN SKELETONS Articulated and Disarticulated HALF SKELETONS, Etc., Etc. ADAM, ROUILL Y & CO. Human Osteology, Anatomy. Etc. 18 FITZROY STREET, FITZROY SQUARE, LONDON, W.1 TELEPHONE: MUSEUM 2703 MEN'S UN)

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AID &: NURSING

AMBULA DES G CE

DYSMENORRH(EA

THIS IS AN IDEAL AMBULANCE FOR HOSPITAi.. USE both in Engla nd and abroad, especially where cases from isolated villages have to be colle-:::ted for conveyance to a central hospi ta', s the general pU i;.' ,e arrangement o f its accommoaalion offers facilities for .:a:·rying a number of p;1':lents under many different ci rcu mstances, In Great Britair. ,L.· possibilities are obvious for inter-hospital conveyance

An entirely new design in ambulances -with many unique features. It incorporates a new low loading top stretcher gear which enables two orderlies to load and elevate patients, the smooth action gear eliminating shock or jolts. The Wide centre gangway prOVides space for three wheel chairs, easily loaded by the ramp and wir.ch .

The flexible accommodation is (a) 4 stretcher and 4 sitting patients (5 stretcher cases in an emergency); ( b) 2 stretcher and 8 sitting patients; (c) 16 sitting patients. Built on Austin, Commer, Bedford or Ford chassis. Adequate provision for storing stretchers, blankets, medical supplies, etc.

YOU ARE INVITED TO APPLY FOR FULL DETAILS OF MOBILE MEDICAL UNITS, AMBULANCES, ETC., BUILT TO YOUR PARTICULAR REQUIREMENTS FOR SERVICE IN ANY PART OF THE WORLD

ARE

:he stars in their courses any more mysterious than the recurring cycle of the menses? As regularly and predictably as the phases of the moon, the average uterus sheds its endometrium every twentyeight days and the average woman experiences discomfort, pain and depression. Measurable relief from these symptoms of dysmenorrhcea may safely be obtained at every period with ANADIN tablets. Anadin combines the benefits of two pain-relieving compounds with those of two mild stimulants. Anadin is not habit forming and is quite safe for self-administration by the patient in the prescribed dosage.

Two to four tablets, according to severity of symptoms, repeated every four hours as required.

•.. Then you will follow tills point-by-point argument and reach the same conclusions as so many doctors, nurses, hospitals and clinics have done.

DO YOU AGREE ... that the causes of most skin infections are the common strains of STAPHYLOCOCCI, STREPTOCOCCI and B. PYOCYANEUS ?

IN THAT CASE . .. a treatment which is effective against all three will be indicated for cuts, abrasions, burns, scalds, boils and most inflammatory skin infections?

THIS IS THE TREATMENT

ANTIPEOL Cutaneous Vaccine Ointment contains the sterile vaccine ·filtrates of the three micro-organisms mentioned. The filtrates destroy the actual micro-organisms and at the same time act as a local immuniser against re-infection. This is a

purely biological action and there is no damage to delicate tissues.

RAPID HEALING is further expedited by the ointment base of proved efficiency. For burns and scalds, ANTIPEOL has special advantages. It is microbicide and non-adhesive. Therefore dressings do not have to be changed every day.

AND . HERE IS THE PROOF.

Antipeol Ointment is proving and reproving itself every day in dozens of surgeries, clinics, hospitals and homes. Letters from the medical and nursing profession bear convincing testimony to its effectiveness.

THERE is the logical argument for including ANTIPEOL Ointment in every First Aid kit. As a logical person, why not send for full details and a clinical sample ?

antipeol

cutaneous vacczne ointment

Produced by the makers of: ENTEROFAGOS for intestinal complaints; R H [NO-ANTIPEOL for nasopharynx infections; OPHTHALMO-ANTIPEOL for ocular infections; DETENSYL for reducing arterial tension. MEDICO-BIOLOGICAL

RD., SOUTH NORWOOD, S.E.2S

First Aid & . Nursing

ICORONATION DAY I 'My heartfelt thanks ...

SCOTLAND Yard's first information about casualties along the procession route in London on _ Coronation Day reveal that 6,873 cases were dealt with by the St. John and Red Cross, and that of these 313 cases were taken to hospital.

There were three ambulances and one ambulance bus standing by on the Embankment, in addition to two police launches which were available

May/June 1953 * In this Issue

Coronation Day

Elementary First Aid... 2

New Books for Nurses 3

Competition News 4

Topical Notes for First Aiders & Nurses 5

Diagnosis 7

Readers' Queries 10

First Aider's Crossword 12

A detailed analysis of casualties is not as yet available, but it is understood that there were no serious cases, most patients suffering from the effects of cold and exposure.

The London County Council ambulance service dealt with a record number of accidents calls on Coronation Day, and in the County of London area about 650 people were removed to hospital, an increase of 40 per cent on the previous highest total of 467 at the 1937 Coronation. In addition , 177 patients were taken t o first aid dressing stations along the route.

In contrast to this record number of accidents cails, the L.e.e. report that of the 33,000 school children assembled on Victoria Embankment the only casualty was one child who was taken home by ambulance.

A casualty is lifted over the dense cro\\ d to waiting St. John men. for transporting cases by water. Fortunately, they were not needed. Over the whole route, there were 39 ambulances, 10 of which were provided by the Joint Committee of Red Cross and St. John, and the remainder by the L.C.e. In addition, the L.C.C. had 48 ambulances on duty throughout the County of London.

St. John and Red Cross headquarters express satisfaction with the first aid arrangements along the route. During the time of the procession St. John dealt with 5,4 48 cases, sending 233 to hospital. Many more were dealt with in the evening, and on subsequent days.

We hope in a later issue to give more details of the work carried out by the first aid organizations during the Coronation period-work which earned an expression of thanks from the Queen.

(continued on page 5)

If you are a logical .person ••.

A St. John team dealing with fainting and exhaustion cases from the crowd in Trafalgar Square

A number of readers have asked for a course of articles dealing with Elementary First Aid. This will be supplied, but it must be clearly understood that no articles can replace the study of standard textbooks, attending lectures and undertaking practical training. Nevertheless, articles have a definite value; for new students they break the ice, for old students they stimulate thought and revision, while for everyone they are intended to clarify textbo oks and to show up the subject in a new light.

Elementary first aid

By A. D. Belilios M.B., B.S. (Lond.), D.P.H. (Eng.)

FIRST AID & NURSING, MAY/JUNE 1953

Cause of the Accident

Definition

IT is always well to begin with a definition. First aid provides immediate treatment for casualties -accidents and cases of sudden illness-Fain the moment of their occurrence IInti! the earliest opportunity of obtaining medical assistance.

This assistance may be needed on the spot, at a hospital or at the patient's own home; in less severe cases, of course, the patient can visit his own doctor during the next available surgery hours. The firstaider's judgment must which of these alternatives is most suitable for any particular case. Hence cultivation of good judgment by first-aiders must be regarded as important as learning how to treat injuries.

First Aid, therefore, caters for an interval of time-an interval that must always be made as short as possible but which, nevertheless, is of the greatest importance to the patient since his future progressand even his life-may well depend on the immediate treatment that he following his emergency.

It IS very important to distinguish between true first aid as defined above and work that is undertaken by who are put In charge of fir.st-aId rooms, works' surgeries, etc., In the smaller factories, places of business, schools, etc., where there is not sufficient work to justify the employment of a qualified nurse. Into these rooms flow a variety of cases. Patients seek advice for colds, coughs, boils, septic fingers and a host of other ailments which are quite beyond the scope of first aid. Their treatment calls for a specialised training which includes elementary nursing and medicine they will not, therefore be discussed in this series. '

Nevertheless, ambulance room attendants, as we may call them, do a most valuable spot of work in many instances. Hence, good luck to them provided they have had adequate training, know their scope and limitations and fully appreciate that they are not practising true first aid except when dealing with emergencies as defined above.

Case Taking

In almost every kind of work, method is essential. A cook, for exam pIe, preparing a meal has to think of many things at once. She must prepare all the foods that are going to be eaten, put on her oven at the right time, put in her dishes in 'the correct order arranging so that they can all be dished up at the same time. Similarly in first aid, method is essential; indeed it is even more important than in most other kinds of work. Case-taking is the name given to the immediate procedure undertaken when dealing with an accident or case of sudden illness. It includes the first actions of the first-aider, diagnosing the complaint and the general administration of the emergency.

Naturally, the amount of casetaking undertaken varies with the type of the emergency. There is not much to be done when a casualty walks into the first-aid room of a factory suffering from a crushed finger; but when a first-aider is called to a similar incident in the factory, for example to a man who has got his hand caught in machinery and cannot remove it, there are indeed many points to be considered.

From the moment he approaches an accident, the first-aider has to take complete control of every detail in connection with the case. Many points in case-taking have to

be considered almost simultaneously and the first-aider must bear them all in mind although the order in which he deals with them will, of course, vary from case to case.

The following are the main points that have to be considered :-

Approach

Naturally when he hears that an accident has occurred, the first-aider goes as quickly as possible to the case. He must, however, bear in mind his physical capacity, remembering that if he arrives hot, out of breath and fiustery, he will not be able to discipline his mind as efficiently as is usually needed when dealing with an emergency. The first-aider must cultivate a calm, cool and collected manner ; he must be confident and reassuring in the way that he deals with his patient. His first duty on arrival at a case is to warn the patient to lie still and not to move; a similar instruction must be given to bystanders. This warning is of some importance si nce if the patient is moved before he has been examined, comparatively simple injuries may be converted into those which are more complicated.

Sources of Danger

It is always important to notice if there are any sources of danger which can cause personal harm to the first-aider or further injury to the patient. Numerous examples could be quoted for example, the danger of oncoming traffic when an accident occurs on the bend of a road, the dangers of electricity, poisonous gases, etc. Suitable precautions must at once be taken to minimise any such sources of danger that are observed.

This must always be considered since it may still be continuing to exert its harmful effects. Part of a motor car, for example, may still be in contact with the patient. The first step in actual first aid is generally to remove the cause; sometimes, of course.> this is impossible as in machinery accidents and then the patient must himself be removed from the cause. When this is done every precaution must be observed to support an injured part and prevent further injury while removal is taking place.

Permission to Attend

Whenever possible the first-aider should obtain the patient's permission before undertaking treatment. This is essential in all minor injuries and whenever possible in those which are more severe. If, however, a patient is obviously too seriously injured or ill to gi ve permission and there are no relatives or friends present, the must carryon without permission but in this event he will be able to justify his action later if it 'is called into question. Strictly speaking attending a patient without his permission can be regarded as an assault.

Immediate Examination

A quick examination, chiefly visual, should be made immediately in every serious case. Its object is to discover if there is any urgent condition which requires immediate treatment. If for example, a patient has stopped breathing, delay in performing artificial respiration may be fatal; severe bleeding of any kind has to be dealt with forthwith. In many cases, however, this immediate examination does not disclose an urgent condition requiring a life-saving measure and then the first-aider can go more slowly and methodically about his task.

Prevention of Shock

This condition occurs in almost every accident to a greater or lesser degree and the sooner it is prevented and treated the better for the patient. It is quite possible even in the eady stages of an accident to begin treatment for shock, for example, by covering the patient, arranging for a Wal111 drink, etc. Shock will, of course, be discussed more fully in a subsequent article.

New Books

Mayes' Handbook for Midwives and Maternity Nurses Revised by F. D. Thomas, S.R.N., S .C.M., MidwifeTeacher's Diploma. Fourth edition. BaiUiere, Tindall and Cox, price 18 -. Four editions and six reprints of this book have been required since it was first published in 1937, which is conclusive evidence of its usefulness. All who knew the late Miss Mayes admired the clarity and thoroughness of her teaching of practical midwifery and fully appreciated her wide knowledge of the subject. The fourth edition has been prepared by Mrs. F. D Thomas, with the help of her husband , Dr. Ivor Thomas, M.D., M. R .C. O.G. She has kept to the original basic arrangement of the text but has rewritten those chapters that required revising in the light of modern advances, the changes that have occurred in the training and status of midwives and the extension of the syllabus of the Central Midwives Board The chapter on GovernmentServices needed to be rewritten in view of the legislation concerned with health services generally. MIS. Thomas is to be congratulated on the excellence of her revision and additions throughout the book,

Scope of First Aid

An early decision must be made as to the amount of first aid that will be given to any particular case. The decision depends largely on proximity to hospitals , availability of ambulances and doctors and the general nature o[ the case. Whenever possible , first aid itself should be reduced to a minimum by quick and temporary measures and transport to a hospital arranged as quickly as p·ossible.

The Doctor

The need for sending for a doctor must be considered. Very often it is far quicker and more satisfactory to obtain an ambulance and have the patient taken to hospital. A doctor at an accident is in much the same position as a first-aider. The scope of his own treatment is limited by the environment. There are, of course, cases where it is very desirable for a doctor to be obtained. Thus, recently at a factory a worker suffered from a severe heart attack. The factory first-aider could easily have obtained an ambulance and had the patient removed to hospital. The degree of shock, however led him to send for a doctor rather than an ambulance. The doctor gave an injection of morphia and left the patient for several hours in the ambulance room while he was

for Nurses

which h as assured the continuance of its popularity and usefulne ss.

A Handbook of Dietetics for Nurses' by Catherine Harris, S.R.r-.:., Dietetic Diploma, R.c'N. Chief Therapeutic Dietitian !liyersity College Hospital. Bailliere: Tmdall and Cox, London, price 176. This is a very factual book which is suitable for the senior student nurse who has mastered the other subjects in her curriculum and for the trained nurse. In its scientific aspect it is completely in line with developments and knowledge, both m food values and in physiology. It contains many charts, diet sheets and tables-those of the nutritive values of foods in common use are particularly comprehensive and are most useful for reference; but they contain much more detail than is required by the student nurse unless she is specialising in dietetics. As a guide to diet therapy the book will prove a most useful addition to the available literature. The subject matter is well arranged, the book has been produced on excellent paper and it has a most attractive 'jacket.'-A.E.P., S.R.N., Diploma in ursing (Univ. of Lond.)

recovering from the shock. In this case, delay in removing the patient until he had recovered from shock considerably increased his chances of recovery.

Bystanders

Bystanders can be very helpful to the first-aider in his work provided he has the organising ability to deal with them. Left to themselves, bystanders can be a serious handicap. Bystanders can be used for many purposes such as assisting in first aid, taking messages for transmission to doctors, ambulances and hospitals and obtaining equipment for the treatment of shock, etc.

Transport

The method by which the patient will be transported to shelter must be considered early in case-taking. If an ambulance is required it should be sent for quickly so that its arrival will coincide with the completion of first aid. There is nothing more embarrassing than forgetting this point when performing first aid in a street accident. Thus the firstaider may carryon doing his first aid perfectly satisfactorily but if he has forgotten to send for an ambulance sufficiently early, his patient will be kept waiting for some time after first aid has been completed while the ambulance is a waited.

FIRST AID & NURSING. MAY/JUNE 1953

Competition News

ST ANLEY SHIELD BRITISH RAILWAYS LONDON TRANSPORT

Stanley Shield

Finals of the Stanley Shield competition,s, British Red CrosS" Society, were held 10 London on 2nd May, the winning teams being orth Riding of Yorkshire (Women) and Kent (Men) Final placing of teams was as follows

British Railways and London Transport (Railways), British Transport Police.

The National First Aid Competitions for teams from British Railways and London Transport (Railways), and the British Transport Commission Police, organized by St. John, were held at Central Hall, Westminster, on 21st May. Thirteen of railwaymen, seven teams of raIlway women, and six teams of B.T.e. Police competed. Results were :-

Men,' Maximum marks 600

1. Southern: Exmouth Junction No.1

2. London Midland: Wolverton

3. Southern: Southampton Docks S.M.E. No.1

4. London Midland: Derby Erecting Shop

5. Western: Bristol D.O.S.O.

6. Eastern: Kings Cross M.P.

7. Western: Taunton

8. North Eastern: Dewsbury Central

9. Eastern: Worksop

The Hetherington Cup for Nursing went to Cambridge 96 women's team, and the awards for highest individual marks were made as follows: Evelyn Wren Cup, Miss

L. W. Lammond (Angus 4); Georgina E. Morgan Bowl, Miss M. D. Buttler (Surrey 6) Margaret Gordon Harker Cup, Mr. A. N. Killick (Kent 87): Lt.-Col.

R. M. West Cup, Mr. W. D. Harris (Kent 87).

H.R.H. The Princess Royal, who presented the trophies, arrived during the afternoon and watched the teams competing. Her Royal Highness said that the past year had proved how important it was to be proficient in first aid and .nursing and t.hat she felt it should be the alffi of the SOCIety and its sister organisations, to spread the knowledge of these subjects throughout the land. This would not be possible unless every member was so fully trained that their skill was instinctive, when others would be inspired to follow their example. The Stanley Shield Competitions provided one of the main incentives to efficiency, and H.R.H. said she was pleased to see the constantly improving standard of work.

10. North Eastern Newcastle Central

11. Scottish: Motherwell

12. London Transport (Railways) Lots Road

13. Scottish Perth Women,' Maximum marks 600.

1. Southern: Brighton

2. London Transport: Broadway

3. NorthEastern: HulID.O.S.

4. Western: Newton Abbot

5. Eastern: Marlebone Bo 1

6. London Midland: Earlestown

7. Scottish: Glasgow

B.T.C. Police,' Maximum marks 600.

1. Sou th Western: Dover

2. Midland: Preston

3. London: Liverpool Street

4. Northern: York

5. Eastern: Nottingham

6. Scottish: Edinburgh

The presentation of trophies was made by Sir John Benstead, Deputy Chairman of the British Transport Commission, and Lt.-General Sir Henry Pownall, Chancellor

of the Order of St. John presided at the presentation ceremony.

British Railways: Southern Region Finals. Highlight of the year's regional ambulance activities was the successful finals competitions staged at the Borough Polytechnic, London, S.E., on 10th April. Eight teams of railway men, seven women's teams, and six teams of B.T.e. Police took part, and the results were announced as follows :-

(Women) Possible marks 600.

1. Brighton No.1

2. Dorking' B

3. Southampton Docks

4. Dorking' C

5. Eastleigh Accts.

6. Brighton No.2

7. B.T.e. Police

(Men) Possible marks 600.

1. Southampton Docks S.M.E.

No.1 487i

2. Exmouth Junction No. 1

3. Lancing' B 478

4. Eastleigh Works... 465l

5. Horsham No.1... 459

6. Ashford Works' A ' 456t

7. Brighton No.1... 440

8. Twickenham' A 439i

9. Lancing' A 413

The' Moore' Cup to Lancing' B who scored highest marks in Individual Practical Section of the Competition. The' Richards' Cup to Lancing 'B' gaining the highest position in the Final as a junior team.

The' Templemen ' Shield to Southampton Docks S.M.E. No.1 winners Semi-Final. London Area Po/ice,' Possible marks 600.

1. Liverpool Street 505

2. Bricklayers' Arms 459

3. Paddington 419t

4. Victoria 416

5. Waterloo 410

London Transport Ambul:'lnce Centre

Final first aid competitions for the Challenge and Probyn Shields took place at the Borough Polytechnic, London, S.E.l, on lith April.

This is the major competition of the year, the leading Road and Rail teams going

forward to represent the Centre at the National Competitions. This has been a record year for this event, forty-four teams ha ving taken part in six District Competitions, followed by two semi-final competitions to select the nine teams to compete in the final.

The winners this year, as in 1952, were Chiswick (leader J. Barnes) with 475 marks out of a possible 600. Other teams members were A. Dolling, A. Darke, R. Terrell and R. Field. The Chiswick team was awarded the Challenge Shield. The Runners-up were Broadway (Women) who obtained 466! marks Oeader Miss E. M. Bristor) other members, Miss L. Duckett, Miss E. Hunt, Miss A. Banister, Mrs. C. Hockley. The third team was Manor House' A with 450 marks. Fourth team, and winners of the Probyn Shield was Vauxhall. This was the leading group two team,and obtamed 423 marks (leader T. Clift) other members e. Richardson, W. Wheeley, W. Bolton, G. Savage. Other teams taking part in the final competition were Manor House' B,' New Cross and Dorking.

B.T.C. Police (Midland Region)

B.T.e. Police (Midland Area) ambulance competition was held at Crewe on 19th March. Preston were first with a total of 349t marks out of a possible 425; Heysham (340t) were second, and Manchester (332) third. The result of the Reserve competltlOn was: 1. Liverpool No. 1 (SIt, max. 60), 2. Heysham, 3. Manchester, 4. Burton, 5. Liverpool No.2.

Prizes were presented by Mr. W. B. Richards Chief of Police, B.T.C., and Mr. W. E. N. Growden, Chief of Police, Birmingham, presided.

Caernarvonshire Brigade Competition

Bangor Railways first-aid with points, won the W. T. DavIes Memonal Challenge Cup, open to first-aid teams in Caernarvonshire, at Llandudno recently.

Bangor St. John Ambulance with 149 and Caernarvon Pohce DlVlSlOD third with 131t. Mrs. Crosbie, Port Dinorwic, daughter of the late Mr. W. T. Davies, fonner Centre-Secretary of St. John Ambulance, presented the cup to the winners.

I Coronation Day (cont. from p. 1) I

In a message on the day after the Coronation Her Majesty said : 'One othe; group I would single out for special mention-the members of the voluntary organiza tions, and particularly of the British Red Cross Society, of the St. John Ambulance Brigade, and the Boy Scouts Association. These not only supplemented the work of the armed services and police but also failed in the discharge of theIr special duties oflooking after casualties.

, To all of these, and to the many thousands of others who have played a part in the preparation o.r accomplishment of the CoronatIOn ceremonies, I send my heartfelt thanks.'

TOPICAL NOTES FOB

FIRST AlDERS & NURSES

Exhibitions at Health Centres

In the Health Service Act (1946), Part 3, Section 21, there appears the following instruction-' It shall be the duty of every local authority to provide, equip and maintain to the satisfaction of the Minister premises which shall be called ., health centres" at which facilities shall be available for all any of the following purposes 'going on to enumerate practically aJl the services, both preventative and curative, that a patient may require; and also the carrying out of functions relating to health education and publicity. Very few of these health centres however, have materialised. Only about 70 of the 150 local authorities upon whom this duty rests have produced projects,' and not more than a tenth of these have come to fruition. The two best known are Woodberry Down Health Centre, Stoke ewington, which is a model centre established by the London County Council, and Amersham Road Health Centre, Deptford. Both of these arranged most mterestlOg and instructive Exhibitions during May. They were well advertised and some sections were open to the general public. The Woodberry Down exhibition was opened by Professor James M. Professor of Public Health, Uruversity of London; who emphasised the need for a health education that would reach every citizen. Much of this education was carried out quite inconspicuously by health visitor in the home and by the family doctor, as well as by the personnel at health centres and hospitals; but group efforts were also necessary. An exhibition showed all the various services for enSUrIng health and preventing disease reached and taught many people at the same home the special points by anlusmg deVices and cautionary tales.' The scope of the W?odberry Down exhibition how the modern concept of positIve health IS developing and stressed the difference between the promotion of health and preventive medicine.

At Deptford also, the exhibition was quite a gay affair. It was sh?w how voluntary services were combInIng WIth local authorities to provide many of the health and welfare services for people of ages. In the mobIle services as mass radlOlogy and meals on wheels' were shown, whilst inside Centre a room called 'Hazard House was arranged to show many of the common causes of accidents in the home.

Fatal Accidents in the Home

With each statistical review dealing with causes of death in England WaI.es the figures referring to fatal In home are seen to be nSlOg, untIl now they exceed the toll of llfe due to road accidents. The same age groups are particularly affected-about 20 per cent. being children under five and 60 per cent.

being adults over 65. Between the ages of one and five fatal home accidents was the third largest cause of death. Like road accidents, the majority of these fatalities could be avoided if only people would examine the causes and tak.e enough trouble in eradicating them; for about 90 per cent. of the fatal accidents occur in private houses, chiefly due to falls, coal-gas poisoning, suffocation and burns and scalds. The Ministry of Housing and Local Government has just published the Report of the Standing Interdepartmental Committee on Accidents in the Home (obtainable from H.M. Stationery Office or any bookseller, price 6d.). The Report is based on five years of research. It expresses the \ ie\\ that faulty design and equipment and human frailty are the two most important causes of such accidents; and that of the two, it is the human element-ignorance, carelessness and physical disability-that is the more important.

The Ministry has sent a Circular ( o. 32 53) to all Housing Authorities reminding them of the recommendations made in the Housing Manuals with regard to proper design, lighting, dimensions of staircases, the provision of fixtures for fireguards on heating appliances, the placing of gas cookers and other gas equipment, and the special points in the planning for old people. Councils are asked to give tion to the position of bedroom doors In relation to the top of the staircase, the design of balconies, and the provision of adequate kerbs where appliances have raised hearths. The Importance of the tenants' understanding of the equipment provided in houses is stressed, as ignorance of these matters is so often a cause of accidents. Regulations under the Heating Appliances 0-ct, 1952, and the Heating ApplIances (Fueguards) Regulations, 1953, require that all gas fires! electric fires and oil heaters for dOmestIC use should be fitted with fireguards if they are so constructed that, without a guard, there is a likelihood of injury from burning.

Books, Pictures and Music in Hospitals

Everyone who becomes a patient ..or who visits hospitals is now qUIte famlh.ar v. ith the Red Cross Library trolle) and ItS collection of attractive books to SUIt all tastes, and realises \\hat a help the e can be in overcoming the bored<?m of Illness when once the acute phase IS. Perhaps less well known, espeCIally 10 hospitals for cases, IS part that art and musIc IS plaYlOg .10 diversional therapy. But It: sanatona, hospitals for long-term dIseases and psychiatric hospitals the. benefit. by both passive and active partICipatIOn, can hardly be over-estimated. .

Recently the Briti h Red SC!clety, in co-operation with the HospItal LIbrary Department of the St. John and. Red Joint Committee and the fo! Mu Ie in Hospitals, held a mo t mterestmg and

H.R.H.Princess Royal presenting the Stanley Shield to the M.R. Yorkshire team.

TOPICAL NOTES

constructive conference to discuss the scope of the use of books, pictures and music among pbysically and mentally sick persons and to examine the interaction of each upon the otber two. The work of the Picture Library Service was described by tbe Viscountess Falmouth. She said that the scheme was inaugurated in 1943, for two main purposes-to try to enliven the bare walls of a ward and so bring pleasure, and to guide tbe patient towards a permanent interest in art by helping him to understand the subject of the picture, the technique used, the school to which it belongs and the inspiration of the artist. Talks and discussions from personnel and among patients, lectures from experts and lessons which encourage the patient to draw or paint for himself are all part of art therapy. Especially in sanatoria the movement has had great success, as anyone who has visited exhibitions of patients' work can testify. In mental hospitals unexpected talent is often displayed, and the expression of ideas and emotions may be found to relieve both physical and mental tension. Picture: libraries are now established in 320 hospitals and there are 6,000 pictures, of wide variety, in circulation.

With regard to music, the Earl of Harewood, as President of the Council for Music in Hospitals, was the chief speaker. He alluded most feelingly to his own indebtedness to the Red Cross during the period when he was a prisoner of warwhich he thought was somewhat like being a long term patient in a hospital, in that one was cut off from the world and from one's normal activities. The Council for Music in Hospitals was formed in 1947, to co-ordinate the develop the facilities for providing music for patients. One concert a month was usual in hospitals availing themselves of these amenities. Gramophone recitals and musical therapy for indi viduals and groups are also provided. Lord Harewood thought that the conditions of illness made for greater susceptibility to music and for concentration. Other informed and interesting speakers included Dr. Mary Woodall, Keeper of the City Museum and Art Gallery, Birmingham, and Dr. S. D. Mitchell, Consultant Pyschiatrist, Cane Hill Hospital, Coulsdon.

'Queen's Nurses' Remains a Voluntary Organisation

Until the National Health Service Act came into operation district nursing was entirely the responsibility of voluntary organisations, the chief of these being the Queen 's Institute of District Nurses . Included in the Health Act there is the promise that the public will have, free of charge, the services of the health visitor, the district nurse, the midwife and the school nurse. The responsibiLity for providing these domiciliary services is placed upon Local Health Authorities, but they have the power to choose whether to delegate this work to an existing organisation and to ask it to be their agent, or to take it over themselves. Local authorities receive a State grant for 90 per cent. of their approved expenditure on health services, and they, (continued at foot of column 2)

St. John Cadet Camp

H.R.H. Princess Margaret, Commandantin-Chief, will visit the St. John Ambulance Brigade Cadet Camp, to be held at Stubbers, North Ockenden, Essex, from 31st July to 7th August.

The camp, which will be entirely under canvas, will be divided into three subcamps, one for ambulance cadets and their unit officers, under Mr. Harris, Assistant Commissioner for Herefordshire; one for nursing cadets and their unit officers under Miss Druitt, Cadet Training Officer for the Priory for Wales; and one for the camp staff under Miss Barlow, County Cadet Officer for Surrey. Feeding, recreation, and other camp activities will be undertaken jointly by all the sub-camps.

The ambulance cadet and nursing cadet sub-camps will be divided into units of

London Transport

The annual report for 1952 of the London Transport Ambulance Centre, St. J.A.A., states that the number of cases of first aid rendered by London Transport staff during the year was 22,241. 'The large number of cases requiring treatment confirms the need for more of our staff to be trained in first aid' the report comments.

During the year the number of voluntary attendances made at classes was 24,466, including ]0,974 at first aid and home nursing lectures. 165 examinations in first aid and 11 examinations in home nursing were held, compared with 1 18 and 7 in the previous year. The total membership of the centre at the end of 1952 was 1703, an increase of 328 on 1951.

During the year 41 special reports of first aid rendered were received, and special certificate awards were made to Mr. H. Wilkinson, Turnpike Lane Station, and Mr. H. Dodd, Conductor, Stonebridge Depot, in recognition of efficient first aid rendered.

in turn, pass on to the district association this prop::>rtion of its cost 111 carrying out the nursing duties which are legally the responsibility of the local authorities. The other 10 per cent. has to be raised by the organisation itself, which also continues to finance its other activities entirely by voluntary contributions,as hitherto but it is enabled to appoint more staff and to extend its work. Thus it comes about that the need to raise funds is as urgent as ever.

Queen's Nurses in London are helping to do this by collecting pennies and halfpennies issued during the reign of Queen Victoria. So please examine your small change, set aside any coppers bearing the head of Queen Victoria and send your collection to your local Branch of Queen's institute of District Nurses or to the SecretaryAccountant, Central Council for District Nursing in London, 25, CockspLlr Street, S.W.l.

28 cadets and 2 officers, one of whom will be appointed the Unit Officer-in-Charge. The cadets of each county will be as far as possible kept to one unit. In the case of a large county contingent it will be necessary to form two or more units and in the case of small county contingents composite units of several counties wilJ be formed. Each unit will be sub-divided into four squads, each under a cadet squadJeader. The senior cadet squad-leader will be the cadet unit-leader.

During tbe camp, a large number of different kinds of activilies, excursions, talks, demonstrations, sports, etc., will be arranged and cadets will be able to choose which out of these they do each day. A special programme will be arranged for the visit of Prir.cess Margaret.

WEARING THE N.H.S.R. BADGE IN UNIFORM

DE \R SIR,

I am a member of the S.l.A.B. and the N.H.S.R.

Woulu you please inform me if it is correct to wear the N.H.S.R. badge when in the S.J.A.B. uniform. Also, if other Civil Defence badges should be worn including the Blood Donors long service medal when wearing S.l.A.B. lInifoml.

If any of these badges may be worn, would you please state which, and on which side of the tunic they s hould be worn. Yours faithfully, HAROLD ROBERTS. New Mills, Via Stockport.

An Officer of St. Jolin rep/irs :-

'Female members of the Brigade wear the N.H.S.R. badge on the right siue of the apron bib in indoor uniform and on the right side of the greatcoat and jacket above the Brigade badge.

Male members of the Brigade wear the N.H.S.R. badge on the right side of the jacket above the breast pocket and Oll the right side of the overcoat.

Jt is not permissible to wear the blood donors long service medal in SJ.A.B. uniform.'

[Cil'i/ defence badges, it is {(ndtrstood, may he worn in the way as the N.H.S.R. hadge. - Ecl.

DENIS MATTHEWS RECITAL

A pianoforte recital is to be given by Denis Matthews in the Chapel, Royal Hospital, Chelsea, in aid of the British Red Cross Society, on Wednesday, J 5th July, at 8 p.m.

Tickets, 5/ -, 10/ 6, and one guinea, are obtainable from the Hon. Sec., Concert Committee, B.R.C.S., COllllly of London Branch, 6, Grosvenor Crescent, London, S.W.l.

FIRST AID & NURSING, MAY/JUNE 1953

M:.. Reeve has lectured many first-aiders on :he subject ?f ai:d has had a number of requests for his Itten.notes on the It occurred to. llIf!1 .that serialIZIng. thiS. artlcle would cover a wider field than by pi oducll7g a booklet, and we are g lad to pubbsh It Il7 our columns 1I1 thiS and the next three issues. The textbook referred to in the article is the St. John Manual.

Dia g nosi s-l

THE following article has been written at the request of a number of students who attended a recent lecture of mine upon this very important subject, as they were desirous of preserving some of its essential features. As it is my practice to lecture extempore, relying only upon the scantiest of notes, I will do my best to recall and repeat here all those points which I consider most important in studying the subject of Diagnosis. So much, then, for my excuse for going into print.

From time to time I have met members of the Brigade, both men and women, who knew their textbook thoroughly, indeed, almost verbatim. Mention the name of any morbid condition described in that text-book and they would rattle off the relevant list of signs and symptoms without hesitation, but, given a list of signs and symptoms and asked to identify the condition represented by these I found that they were all at sea. Now, this is exactly what you have to do when called to deal with a casualty in the street, be it medical or surgical. You have not standing behind you a kindly doctor who suggests' Isn't that a case of epilepsy? Don't you think he is suffering from diabetic coma? Isn't that a fracture rather than a dislocation?' No, you have to decide for yourself without any professional help. You must fish out the signs and symptoms, piece them together like a jigsaw puzzle, complete the picture and then name the condition, for no treatment can be attempted until a correct diagnosis has been made out.

I think that most of you who have watched competition teams at work will agree with me that it is in Diagnosis that most of our teams fail. How often have we seen the

By F. C. Reeve F.Z.S., F.R.E.S.

team leader, with a mystified look upon his countenance, kneel down at the side of the patient and commence 'mauling' him about', with no idea whatever as to what he was tryi ng to discover? At last, by a process, partly of elimination, partly of guesswork, he has arrived at a conclusion (right or wrong), and, having done so, the team has then proceeded to give an excellent show both of treatment and of transport. Unfortunately, however, valuable time has been lost during the first part of the test, and the team has learned to its chagrin that either the diagnosis was incorrect or that they had taken longer than the scheduled time set for the test. Yes, this important subject is very much neglected, and I propose in this article to endeavour to show you how to approach the proposition in a scientific manner.

Before proceeding further ] want to emphasize here that first-aiders are not doctors, a point which your text-book is at pains to impress upon you throughout its teachings. It is necessary to observe most strictly the line of demarkation which separates the work of the first-aider from that of the doctor. 'The duty of the ambulance pupil ends where the doctor's begins, and there should be no overlapping or clashing of duty or interests.' I am quoting from an earlier edition of the textbook because I feel that it emphasizes this point more strongly. Two other sentences from this earlier edition are, I think, well worth quoting: 'The first-aider must on no account take upon himself the duties and responsibilities of a doctor' and 'The importance of making early provision for medical aid cannot be too stongly insisted upon,' but the present edition does, however, remind you

that 'It is not intended that the first-aider should take the place of the doctor.' I do not propose, therefore; to attempt to teach you Diagnosis as it would be taught to a class of medical students. What I do propose to do is to show you how the methods employed by the surgeon and physician can be adapted to First Aid.

Those of you who have ever studied any of the sciences will know that the basis upon which rests all scientific research is classification,' and the doctor, who is, of course, a scientist , divides his Diagnosis, or examination , into four distinct parts which he calls 'Inspection.' 'Palpation,' , Percussion' and' Auscultation.' It will be found that your text-book, whilst avoiding these technical names, does exactly the same thing. Let us see how it does so by examining each of them in turn, after having obtained a clear idea of the exact meaning of each word.

Inspection' means examination by looking.

Palpation' means examination by feeling.

, Percussion' means examination by striking (gently) or tapping.

Auscultation' means examination by listening .

On page 22 we find descriptions of Signs , Symptoms and History (1 have purposely rearranged the order), and it is clear that they can each be recognized by one or other of the senses. Signs ca n be recognized by either sight, touch, hearing and sometimes by smell - but NEVER by taste. 'We learn the symptoms by listening to the description given by the patient, we listen to his cough or to his heartbeat (the surgeon is assisted in this by his stethoscope, which is merely an instrument which amp li fie

Accidents from Explosives

The annual report of H.M. Inspectors of Explosives for the year 1951 states 80 accidents involving petroleum spmt or mixture were reported during the year, causing 31 deaths and injuries to 96

The number of fatalities was the hIghest for 10 years and was mainly to two serious accidents at Bnstol and Swansea.

In one case reported a woman poured a mixture of petrol on to a J?udding,. thinking it was golden syrup as It was In. a. one gaUon syrup tin. The woman was and the resulting fire melted a lead gas pIpe and set the gas on fire.

Some 174 cases of ' suspected explosives' found in coal are reported. were 39 incidents involving. on domestic premises, resultmg In InJunes to 22 people.

Unguarded Fires Chief Hazard in Home Accidents

According to Dr. Leonard Colebrook, formerly Director of J\:1edi.cal Rese.a rch Council Burns Unit, WrItmg In The Times, unguarded fires are still the outstanding hazard in accidents involving burns and scalds in the home.

No less than 90,000 people have been killed by burning and scalding in this country during the first half of the century, and the average is about 700 per annum. Such accidents produce 15 000 in-patients and 50,000 out-patients every year for our hospitals.

Unguarded fires, coal, electric and gas, are the chief hazard. Four-fifths of burns and scalds happen to young children.

Many of the manufacturers are now co-operating by supplying guards, and a British Standard for guards has recently been published.

Miscellaneous Advertisements

Advertisements with remittance should be sent to First Aid & Nursing, 32 Finsbury Square, London, E.C 2. Rate 3d. per word, minimum 45. 6d. Trade Advertisements 4d. per word, minimum 65. Box numbers 15. extra.

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DIAGNOSIS

sound) and history is also obtained by me;ns of the same sense, in other words by hearing. History by hearing, however, is often supported what we can see, e.g. , two cars In collision, a fallen ladder, a broken stage-plank on a building, a smashed bicycle, etc. Perhaps the most vious use of the sense of touch IS in the case of suspected fracture, although this must be used with the greatest care. I Shall deal with the subject of fractures more fully later.

, Percussion ' is never employed by the first-aider, this being the sole prerogative of the doctor (or traine? nurse) who has learned to use It correctly.

Having grasped these preliminary facts we are now in a position to try to deal with an imaginary incident. It was at this stage in my lecture that I called upon two students to come forward to examine a patient whom I had placed upon the floor. All I said to them was 'There is the patient. Get on with it.' I well recall the look of blank amazement with which they regarded me and almost simultaneously asked' Well, what is the matter with him?'

'That is for you to find out' I replied, and neither of them had the slightest idea as to where to begin. I did this for the express purpose of emphasizing my next point. YOU MUST ADOPT A METHOD.

Now, whilst no two doctors adopt the same method of procedure, all work upon a definite principle. Every doctor, in conducting an examination, does so in an orderly manner, commencing at a definite point and finishing at another definite point, and it is this principle I want you to learn to adopt. However, I do not want you to copy in detail the plan of campaign I now propose to put to you, but you can accept it as a model to work upon, varying it and adapting it to circumstances as each of you see fit. Memorize the points, and you can then use them in whatever order you choose, but adhering to the principle of orderly examination once you have established it.

The patient you have on the floor awaiting your attention may be either conscious or unconscious,

each condition demanding a separate method of approach, so we will consider the conscious patient first. In doing so we are spared many of the difficulties which beset our path in dealing with the unconscious patient as in this case h.e is able. to furnish much valuable mformatlOn which would be obscure in the case of the unconscious patient. He can tell us how the accident happened, he can describe the character and position of any pain or. sensation he may be expenencmg, and whether or not any measures taken appear to lessen or aggravate such sensation.

Assuming that those three giants, Haemorrhage, Asphyxia and Shock, which usually present little difficulty, have been dealt with you can now proceed with your examination, although a word about shock may not be out of place here. You have learned from your textbook that shock is aggravated by pain. It must be remembered, however, that although great local pain may have been camouflaged by numbness or some other condition (unconsciousness, for instance), the nerve impulses from the peripheral nerve-endings, which represent pain, still continue to travel to the brain despite the fact that no pain is actually felt by the patient. It is, therefore, of the greatest importance that the utmost care be exercised in handling the patient, and especially any part which may have been injured, in order to minimize the possibility of increasing shock.

Now let us return to our conscious patient and note the points upon which he can supply information. I have already mentioned pain, but I wonder how many of you have ever realised how many different types of pain there are, and the significance of the character and position of pain. This subject alone would provide material for a whole lecture, but I will briefly tabulate here a few which occur to me, adding in brackets one or two notes which may stimulate your own further study.

Pain

Throbbing: (presence of pus).

Gnawing or aching : (disease of bone).

(continued overleaf)

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DIAGNOSIS

Tingling, numbness, hyperaesthesia, analgesia: (pressure on nerve).

Dull aching: (chronic inflammatory con<!ition .o.f a nerve, possibly chronic neuntIs or tism , especially when the part IS warm or at rest).

Shooting: (acute nerve lesions, perhaps neuralgia).

Hot, burning: (pressure by splint or pla ster-of-Paris).

Sharp an d shooting: (serous membrane, e.g., pleurisy).

Itching (urticaria, sometimes a symptom of JaundIce), etc.

Pain can also be boring, continuous, intermittent, colicky, ing, radiating, stabbll1g, transient, referred, mcreased by movement, aggrava ted by c<;mghmg or inspiration, accompal1led by vomiting, attended by tenderness, etc. This should be carefully noted and reported to the doctor. The position of the p ai n should also be noted, e.g., headache, over kidneys , epigastrium, chest,. groin,. Space forbids me to dea11l1 detaIl WIth each of these, but I will, however say a word of warning regarding headache. Headache is not a disease in itself, but a symptom. It is most essel!tial that the origin should be determmed before any attempt is made to relieve the condition. The a11-toocommon practice of administering drugs to relieve headache is to be st rongly condemned, for it may be the means of doing incalculable harm. Headache may be the precurse)' of so many morbid conditions - concussion, meningitis, certain febrile diseases like acute influenza, pneumonia, typhoid, diptheria, etc. -or it may indicate infection of the cranial sinuses, appendix or gallbladder as well as eyestrain, nephritis or toxaemia due to sepsis or constipation. In all cases of headache advise your patient to see his own doctor, and you may be the means of preventing much future suffering, or even saving a precious human life.

The duration, intensity, extent and degree of pain should also be noted.

S j Sgt. J. Mathews (Quebec) writes:

In case of fractured thigh or leg when paUent has to be transported a aood distance on uneven ground, a may be used, but carrying out Rules ] to 4, then placing splint in position, then applying bandages mentioned in Rule 5 and 6 seems insufficient to keep splint in control. Would it be advisable to use extra bandages or other means of restraint if available. Do y ou think we would lose points in a competition if we did use extra bandages?

Answer

Warmest greetings to an Overseas reader! The answer to your question is a m<'Ltter of opinion but personally I would agree with you and would certainly not deduct marks. In the case of the femur I prefer the original method, i.e., with the s plint and bandages applied as in Fig. 103.

R. L. M. (Bristol) writes :-

I was studying the latest, ] Oth edition of the Red .cross Socie ty'S First Aid Manual during the weekend, and I should be glad if y ou could explain the apparently contradictory teaching on haemorrhage given in chapters 4 and 5. Digital pressure applied direct to the wound is purposely left out from the treatment of venous haemorrhage on page 28, and of arterial haemorrhage on page 30, and yet it is specifically mentioned in the following chapter 5, in five examples out of ten. To make the confusion still worse, chapter 5, following the tea ching given in General Methods of Treatment given in. chapter 4, again purpose ly makes no mention of applying digital pressure to the wound in. the summary at the foot of page 47.

I did wonder if digital pressure applied to the wound in the instances given in chapter 5 was to control the venous haemorrhage, but I assume that can hardly be so, because digital pressure applied to the wound has

Queries

Answered by Dr. A. D. Beliiios, M.B., B.S. (Land.), D.P.H. (Eng. )

been studiously left out as a means of stopping venous haemorrhage 011 page 28.

Has the inclusion of digital pressur e to the wound b ee n carried forward by an oversight from th e old 8th edition, lvhen the pre sen t edition being written, or is there a d efil1lt e medical reason for using it in th e instances quoted in chapter 5 ?

If there is a definite reason, why is it not given as a d efinite means of stopping haemorrhage when the eral Methods of Treatment are bell1g stated in th e pre ce ding chapter?

The teaching in the two chapters does not seem to make sense, chapter 4 tells us not to u se digital pressure direct to a lvound either for ve nous or arterial ha emorrhag e, so does th e summary at the end of chapt er 5, yet we are told to use it in 50 p el' cent. of the cases cited in chapter 5.

Answer

Your comments are fair and it would appear that some clarification of the book is desirable Wheneve r direct digital pressure is applied, however, it is always desirable to interpose between the digits and the wound, a clean material such as a pad to prevent contamination, hence sometimes pad and bandage pressure can be applied very quickly if equipment is to hand. The B.R.C.S method of temporarily controlling haemorrhage by the use of pressure points has many advocates since it leaves the first-aider free to de al adequately with the wound.

W. P. (Bristol) writes :-

At a recent competition, one of th e team I llss ist to train lva s given a fractured thumb to treat for his individual test. Th e injury was made up to show a swelling at the poin t of the upper part of the metacaJp al bone and the commencement of th e phalanges . The only equipment available was triangular and roller bandages. He applied a triangular bandage round the hand in prescribe d

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Readers' Queries

manner, no splint available, and put arm in large sling. It was ruled out by the judge. Would a splint applied to the thumb, and arm put in large arm sling have been better treatment, if not, what in your view should he have done. The B.R.C.S. textbook does not give a lead.

Answer

If an improvised splint of any kind is available, the B.R.C.S. manual gives a lead on page 182, section 3, and should be followed by a sling. If no splint is available, you would be wise to follow the S.l.A.A. method of body-splinting devised for all fractures of the upper limb when the elbow can be bent without difficulty, being careful to avoid a bandage directly over the site of fracture.

M. C. C. (Richmond) writes :-

When a person is asphyxiated in a fire, are unconsciousness and death due to lack of oxygen or the effect of poisonous gases? If the latter what gases? What is the correct treatment?

Answer

Lack of oxygen is the most important factor. Both carbon monoxide and carbon dioxide play a part; the fonner combines with the haemoglobin in the blood forming a stable compound which cannot carry oxygen. This, however, is not usually sufficient by itself to endanger life. Treatment includes artificial respiration combined with continuous inhalations of oxygen, no carbon dioxide; general measures including observation, and hospitalisation in every case when unconsciousness has occurred, owing to the risk of a relapse.

P. M. (London) writes :-

While visiting the Continent, 1 became unwell and borrowed a thermometer to take my temperature. I found their scale quite differen t from ours and would be grateful for advice as to how to compare the two

Answer

In England we use the Fahrenheit scale in which the boiling point of (continued on pag e 14)

First C,·ossword No.5

Compiled by W. A. Potter

ACROSS

1. May cause fracture at some distance from where violence occurs

10. Noblemen have an ear and a guinea

11. It must be safe, steady, and speedy

12. Live to change a plant

13. Toinjure,or a ninjury ..

16. Standard amount ora drug

17. He is usually elderly with high blood pressure

20. Usually carried by diabetic taking insulin

21. Describes bleeding from incised wounds

23. A married person

25. State ofmusc!es in shock

28. Perform about 4, for the governing body

29. In a wound, blood clots may act as these to torn vessels

30. Haemorrhage from here may be concealed

DOWN

2. Ran backwards before rowing

3. Part of the foot for marching?

4 Takes food, or teas differently

5. Its setting is taught in home nursing

6. There are three in each ear

7. Farm which contains royal ordnance factory

8. Controls movements and functions of the body

9. This patient must not be allowed to walk at all

]

4. Pouring part of a vessel

15. Peers make a merry frolic

18. Poisonous spider gives its name to a dance

]

9. Point to bear in mind in treating haemorrhage

22. Partial loss of consciousness

24. It is more than 5 miles deep in parts

26. Variation from normal found on examination

27. Weak part of Achilles anatomy

(Solution next issue)

FIRST AID:-

General Rules

Examination

Fractures

Dislocations

Sprains

Wounds

Hcemorrhage

Types of Bandages

Splints

ACROSS

SOLUTION TO CROSSWORD No. 4 DOWN

1, Roller bandage; 10, odium; 11, disparage; 12, friend; 13, tomtom; 16, eyas; 17, laceration; 20, rheumatoid; 21, a tie; 23, upshot; 25, misses; 28, diaphragm; 29, glide; 30, student nurses.

2, Originate; 3, lament; 4, rods; 5 also; 6, diagonal; 7, grant; 8, coffee grounds; 9, german measles; 14, taste ; 15, belie; 18, intestine; 19, smoothed ; 22, finger; 24, slant; 26, pain; 27, omen

Footnotes on fungous infections

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Their Cause, Treatment and Cure

A few of the Subjects treated:

First Aid

What to Do in Emergencies

Influenza, Colds, etc.

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Corns and Warts

Physical Culture, Self Defence

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Hygiene, Anatomy, Pharmacy

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Pregnancy, Childbirth

Home Remedies, Diet

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Chest, the Heart teaching pictures

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Readers' Queries

(continu ed from page 12)

water is 212 0 and the normal temperature of the body 98.4 o Abroad the Centigrade scale is used - boiling point of water being 100 0 with normal human temperature 36.8 o

To convert centigrade to fahrenheit , mUltiply by 9 , divide by five and then add 32.

* * *

T. N. J. (Cardiff) writes

In abdominal hernia , according to the S.J.A.A. Manual, lve are advise d fa apply ice or a cold compress to the affect ed part. What is the value of this tr eatment?

Answer

Cold acts as an as causes the swelling to shrink. contents of the swelling sufficiently , the rupture appear and an operation be The treatment is often s but a medical opinion must always be obtained.

J. O. (Dublin) writes :-

One of the clerks, age d 30 in the big office where I do the fir s t aid, frequently suffers from nose-bleeds which generally stop with first aid measur es in 15-30 minutes. He thinks high blood pressur e is the c<nd that th ey do him good. Can y ou advise please ?

Answer

It 1S most unlikely at his age that blood pressure is the cause or that they do him good. It is most probable that he has a small dilated vein within his nose which gives way periodically. Refer him to hi s own doctor , reassuring him that the condition is in all probability purely local. His doctor may send him to a specialist who will discover the dilated vein and seal it by

Answer

Probably enlar gement of the prostate gland at the nec k of the bladder. Hospital is the wisest treatment , only if this is impossible should fiTst aid measures be tried. These include hot fomentations to the lower part of the abdomen, sitting in a hot bath if available and then making another attempt to the sound of a running tap.

* * *

J. Mc . (Paisley) write s What eye drop s c an b e us ed to cause un equal pupils for comp e tition lVork ? Are th e re an y dal/ ge rs ?

Answer

1t( rorlWlT ort sll1ce to pass lvater adequately What was the probable caus e and tr eatm ent?

TH E FI RST STEP

Homatropine sometimes comcocaine will cause an will rQduce rged by used there are called Atropine should never be employed for this purpose.

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BAILLIERE BOOKS FOR FIRST AlDERS

A HANDBOOK OF ELEMENTARY NURSING

Arthur D. Belilios, M.B , B.S., D.P.H., and Dorothea Duncan-Johnstone, S.R.N. This handbock is the ideal guide for anyone who is called upon to carry out any form of emergency nursing. It describes in simple language the basic principles and procedures that underlie the science of nursing, and contains brief descriptions of the more cornmon diseases, with general notes on the nursing required in each case. A complete chapter is devoted to the subject of home nursing, and the whole book provides for every first aider the essentials of nursing in a handy yet comprehensive form.

With 314 pages and 57 drawings, 7s. 6d.

Arthur D. Belilios, M.B., B.S., D.P.H., D. K. Mulvany, M.B., F.R.C.S. , and Katharine F. Armstrong, S.R.N., S.C.M.

HANDBOOK OF FIRST AID & BANDAGING

The most comprehensive and up-to-date book on the subject, giving full details of the first-aid treatment of medical emergencies as well as of injuries and accidents.

With 520 pages an d 244 drawings. 6s.

DALE, REYNOLDS & CO. LTD. 32 Finsbury Square London EC2 OR

ELEMENTARY ANATOMY & PHYSIOLOGY

A handy, compact manual which gives a complete outline of the anatomy and physiology of the human body. 'A most straightforward, reliable li t tle book.'-

Th e Nursing Times

With 194 pages and 116 dr awings 4S. 6d.

BAILLIERE, TINDALL & COX 7-8 Henrietta Street London WC2

{ copy/ies of First Aid and Bandaging

Please send me copy/ ies of A Handbook of Elementary Nursing copy/ ies of Elementary Anatomy and Pbyo;iology for which I enclose remittance of... (Postage 6d. extra per volume.)

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SOMETHING NEW IN AMBULANCE DESIGN

THIS IS AN IDEAL AMBULANCE FOR HOSPITAL USE both in England and abroad, e speci a II y where cases from isolated villages have to be co ii ected for conveyance to a central hospital, as the general purpose arrangement of its accommodation offers facilities for carrying a number of patients under many different circumstances. In Great Britain its possibilities are obv ous for inter-hospital conveyance

An entirely design in amb ulances with many unique features. It Incorporates a new low loading top stretcher gear which enables two orderlies to load and elevate patients, the smooth action gear eliminating shock or jolts. The wide centre gangway provides space for three wheel chairs, easily loaded by the ramp and winch

The flexible accommodation is (a) 4 stretcher and 4 sitting patients (5 stretcher cases in an emergency); (b) 2 stretcher and 8 sitting patients; (c) 16 sitting patients. Built on Austin, Commer, Bedford or Ford chassis. Adequate provision for storing stretchers, blankets. medical supplies, etc.

YOU ARE INVITED TO APPLY FOR FULL DETAILS OF MOBILE MEDICAL UNITS, AMBULANCES, ETC., BUILT TO YOUR PARTICULAR REQUIREMENTS FOR SERVICE IN ANY PART OF THE WORLD

ID

ARE the stars in their courses any more mysterious than the recurring cycle of the menses? As regularly and predictably as the phases of the moon, the average uterus sheds its endometrium every twentyeight days and the average woman experiences discomfort, pain and depression. Measurable relief from these symptoms of dysmenorrhCl!a may safely be obtained at every period with ANADIN tablets. Anadin combines the benefits of two pain-relieving compounds with those of two mild stimulants. Anadin is not habit forming and is quite safe for self-administration by the patient in the prescribed dosage. DOS E

Two to four tablets, according to severity of symptoms, repeated every four hours as required.

If you are logical person •.•

• Then you will follow this point-by-point argument and reach the same conclusions as so many doctors, nurses, hospitals and clinics have done.

DO YOU AGREE ... that the causes of most skin infections are the common strains of STAPHYLOCOCCI, STREPTOCOCCI and B. PYOCY ANEUS ?

IN THAT CASE . a treatment which is effective against all three will be indicated for cuts, abrasions, burns, scalds, boils <l;nd most inflammatory skin infections?

THIS IS THE TREATMENT

ANTIPEOL Cutaneous Vaccine Ointment contains the sterile vaccine filtrates of the three micro-organisms mentioned. The filtra tes destroy the actual micro-organisms and at the same time act as a local imrnuniser against re-infection. This is a

purely biological action and there is no . damage to delicate tissues.

RAPID HEALING is further expedited by the ointment base of proved efficiency. For burns and scalds, ANTIPEOL has special advantages. It is microbicide and non-adhesive. Therefore dressings do not have to be changed every day.

AND HERE IS THE PROOF.

Antipeol Ointment is proving and reproving itself every day in dozens of surgeries, clinics, hospitals and homes. Letters from the medical and nursing profession bear convincing testimony to its effectiveness.

THERE is the logical argument for including ANfIPEOL Ointment in every First Aid kit. As a logical person, why not send for full details and a clinical sample ?

antipeol

cutaneous vaCCIne ointment

Produced by the makers of: ENTEROFAGOS for intestinal complaints; RHINO-ANTIPEOL for nasopharynx infections; OPHTHALMO-ANTlPEOL for ocular infections; DETENSYL for reducing arterial tension.

CARGREEN RD., SOUTH NORWOOD, S.E.2S

First Aid & Nursing

Land Rover Ambulance

July/August 1953

Land Rover Ambulance

Elementary First Aid :Fractures 2

World's Enemy No.1 3

Competition News 4

Topical Notes for First-Aiders and Nurses 5 Books 6 Diagnosis-2

Care and Welfare of Children

Victory over Rabies ... Readers' Queries

First-Aider's Crossword

7 8 9 10 12

This new ambulance shown here has been built on the sturdy Land Rover, and provides a single stretcher ambulance which can be used in emergency cases over rough ground or where access is difficult. The vehicle is amply insulated and ventilated, and accommodation includes two sitting cases in addition to the stretcher case.

Its use in industrial first aid, where space is limited or where the use of a full-sized ambulance would be uneconomical, is an important feature. The Land Rover can negotiate all kinds of obstacles, and its manoeuvrability is a great asset for ambulance work.

The conversion was carried out by Pilchers of Wimbledon, London, S.W.20.

This has been a good year for the Addlestone (Airscrew Works) S.J.A.B. team, shown here with the trophies gained. Successes were: the 'Billing Shield,' the 'Martin Williamson Chal1enge Cup' (runners -up in the Surrey County competition), and the 'Cotton Shield' awarded to the second team in the Surrey, Sussex, Kent, Channel Islands, regional competition held this year at Horsham. Team members are: left to right, Pte R. Dyer, Pte. D. E. Henderson, A 0 E. T. Barham, Pte. R. Kemp and Sgt. P. P. Thomas.

a

MEDICO-BIOLOGICAL LABORATORIES LTD.,

A COURSE IN ELEl\fENTARY FIRST AID Fr .aetures

By A. D. Belilios M.B., B.S. (Lond.), D.P.H. (Eng.)

The next article in this course It'ould have been on Diagnosis, but since a series of articles on this subject is running at the moment in the JoU/·naT, we skip to the subject of Fractures.

A BROKEN bone is called a fracture, even though it may only be cracked. This latter condition will be described later since it is of considerable importance in diagnosis.

Causes of Fractures

As would be expected fractures are c.aused by violence or force applied in some way or other to the bone. Occasionally a bone will break without receiving violence but this only takes place when there is disease present

The three different kinds of violence liable to cause fractures are classified as follows :-

Direct Violence.- This is the cause when a bone breaks at the site at which the violence is received. Thus for example, when a blow is received on the hand and a bone gives way at that spot.

Indirect violence is transmitted along the length of one or more bones and the fracture occurs some distance away from the site at which the violence is received. An example of this was given in the last article when the history of a broken collar bone was described. Other examples include falling on the feet and the neck of the femur or even the spine, falling on the head and breaking the base of the skull.

Muscular Acfion -A violent and forcible contraction of a muscle is sufficient to break a bone. A common example occurs in the case of a patella when in attempting to prevent a fall, a patient braces his knee back suddenly. Another interesting example of a fracture due to this cause occurs occasionally when ribs are

broken through violence in coughing. An· injury known in medical language as a cough fracture.'

Fragments

The broken pieces of a bone that has been fractured are called the fragments. Their ends are often jagged and are therefore liable to cause further damage to tissues in the vicinity.

VVhen a bone has been broken completely, the fragments may become displaced owing to the involuntary action of the muscles which are in a state of spasm.

Varieties

There are a number of different kinds of fractures as follows :-

(1) Simple.- This tem1 is applied to any fracture which is not accompanied by complications and when air cannot gain access to the fracture.

The term is grad ually being replaced by the more satisfactory title of , closed fracture' which emphasises that the injury is one that is closed to the air.

These are several different kinds of simple fractures, for example, a spiral fracture when the bone is broken across on the slant and a transverse fracture when it is broken straight across.

A most important variety not usually described in text books is the fissured fracture. This occurs when the bone is cracked but not completely broken. It is a difficult fracture to diagnose.

(2) Compound.-Any fracture to which air can enter is called a compound or open fracture. The fact that the fracture is open is of great importance because germs can readily enter and set up sepsis. Although this sepsis may be confined to the injury itself, sometimes, unfortunately it spreads to the blood stream setting up serious complications such as septicaemia.

The most common variety of compound fracture is when there is a

skin wound which leads down to the injury, while sometimes the sharp ends of the fragments may protrude through the skin. Sometimes the air enters the injury in a more subtle manner thus in fractures of the base of the skull when the drum of the ear is torn air can readily gain access to the inner aspect of the skull.

(3) Complicated.- This, of course, is a fracture when there are complications present such as injury to an important blood vessel, a nerve, or to ajoint. In this respect it should be noted that sometimes, particularly in an oblique fracture, the injury may extend into the joint itself; moreover, it is not uncommon to find in an accident a combination of a fracture with a dislocation. Another variety of complicated fracture occurs when the fragments injure an important organ such as the brain, lungs, liver or spleen.

A variety of the complicated type, is called a depressed fracture. It usually affects the vault of the skull and one of the fragments is depressed below its normal level. This may damage the brain and cause compression. An operation may be necessary to remove the fragments and restore consciousness.

(4) Comminuted.-VVhen there are more than two fragments and the bones have been splintered, the fracture is said to be comminuted. It is interesting to notice that this type of fracture sometimes heals up more quickly than the simple variety.

(5) Impacted.- This term is applied to any fracture when the fragments are driven into each other and wedged firmly. An impacted fracture is generally of the spiral type and occurs at the ends of long bones. It has the advantage that since the fragments are wedged together splinting is unnecessary; all that is necessary as a rule is to put an upper limb in a sling. Common impacted

FIRST AID & NURSING, JULY /AUGUST 1953

fractures include the neck of the humerus, Colles and Chauffeur's fractures at the wrist, and the neck of the femur. If impaction occurs in a good position, i.e., the fragments remain in a straight line, medical treatment of the condition is easy. But when the fragments are impacted in a bad position, the doctor has to give the patient an anaesthetic, pull the fragments apart and reset them in a satisfactory manner.

(6) Greenstick Fracture.-This type of injury occurs in children up to the age of twelve whose bones are comparatively soft and tend to bend rather than break completely across.

It must be remembered that combinations of varieties often occur. Thus a complicated or comminuted fracture may be either open or closed. Greenstick and impacted fractures, however, are generally of the closed type.

Healing of Fractures

The body has an excellent method

of promoting healing of fractures. The first stage is that blood collects between the fragments, clots and holds them temporarily together. Small blood vessels and new cells grow into the clot and convert it into a red jelly-like material of a healing character called granulation tissue.

Cells that produce bone enter the granulation tissue and make a bone like material called callus. This grows like two temporary splints-one on the outer aspect of the bone and the other within the bone cavity itself. It begins to form within ten days of the injury.

Permanent callus ultimately forms between the fragments themselves, and when it has hardened, the temporary gradually disappears, leaving the bone firmly united.

The length of time taken on healing varies with the age of the patient, the size of the bone and the variety of the fracture.

Enemy

By Dr. Matthieu Jean Freyche, W.H.O.

' ON 28th February, 1940' states Dr. MacCallan, the famous British ophthalmologist, 'I was carrying out mechanical treatment for trachoma at Westrrunster Hospital for a young man who was a refugee from central Europe. The operation was carried out under general anaesthesia, and I wore a very fine silk mask. I had thought that such a mask, similar to those used by workers in the manufacture of emery, would not have passed any droplets which might be thrown up during the operation.'

, However, one such droplet hit the mask and, as I thought, went through the veil to my right lower eyelid. I went on with the operation and applied no treatment. Four days later I felt some discomfort in the right eye. By the eleventh there was definite conjunctivitis.'

, On the sixteenth day after the accident, the whole of the right conjunctiva was acutely infl a med and there was discomfort of the left eye. In a scraping from the conjunctiva I found intracellular inclusion bodies. Out of twenty such scrapings, taken between March 1940 and February ] 945, inclusion bodies were found on eleven occasions- the last of these being on 3rd July, 1943, that is, more than thr ee years a/tn the infec tion.'

Properly treated, Dr. MacCaIlan, who is president of the Organization again t Trachoma, and whose work as the organizer of the trachoma control campaign in Egypt is known and admired the world over, recovered from this attack without any subsequent infirmity.

3 multiplies and forms the' inclusion bodies' mentioned above. These virus colonies are often also called 'Halberstaedter and Prowazek bodies' after the two German scientists who observed them for the first time in 1907, in Java.

Although they are found only in the most cells, the deep tissues are rapidly affected (It seems that the parasite secretes a toxin '. which acts as a veritable poison on these tissues). The disease soon becomes manifest in small granulations which raise the conjunctiva and give it a characteristic rough, uneven appearance. In fact it is from this that the disease takes its : trakoma' in G reek means a crag-a roughness.' At the same time the cornea is affected by a kind of opaque film which descends from its upper edge: this is the , pannus.'

I n some patients, particularly among the youngest sufferers, spontaneous cure may develop at this stage. The film clears more or less and the granulations disappear leaving behind, as a rule, very fine cicatrices In the great majority of cases, howeverand particularly in countries where' seasonal conjunctivitis' is also pre"alent, and in cases where patients' occupational or home surroundings cause frequent eye irritation (factory smoke, dust, etc.}-tbe disease continues for years. It may e\ 'en drag on for a lifetime with constantly recurring painful, acute periods.

The eyelids become thickened and deformed, eyelashes which have turned inward prick the ulcerating cornea, the pannus continues to extend and becomes more and more opaque until it reaches and even covers the pupil. At this stage the unhappy sufferer'S sight is seriOUS ly impaired or he may even become blind.

This is not true, unfortunately, of innumerable patients who, infected in a more insidious manr:er and unable to obtain medical attention, have lost their sight as a result of this terrible malady. And yet-trachoma is not a very infectious disease. Only three cases of authentic trachoma were found among the American troops who, during the last world war, were stationed among populations extensively contaminated by the disease. A few simple precautions, such as meticulous cleanliness of the hands and the use of individual towels , will suffice to prevent the disease, since the virus which causes it, and which is found in tears and secretions from affected eyes, is not capable of long survival outside the human organism. Children are more exposed to contagion than adultsnot, of course, that the disease is hereditary, but because they may be contaminated by their parents or by playfellows suffering from the disease.

In addition to towels and hands, there is also the danger of the' kh 61 stick which is in constant use in the Middle East. It serves the whole family, and is applied to the eyes of newly-born infants after having been used on the eyes of the sick mother. There are also the flies, with which certain regions are swam1ing, and whole role in the transmission of the various forms of seasonal conjunctivitis' (another formidable eye complaint) has been well established.

Recent research has provided fuller knowledge of the disease virus which is a minute parasite which lodges in the human conjunctival and corneal cells, where it

This is no new disease In China, in the time of the Emperor Huang Ti ei Ching, a book of medicine described the treatment of certain trachoma complications in the year 2769 B.c. The disease was knO\\n in Egypt at least 1,500 years ago. Dr. MacCallan believes that it started in Mongolia, whence it spread to the rest of Asia and to Europe after the Mongolian invasion, and to the American continent across the Pacific.

The World Health Organi za tion, after having carried out in 1948 and 1949 a preliminar) study of \vorld distribution of the disease and its consequences, set itself to define the most effective, and at the same time least expensive, means of combating it. An international Expert Committee met under W.H.O:s auspices and put forward a series of clear and complete recommendations to serve a a guide both to physicians and to interested national administrations. The Committee's report has just been published. Offers of support were made also by other specialized agencies of the United ations. This support already makes it possible to envisage' mass campaigns' in several countries for the treatment of many hundreds of thousands of patients. The preliminary sty dies for the e campaigns are under way; 10 two or three years it will be possible to draw. elusions from these large-scale actn Itle , which are to be undertaken without delay, and to know whether the trachoma scourge can be finally defeated.

Fro/ll World Health Organi::atioll Dil'isiO/l of Public Infol'lnation, Geneva.

FIRST AID & NURSfNG. JULY/ UGUST 1953

Compet ition NelVS

St. John Finals

Twelve ambulance teams and ele\ en nursing teams contested in. the S1. Ambulance Brigade first aid cO!DpetltlOn finals at the Central Hall, Westmmster, on 4th July. Winners were: AmbulaI?ce, Wolverton (Bucks), 352 marks; ursmg, Spalding (Lincs), 32Q4 marks.

The winning men's team. ipcluded Privates H. J. Green, L. H. Billingham, A. G. Keeves , R. P. Bennett, and R. L. Ditum (reserve). The winning nurses were: D 0 M. Lawton, T M G. borough, F. V. Braybrooks, J. T. Mellmg, and E. M. Shields (reserve).

Second and third were: Ambulance, 2nd Fishponds (Bristol), 3I9}; 3rd, Cam?ridge City Police, ursmg : 2nd, Bngt:ton (Sussex), 322k; 3rd, Moseley A (Bmmngham) 306.

Trophies and prizes were presented by Alderman Charles Russell, Mayor of Westminster, and the Chief, Lt.-General Sir Otto Lund, preSided.

XR.P.T.A.A.

Competitions

The Final First Aid Competitions for the Stirk Trophy and Lewis Cup, arranged by the ational Road Passenger Transport Ambulance Association, took place at Plymouth , on Sunday, 12th July.

the Central Hall, Westminster, on 26th June were :-

Ambulance:

1st. R.O.F. Glascoed.

2nd. Windscale Works, Cumberland

3rd. R.A .E., Farnborough.

ursing:

1st. Storage Depot Elstow.

2nd. R .A.E, Farnborough.

3rd. H.Q. Offices, Adelphi.

Prizes were presented by Slf James Helmore, Permanent Secretary to the Ministry of Supply.

London Transport

The First Aid Competition for the Hally Tablet took place at the Ambulance Hall Baker Street Station, on Thursday and 25th and 26th JUI?e. This is a contest for the highest profiCIency ?f marks amongst First, Second and Third year members respectively.

The results were as follows :-

1st year Winner:

Miss A. M. Burrell (Broadway).

Runner-up:

Mr. A. Meadows (Ley ton).

2nd year Winner:

Mr. E. J. Talbott (Charlton Works).

Runner-up: Mr. L. G. Edwards (Catford).

3rd yea r Winner:

Mr. W. N. Bolton (Clapham).

Runners-up:

Mr. K. Boyne (Stamford Hill).

Mr. P. Henry ( easden).

The Centre Secretary , Mr. S. W. Harden congratulated the winners on their performances, particularly the wIDner of the Second year, Mr. E. J. Talbott, who previously won the First year co?test m 1952. He also thanked the competitors for their interest in the Competition and the Judges and Stewards for their willing assistance.

Disappointment for St. John's Cadets

The S1. John Cadet Coronation Camp, held at orth Ockenden, Essex, from 1st to 8th August, was attended by over 2,000 Cadets, including those from Australia, Canada, Cyprus, Kenya India, Malta, New Zealand , Rhodes ia and South Africa.

Among the activities were competitions in first aid, bedmaking, child welfare, road safety and firefighting. A special competition in first aid was held for the , Springbok' trophy, which was to have been presented to the winning pair by H.R.H Princess Margaret when she visited the camp.

Unfortunately, owing to a single case of infectious disease in the camp, the vi:;it by Princess Margaret was cancelled, much to the disappointment of the Cadets, who were looking forward to the In spection and March Past. A message from H .R.H. was sent to the Cadets.

Elstree Division Jubilee

A social was held on 13th June at Boreham Wood, to celebrate the Silver Jubilee of Elstree Division S.J.A B Guests the Northern Area Commissioner, Dr. G. M. Shaw Smith and Mrs. Smith, Area Surgeon Major E. W. Tapley, Area Superintendent F. J. Middleton and Mrs. Middleton, Area Superintendent Mrs. 1. R. Burns and Mr. Burns , Area Officer Capt. R. A. Payne, Area Cadet Officer S. C. Andrews, the Rev. W. Maddock Vicar of All Saints Church, Bareham Wood and Mrs. Maddock, Councillor A. Armstrong, Chairman of Elstree Rural District Council and Councillor H. Farr.

The evenings' entertainment included games and dancing, and Miss Angela Hatch, a brilliant accordionist, Mr. W. Sewell and Mr. D. Sewell entertained the guests. Mr. J. J. Oliver accompanied on the piano, and Private C. Dyer of Elstree Division and his coJieague, Mr. E. Jackson provided music for dancing.

H.R.H. The Princess Royal attended the British Red Cross Society's annual service of dedication in Sf. Paul's Cathedral on 15th July. In the picture above H.R.H. is being greeted by the Lord Lord Mayor of London, who was accompanied by Aldermen and Sheriffs of the City of London.

The Area Commissioner presented Di visional Officer A. E Bailey v, ith a wrist watch on behalf of the Di vision as a token of esteem from the members. Divisional Officer Bailey has been associated with the Division since its formation.

Area Superintendents F. J. Middleton and Mrs. 1. R. Burns spoke on the work of the Brigade and Mrs. Burns said how much she would like to see a Nursing Division formed in the district. The Division is actively engaged in encouraging this venture and it is hoped that this historic year will see this ambition realised. Plans are going ahead too, to form Cadet Divisions

Pen Friend Wanted

Cadet Superintendent Mrs. E. Reinhardt, of7 Cairnfield Road, WhangareJ, Northland New Zealand, sends us an interesting'letter about St. John activities in her district. Among the items of special interest we learn that for the nrst time a team' of Maori girls took part in the Dominion competitions for St. John nursing cadets and won a Shield. She sends also a copy of 'News Flash' the Division's

magazine from which it is obvious that S1. John work is being energetically and enthusiastically pursued there.

Mrs. E. M. Reinh ardt, who originally came from London, would be glad to hear from first-aiders in this country.

Back Copies of First Aid

Me G. E. Bradley , 44 Ravensdale Road, Coventry, has a number of back copies of this journal which he will be pleased to send to any reader who will pay the postage. The copies are: all issues in 1942, 1943, 1944, 1947, 1948, 1949, 1950, 1951, 1952, January to October in 1945, January / April and June December 1946.

Institute of Certified Ambulance Personnel

The following were successful in the Examinations of the Institute held in April, ] 953, in London and Middlesbrougb.

Final Examination: Blower, A. G., orwich, orfolle ; Clover, F. G., orwich, orfolle; Coates, J., Leeds. Yorks; Fitton, W., Halifax, Yorks; Gillard, D. E. London; Griffen, W. R ., London; Hayes, A. B ., Matlock, Derb ys; Hayward, H. K, Norwich, orfolle ; Hooper, D. M. , Bath, Somerset· Howarth, D. A., CaIne. Lanes; Moss, W. Derby; PO\vles, E. W., Liverpool, Lanes; Spring, E., Halifax, Yorks; Templeton, M., Glasgow, West, G. W. H., Nottingham.

Mr. W. Fitton gained first place in the Final Exanlination and Miss Moss gained second place.

Preliminary ExaJllination : Bali, G., Warrington Lanes; Betts, P. Norwich, orfolk; Connolley, J. c., Preston Lancs; Dawes, M., Middlesbrough, Yorks; Goulding, A., Middlesbrough, Yorks; Haygarth, J., Middlesbrough, Yorks; Love, E., Middlesbrough ; Overy , H., Stockton-an-Tees, Co. Durham; Robson , S., Middlesbrough, Yorks; Roger, R., Middlesbrough, Yorks; Shackleton, c., Telson, Lanes; Smurtbwaite, H ., Middlesbrough, Yorks; Tennekoon, M. V., Norwich, orfolk; Worthington, M., Preston , Lanes.

Mr. H. Smurthwaite gained first place in the Preliminary Examination.

Nylon for urses

Women's overalls in nylon are now available, and have special advantages of being long wearing and good looking. Speed of laundering make this garment particularly useful for home nursing and industrial first aid, etc.

The smartly-tailored style shown in the photograph has a cross-cut flared skirt and collar which can be worn either fastened up to the neck or turned down to form a lapel. It has detachable buttons. and is offered in white, lido blue, turquOIse and spring-leaf green.

Any of our readers interested in these nylon overalls may obtain details of their price and purchase from this office.

Price Reductions

Price reductions are announced for , Benzedrine tablets and ampoules, Dexedrine tablets and ampoules, 'Drinamyl' tablets, 'Eskaci llin' 50 and 100 and 'Pendex.' Price lists are available on application.

TOPICAL NOTES FOR FmST-AIDERS & NURSES

Skin Reactions after administering Antibiotics

The occurrence of disabling sensitivity to penicillin and streptomycin in doctors and nurses administering these drugs has been recorded during the past few years, and often after they had been used safely over a long period. An investigation by the Ministry of Health showed that 73 district nurses, as well as others in hospital had had to give up nursing for varying periods. The following advice has, therefore, been issued by the Ministry of Health

The dermatiti s, usually confined to the hands and face, has been shown by experiments to be due to sensitization produced by contact of the solution with the skin, and this is believed to occur more often with streptomycin than \"lith penicillin. The contact can occur when the syringe is held vertically at eye level and air is expelled from it before

the injection i given: for bubbles bur ting at the tip of the needle liberate a fine pray of the solution. The procedure recommended bv the Mini try of Health pamphlet the matter ugge ts changes in the technique usually taught to nur e , in that. having taken special care to ensure that the needle i firmly attached to the syringe so that 110 sudden leakage can occur under pressure, the air should be expelled from the syringe whilst the needle is still in the bottle from which the olution ha been \\ ithdra\vl1. Care should be taken to upport the piston during and after withdrmyal. so that further air doe not enter. The same needle should be u ed both for \\'ithdrawal and injection; for contamination of the hands with the solution can take place if the needle is changed after withdrawing the drug and another ubstituted for actually giving the injection.

This changing of the needle 11a been taught in the past either because a larger bore needle make it ea ier to withdraw a viscous fluid from the bottle or becau e it i believed that perforation of the rubber cap blunt the needle. The latter has been proved incorrect. for the piercing of the rubber cap a many as 100 time doe not affect the sharpness of the needle. Streptomycin not vi cou so as fine a needle as desired can be u ed. After use, the syringe hould be rin ed in plenty of water and the nur e, or doctor, should immediately wash the hands to rid them of an} traces of olution that may have reached them.

'Vellcome Centenary Exhibition

This exhibition i taged at the Wellcome Foundation, Eu ton Road, London, to commemorate the centenary of the birth of Sir Henry Wellcome, LL.D., F.F.A., F.R.S. He was born 111 America. At the age of 13 hehelped his father in a. drug store where he howed a great 1l1tere t and proficiency in chemi try and pharmacy. At 17 he left home to take a junior po t\\'ith a fir!11 of pharmaceutical chemist. HI hour were

6

from 6 a.m. till 10 p.m. and he devoted all his leisure to study.

At the age of 20 he graduated from the College of Pharmacy in Philadelphia, having worked his way through college by taking part-time jobs. He continued to spend all his spare time in research, particularly with regard to plant remedies. He came to England in 1878 and entered into partnership with Silas Burroughs to found the firm of Burroughs, Wellcome and Co. Both partners were experienced in handling the products they wished to sell, there was a popular demand for medicines, and the compressed drugs from America with their accurately measured and easily administered doses had an immediate success.

How Henry Wel1come progressed from this point and founded the Wellcome Physiological Research Laboratories in London in 1894 for the immediate and specific purpose of making diphtheria antitoxin, the Tropical Research Laboratories at Khartoum and, later, the Wellcome Historical Medical Museum and Library in London are described in an attractive booklet which is presented to visitors to the Exhibition. It was in 1924 that Sir Henry consolidated his many interests within a single framework by forming the Wellcome Foundation, Ltd., with its headquarters in the impressive building almost opposite Euston Station. He died in 1936, and by the terms of his will all the shares of the Foundation were vested in five trustees, and all dividends were to be utilized 'for the advancement of research work bearing upon medicine, surgery, physiology, chemistry, bacteriology' -and allied subjects. The will also provided for the establishment or endowment of research museums and libraries; the profits of a great manufacturing and trading concern being permanently dedicated to the advancement of knowledge and the benefit of mankind.

The Exhibition will remain open until September, from 10 a.m.5 p.m. each weekday, except Saturdays, admission is free and parties are welcomed and conducted round the many interesting exhibits; which are not entirely ssientific.

Nurses'

Role in the Health Service

.After five years from -its inauguratIOn the National Health Service

is now recognized as an integral and permanent part of our national life. One of its greatest problems is still the enormous demand upon hospital beds and the difficulty in finding sufficient nursing staff to keep all beds occupied. Recruitment of student nurses has increased from 42,000 in 1948 to 50,500 in 1952, and the total nursi ng staff from 110,000 to 135,000 during the same period; and yet there are still 28,500 unstaffed beds in our hospitals, in spite of the fact that 22,500 full-time and 12,000 part-time nursing auxiliaries are employed in hospitals. The task ahead must, therefore, be two-fold :-to reduce the need for hospital beds and to make the most effective use of all nursing personnel. As Miss HornsbySmith said recently, 'In the long run our Health Service must be judged rather by the amount of sickness it prevents than by the amount it succeeds in curing, and the nurse has her part to play in the preventive process no matter in what field of work she may be engaged. Furthermore, when a patient becomes ill, it is neither in his own interests nor in those of the community that he should be admitted to hospital if he can be equally well cared for at home or, if he does go to hospital, that he should be kept there longer than necessary.'

The training gjven to the National Hospital Service Reserve must surely help in the care of patients in their own homes, for the members of this service go back into their own jobs possessing greater knowledge and proficiency in nursing care than they ever had before, and so can do much for their sick relatives. In the conservation of trained nursing skill for its essential purposes, the Job Analysis Report of the Nuffield Provincial Trust suggests re-allocation to other staff of many non-bedside tasks, the standardization, or in some cases the elimination, of certain routine procedures the provision of more labour-saving devices, and the revision of working hours to take account of the -oeak periods in nursing. One must, however, never lose sight of the main object of hospitals, which is to provide for the care and comfort of patient in the most practical, skIlful, human and sympathetic way.

Books

'Aids to Ear, Nose and Throat Nursing,' by Susanna Marshall, S.R.N., S.C.M. D.N. (Lond.). Bailliere, Tindall & Cox, price 6 -.

This is a subject upon which a small, up-to-date textbook was sorely needed and Miss Marshall has most effectively supplied that need. The book is arranged in five sections, the first being an introduction to the whole. It gives the anatomy of the organs concerned and explains the need for hygienic habits in maintaining the health of the structures involved. The arrangement of out-patient departments, a description of nursing techniques and a survey of important drugs used in ear, nose and throat treatments completes this section. Section n deals with diseases of the nose and accessory sinuses, followed by a description of the various operations that might be required and the nursing care involved. Section III is arranged on the same lines, but with regard to the mouth and pharynx; Section IV concerns the larynx, trachea and oesophagus; and Section V is devoted to the ear. An appendix contains an illustrated glossary of the surgical instruments and equipment mentioned in the various sections of the book. Miss Marshall shows a wide knowledge of her subject and a clarity in presenting it to her readers; and this could not have been an easy task. What one would welcome now is a companion volume on ophthalmic nursing.

'Bailliere's Pocket Book of Ward Information,' Heimann & revised by Marjorie Houghton, M.B.E., 7th edition, price 5 /-.

This small book-it is 5 X 4 in. in sizeis most convenient for the apron or the waistcoat pocket, and it contains a mine of information to which the nurse can refer whilst carrying out ward duties. In its early editions it was concerned chiefly with drugs and their administration, and it was entitled' Nurses Pharmacopeia.' Its scope has now been extended to cover almost every aspect of clinical ward work, hence its change of title. The additional subject matter in the seventh edition includes the newer antibiotics and chemitherapeutic substances, and the therapeutic use of radioactive isotopes. The vitamin chart is a masterly condensation of present day knowledge of these food factors in so far as this knowledge is related to the work of a nurse.

, The Proudest Badge, The Story of the Red Cross,' published by the British Red Cross Society, price 11-.

This book is dedicated to Miss Margaret Cross, M_RE., who worked so untiringly to establish the Junior Red Cross in this country and who died on 25th March, 1948. It is intended for junior members and recruits and gives an account of the beginning and development of the Red Cross movement, its present work and its national and international organization. It is simply but inspiringly written and it is a story that should capture the imagination of all young people, and make them very proud of their opportunity to be in on such an important service to the sick, the suffering and the nca paci ta ted.

Diagnosis-2

By F. C. Reeve F.Z.S., F.R.E.S.

BEFORE leaving the question of the conscious patient I will mention a few more points upon which he should be able to furnish useful information.

Thirst: (suggesting dehydration), Loss of memory: (concussion), Dimness of vision: (impending collapse foHowing haemorrhage), Faintness: (shock, sun- or heatstroke), Nausea: (sunstroke), Cramp: (in legs, heat exhaustion; in back, strained or ruptured muscles; in leg and abdominal muscles, heat cramps), etc. If the patient has fallen, try to ascertain the height from which he has fallen, and, if possible, the position in which he landed. Did he hear the crack of a fractured bone? Has he ever suffered from diabetes?

In eliciting this information it must not be forgotten that your patient is more or less distressed, either in mind or body, or both, and his endeavours to answer your questions entail a severe strain upon his weakened constitution, both mental and physical. Questioning a patient is a fine art, and to be thoroughly successful you must be a psychologist. Try to put yourself in the position of the patient. He has never seen you before and knows nothing about you, so that it is necessary that, as early in the interview as possible, you secure his confidence. Ten him you are a First-Aider, and that everything that can be done you will do. But do not forget that you cannot inspire confidence in him unless you have confidence in yourself. You will need patience and understanding.

Try to divine what kind of a man he is, for one patient is better at making descriptions than another. The ney, for .instance, is direct and logical, dwelling laboriously upon detail , whereas at the other end of the scale is the rustic, slow, deliberate, suspicious and sometimes with a mixture of superstition. Only

experience will enable you successfully to sort out the relevant from the irrelevant.

ever ask a single unnecessary question, but be certain that you have a definite reason for each one you do ask. No question should be asked unless you believe that the answer will prove to be one from which you can hope to make some useful deduction. Further. avoid asking any question twice, for this may lead to the assumption that you have not been taking notice of the answers that have been given, and, therefore, taking little interest in the case.

The clinical examination of children presents special difficulties, for it often has to be carried out with very little help, whether the patient is conscious or unconscious. It will often be found in practice that it is better not to stick too rigidly to your order of examination but to deal with the various points as they are presented to you, especially if, in the case of a conscious child, you meet with strenuous opposition.

We must on no account overlook the valuable information to be gleaned from temperature, pulse and respiration, although I have heard of Brigade officers who will tell you that this is beyond the scope of First Aid. The meticulous care, however, with which the authors of the textbooks have included these in their diagnoses of various conditions provides a sufficient answer to this criticism. By sticking to the textbooks no First-Aider can go wrong. You should bear in mind that, although the· normal' temperature is usuallv stated to be 98.4 OF., variations within certain limits are continually occurring in healthy persons. Any temperature registered between 97 oF. and 99 OF. need not necessarily give cause for alarm, and variations of half-a-degree often take place between morning and evening. I prefer, therefore to u e the word 'average' to the word , normal' to describe the 98.4 OF.

usually quoted. If no thermometer is handy, placing the back of the hand on the patient's forehead \\ ill give you a rough idea of his temperature although, of course, by no means as accurately as it can be taken \\'ith a clinical thermometer. A subnormal temperature is, as a rule, more dangerous than a n abnormally high one.

Perhaps it should be mentioned in passing that recently some doubt has been expressed in medical circles as to whether or not the 'average' temperature should be regarded as 98.4 oF. For some years past Dr. Gerald Ralston has been making observations from which he is led to believe that it should be placed at 97.6 °F. and that any temperature registered in a patient above that should be inve tigated. However, for the time being at any rate, until the new theory has received confirmation, you must continue to regard it as 98.4 OF.

Although the normal pulse rate of an adult is usually quoted as 70-80 beats to the minute, considerable variation is to be found, even in healthy perso·ns, and it, of course, varies with age. The following pulse table is well worth memorizing :-

Foetus in utero 140-160

Newborn infant 130-140

During 1st year 115-130

During 2nd year 100-115

During 3rd year 90-100

During 7th year 85-90

About 14th year 80 - 85

Adult 70-80

Old age 60-70

Decrepitude 65-75

In conducting our examination not only should the pulse rate be noted but also the frequency, regularity, quality (volume and tension) and the condition of the artery. Frequency is increased by exercise, excitement, emotion, eating, upright position, alcohol and cardiac stimulants. It is decreased by repo e, leep, fatigue, expo ure, fasting and drug which quieten and strengthen

the heart, like digitalis, aconite, etc.

Tachycardia (over 130) and bradycardia (under 60) are serious conditions. The following nomenclature has been adopted to describe the various groups of pulse-rates :-

Slow or infrequent under 58

Normal 60- 80

Quick or frequent... 100-120

Rapid ] 20-150

Running over 150

A pulse may be irregular both in rate and strength, and can also be irregular and intermittent at the same time. In judging the quality of the pulse you must note (a) its volume (full, full and bounding, small, thready, etc.), and (b) its tension (high or low), each of which conditions represent some specific significance. In studying this question the following table, whilst by no means exhaustive, should prove useful :-

Rapid and feeble : (concussion, faintness, collapse following haemorrhage, fright, exertion, shock, sun- and heat-stroke, alcoholic excess, asphyxia, acute heart attack, toxaemia, etc.).

Full and slow: (compression, apoplexy, etc.).

Irregular: (concussion, acute heart attack , etc.). Not often by injury, except as a result of haemorrhage into the pericardial sac (cardiac tamponade).

Quick and bounding: (sun- and heat-stroke, etc.).

Strong.' (uraemic coma).

Thready : (shock).

Slow and irregular : (asphyxia).

Absence: (acute heart attack).

It will be found that the respiration rate is usually one-fourth (roughly) that of the pulse rate, although there are exceptions, even in the healthy state. The respiration is increased in disease of the lungs and air passages , fever due to toxins, organic disease affecting the in which the composition of the blood is altered, haemorrhage, drugs which stimulate the respiratory centres, etc. It is decreased in certain brain diseases, e.g., coma or compression, and by drugs which depress the respiratory centres, e.g., opium, etc. Of the many types of abnormal re.spiration the following, together WIth notes on their significance will I trust, be found useful :- ,

Rapid: (exertion, excitement, emotion, sudden chilling, concussion

if weak, fainting if sighing and irregular, asphyxia if difficult and irregular , disease of the lung and air passages, some feverish conditions due to toxins , disorders altering the composition of the blood, fright, heart disease , exhaustion, obstruction if accompanied by stridor, internal haemorrhage if laboured, poisoning by prussic acid or cyanide if panting, etc.).

Slow: (repose, sleep, fatigue, Stokes-Adams syndrome, hypoglycaemia if shallow and quiet, some diseases of the brain like coma or compression, narcotic poisoning, etc.).

Deep: (uraemic coma; if slow it is characteristic of many brain diseases).

Shallow : (concussion, faintness, collapse following haemorrhage, shock, hypoglycaemia if quiet and slow).

Holding of breath: (infantile convulsions).

Stridor: (obstruction of the air passages, laryngitis, croup, etc.).

Irregular: (fainting,uraemic coma, brain injury, apoplexy, asphyxia, etc.).

Stertorous: (brain disease, compression, apoplexy, alcoholic excess, etc.).

Hurried and labour ed: (haemorrhage).

Yawning and sighing: (collapse after haemorrhage).

Air hunger : (collapse after haemorrhage, acetonepnoea).

Acidosis: (uraemic coma, diabetic coma).

Distressed: (diabetic coma, etc.).

Hiccough: (alcoholic axcess).

Cheyne-Stokes: (senility, morphine poisoning, uraemic coma, brain injury, apoplexy, diseases of the brain and membranes, diseases of the heart and great blood vessels, diseases of the lung, diseases of the kidneys, certain acute fevers, sunstroke).

Apnoea: (asphyxia, electrocution, epilepsy, shock, death).

Dyspnoea: (asphyxia, left heart failurer

Wheezing: (bronchitis, etc.).

Grunting: (pneumonia, pleurisy, other diseases of the lung).

Crowing: (croup).

The above observations on T.P.R. should also be borne in mind in examining for head injuries.

CARE AND WELFARE OF CHILDREN

Concluding article in a series by Agnes Pavey S.R.N.

The First Home for Destitute Boys

FIRST AID & NURSING, JULY/AUGUST 1953

A Village Home for Girls at Barkingside

One of Dr. Barnardo's wedding gifts was a lease of Mossford Lodge, a spacIOus house at Barkingside, Essex. At the back of it was a coach-house which was re-modelled, had an upper floor added and was opened as a home for forty girls, whose life stories were appalling in their revelations of neglect and degradation. The number grew to sixty in a few months, and then the accidental overhearing of some vile conversation amongst the girls came as a great shock to Dr. Barnardo, who realized tha one depraved girl could contaminate the whole sixty and that the absence of any real home life and the wearing of a dull uniform was the wrong way to reclaim little girl savages. thought over the problem and, to quote hiS own words: 'I saw what I ought to do. I would arrange for a number of ivy-clad cottages to arise, each presided over by a kindly Christian woman who would be the "Mother." The children should be of all ages, from the baby-inarms to the girl in her teens. They should be dressed as simply and with as much variety as possible. Anything approaching institutionalism would be scrupulously excluded. In such a home and in such an atmosphere the affectionate ties of family life and family love would have a chance of being created and fostered in the experience of the children , while the daily performance of commonplace duties would tend to fit them for their future career.' That was in 1873, but it was three years before his plan could be put into action. He acquired thirteen acres of freehold land aCijoining Mossford Lodge, and on this site eventually arose a number of two-storied cottages surrounding a village green , each large enough to house twenty girls , with a , mother' in charge; and there was also a church, a hospital and a laundry.

had rescued 130,000 destitute children. Finances were helped by the establishment of several funds, including the National and Farthing League, the Sunshme Fund and the Barnardo Helpers' League; and once a year Dr Bamardo hired the Roy al Albert Hall and presented a programme carried through by as many as 1,000 of his children and which demonstrated the character of the work being done. A similar comprehensive programme is arranged for Founder's Day at the Village Homes, Barkingside, when from 1,000 to 1,500 visitors usually attend.

Present Work

The Barnardo 'family' is now about 7,000, including 1,650 babies and 150 crippled or deformed children ; and 2,230 in the care of foster parents. It is thus the largest organization of its kind. It became a Registered Adoption Society in 1947. Its Patrons are Queen Elizabeth and the Queen Mother. Its President is Princess Margaret. Some of the centres for specialized training demand individual mention. Among these areThe Garden City, Woodford Bridge, Essex

Victo,·y ove,·

Babies

9

POR centuries rabies has held the grim title of the world's most dreaded disease. To-day , except in a handful of countries which h ave succeeded either in eradicating the disease or in preventing its introduction, the fear of rabies still strikes a chill into men 's hearts everywhere from t he arctic to the equator and in both the old and the new worlds. For there is still no cure and no hope of recovery once this pitiless disease has really taken hold.

If rabies cannot be cured, it can be prevented in most people who have been exposed to infection from the bite of a rabid animal. Generally the disease does not appear in man until many weeks, and sometimes several months , after exposure to infection.

It "Was Pa steur who first discovered that anti-rabies vaccination, if begun early enough, could prevent the disease from developing in most people bitten by rabid animals. In the last seventy years, the Pasteur vaccine, or various improvements on it , has been made and used on millions of people in most countries of the world.

THE.

roung medical student was now lIvmg an extremely busy life. His work among the destitute children of the East End claimed many of his nights, he had about twenty boys sustained in various lodgings by himself and his friends but he still felt bound by his choice to a medical missionary in China. Many advisors,. including L<:>rd Shaftesbury, urged htm to devote himself entirely to rescue work among children but he had no financial assets. Just then,' he received a letter from a well-known Member of Parliament, whom he had never met offering to provide £ 1,000 to establish home for destitute children if Bamardo wouJd give up, least. for the time being, the Idea of work m Chma. So in 1870 he temporarily abandoned his medical studies and took a house in Stepney Causeway that would accommodate about 25 boys. He determined. to take in as many boys as he could proVide for, but never to get into debt. Very Soon afterwards an event occurred caused him to reconsider this. A child who had pleaded hard to be taken into the already full home had been promised the next but a few mornings later a porter at Billingsgate found him dead. The mquest verdict was' death from exhaustion the result of frequent exposure and want of

food.' The tragedy so shocked Barnardo that he threw financial caution to the winds and nailed up a prominent signboard outside the Home in Stepney Causeway which read: 'No Destitute Child Ever Refused Admission,' and that caption has remained there ever since. Soon, adjoining houses were taken and the family was increased to 250, and later to 400. No. 10 Stepney Causeway was kept open by night as well as by day, and provided immediate shelter, food and, when necessary, medical attention to all children in need of such help. A lantern, suspended from a wall bracket that projected well into the street, was kept burning all night and drew attention to , The Ever Open Door.' Bamardo's custom was to go out at night with a lantern and search for homeless and starving children in all sorts of dark corners and recesses. He received valuable co-operation, in this respect, from the police He found little girls as well as boys, and for these he obtained lodgings, for it was not until after his marriage, in 1873, that he founded his first home for girls. Meanwhile, his medical studies were in abeyance, and it was not until 1876 that he resumed them at Edinburgh and took his qualifying examinations. Four years later he obtained the F.R.C.S. (Edinburgh).

At the outbreak of war in 1939 over 1,500 girls from the Village Homes were evacuated and, later, the local authority requisitioned the village to house bombedout people who were working in the East End. The requisitioning lasted for five years after the war. In its reconstruction the village difiers entirely from its pre-war activities. It is no longer a village of girls. It comprises a Reception Centre, a Nursery Group and permanent residential groups of boys and girls living in separate families, each in the care of a cottage mother.

Later Work

By 1890 at least twenty Branch Homes had been established in different parts of the country, and also shelters for homeless young women, a shelter for cab and bus men, and a Medical Mission under the care of a physician, a dispenser and a band of women helpers who visited the sick in their own homes when they were too ill to attend the clinic. Boarding-out commenced in 1886. Centres were established in Toronto, Ontario and Winnipeg, to which 28,000 boys were emigrated in Barnardo s own lifetime. Hospitals and convalescent homes were founded for the crippled, deformed, blind, deaf, dumb and tuberculous, even for those in the last stages of disease. The only conditions rendering a child ineligible were epilepsy and mental deficiency. Many years before Old Age Pensions were even debated in Parliament Dr. Barnardo instituted a rent-grant scheme to help aged women. By the time of his death, in September, 1903, it is estimated that Dr. Barnardo

This was started first, for boys, on the same lines as the Girls Village Homes at Barkingside, when Dr. Barnardo was gradually closing the Branch Homes in thickly populated districts and transferring the children to the country. It now comprises cottage homes for babies, for girls and for boys, a Hospital Home, the Princess Margaret School for Girls and a Staff Training Centre. The Princess Margaret School gives higher general education and specialized training to older girls. It is run on boarding school lines, the girls going home for holidays. At the Staff Training Centre students become eligible for theHome Office Certificate in Child Care. A Child Care Cadet scheme has recently been started for girls of 16 who are hoping, when they are old enough to take the Home Office Course. They have three periods at the Staff Training Centre and go to selected Homes for practical work.

Warlies School of HOllsecrajt, Waltham Abbey, Ess ex

This was establishe d, in 1927, for girls of 15 who are not going on for higher education. The course is one to two years, and all forms of housecraft are taught before the girl decides on her career.

Th e Parkstone Sea Training School, Dorset

In June 1901, owing to the generosity of Mr. E. H. Watts, a large building at Elmham, Norfolk, was converted into the Watts Naval Training School for boys who wished to enter the Royal Navy. Later, through the generosity of Sir Merton Russell-Co tes , the C o tes Nautical Training School was established at Parkstone to train boys for the Merchant Navy. In 1949, these two maritime schools were amalgamated into the Parkstone Sea Training School.

The William Baker Technical School, Goldings, Herts

This was founded in 1921. It is now a well-equipped modern Technical School where boys are taught a variety of trades.

For fifty years the Industrial Training Centre had been in the heart of the East End and It moved to 'Goldings when this school was built as a memorial to William Baker, who was Dr. Barnardo's successor until his death in [920.

Despite its undoubted usefulness this , classical' anti-rabies treatment initiated by Pasteur by no means provides a final answer to the rabies problem. In quite recent years a handful of medical scientists working both in the laboratory and in the field in different parts of the world have made new and significant advances in the knowledge of rabies and the means of controlling it. The news of these advances aroused intense interest among public health authorities and rabies workers everywhere However, many countries, especially the countries where the rabies problem is most serious, could not afford to send their rabies specialists away for the months of travel and study necessary for them to keep abreast of the new developments.

The World Health Organization took up the challenge of this situation and arranged for rabies workers from a limited number of countries to meet a number of the world's leading researchers and other authorities on rabies in a new kind of seminar-cumconference-cum-teaching-session.

The first such conference was held in Coonoor high in the beautiful Nilgiri Hills of South India, for two weeks during July 1952. The Indian Government acted as host, and the DLrector and staff of the Pasteur Institute of Southern India in Coonoor put themselves and their fine laboratories and lecture rooms entirely at the service of the conference. Coonoor was a most appropriate setting, for its Pasteur Ins.titute has long been one of the most Important producers in India of anti-rabies vaccine. By lectures, films, lantern slides and discussions, participants were br0.ught l:1P to date in modern methods of the diagnOSIs, treatment and control of rabies. Even more important, they received intensive tuition in the difficult and compltcated laboratory procedures which are basic to these new advances.

One great advantage of intensiv:e laboratory training is the res.ultll1g zation of laboratory techniques whIch Will

(continued on page 12)

Querie.f1

K. B. (Hove) writes :-

When I was on public duty recently, a woman applied for treatment. She had a finger which was swollen, red and painful and so was the back of her hand. She told us it dated ./i"om a gnat sting three days before and that she had been to a chemist who had given her some ointment which, however, seemed to have made it lVorse. What was the correct treatment to give?

Answer

N one whatever. She should go to her own doctor. It sounds as if the finger was going septic, and that penicillin might be required. Complications of stings which have occurred three days before are beyond the scope of first aid. * * *

J. W. (Hull) writes :-

I am frequently seeing cases of coronary thrombosis referred to in the newspapers. Can you tell us something about this complaint and its first aid?

Answer

A clot of blood forms in one of the main blood vessels of the heart. It occurs suddenly causing a heart attack. Chief symptoms - severe pain over the heart, often also felt in the left ann or neck, accompanied by shock. Uncommon under the age of 45. Send immediately for a doctor. Keep the patient resting and apply simple measures for shock provided they do not disturb the patient.

* * *

A. S. (Birmingham) writes :-

I am somewhat nervous of the new method of treating the fractured collar bone (S.J.A.A. textbook). J tried to do it recently on a patient and he complained of such severe pain that I had to take the bandage off Another member of our Division has had a similar experience.

Answer

The three hand kerchief method, as it is called, is not new and has been used for many years by the medical profession with great success. I can understand the patient complaining of severe pain if one of the rings is actually applied over the fracture but otherwise the treatment should not be painful. Any action which produces pain should be avoidede.g., bracing the shoulders backwards too forcibly.

* * *

L. P. D. (Watford) writes :-

An elderly man, getting out of a train, complained of excruciating pain at the back of his ankle. He could only limp along. I could find no evidence of a fracture but there was tenderness at the back of his ankle. I treated him for a sprained ankle but heard later that he was in hospital, had an operation, and then his leg and foot put into plaster of Paris. Can you throw some light on the condition from which he suffered?

Answer

There are, of course, several possibilities. Assuming that this was no fracture, it is probable that he had torn his tendo Achilles, the strong tendon that can easily be felt at the back of the ankle. When this occurs it has to be stitched up and plaster of Paris applied to ensure healing.

* * *

C. H. H. (Tooting) writes :Jnternal haemorrhage has, as one of its symptoms, air-hunger; so has haeinorrhagic shock. What is the explanation of this condition ?

Answer

The chief cause is lack of oxygen in the circulating blood caused by loss of the red blood corpuscles. Loss of fluid itself from the body may also playa part.

D. N. B. (Earlsfield) writes :-

While on holiday, il1 the country, Twas swprised to hear once again the story that if you cut yourself between your finger and thumb you are particularly liable to develop lock-jaw. I thought this was an , old wives tale' and had been given up, but I suppose there must be some foundation for the statement and would like your opinion.

Answer

Any wound ll1 the body contaminated with the tetanus bacillus may be followed by the complaint if the germ can grow. The germ grows particularly in the absence of oxygen hence deep wounds are always sources of danger. A wound in the region you mention is not really more dangerous than anywhere else provided it is adequately treated and anti-tetanic serum given when necessary.

* * *

F. Y. H. (London, S.W.19) writes :One of my sisters is liable to recurrent nose-bleeds. What are the likely causes and what can be done?

Answer

There are a large number of possible causes such as high blood pressure, certain diseases of the blood and, in many cases, dilated veins within the nose. It is for a doctor to determine the cause and treat it as far as possible. Dilated veins, liable to burst like varicose veins, can be successfully treated by cauterization.

'Atomic Warfare: The Nurses' Part in Prevention and Care of Atom Bomb Casualties,' price 1 9, by post 2/ -, from the Nursing Mirror, Dorset House, Stamford Street, London, S.E.t.

A short time ago the' Nursing Mirror published a series of articles written by specialists on the staff of the Royal Naval Medical School , Alversloke; and they were based on the lectures given to nurses and doctors attending the Radiological Defence courses at the School. They consist of a simple exposition of the elemenprinciples underlying atomic explosions, their effects on the human body, the medical and nursing treatment of casualties and the elementary precautions which can be taken. These articles have now been reprinted in booklet form in response to many requests from readers.

THERMAL in a

TREATMENT Tube!

I-Bathe the part with warm water and dry thoroughly.

With Sprains, Rheumatic Pains, Aching Muscles and Joints, warmth applied to the source of the pain is a first step to relief.

IODISED BALMOSA quickly penetrates under the skin, and

induces a local increase in temperature, which eases the pain at once. The iodine and salicylate contents are then absorbed, and the causes of the condition are treated.

Very convenient to -apply :NON - GREASY DOES NOT SOIL CLOTHING DOES NOT IRRITATE THE SKIN

IODISED BALMOSA

RELIEVES PAIN

[11 lUbes. from all Chemists FREE SAMPLE for Clinical Test

To Handforth Please send me FREE SAMPLE of "I odised Balmosa ."

La bora tor es Name 51 Clapham Rd., Address

3-Cover with wool or flannel. London, S.W.9. ...... ..................................

THE INSTITUTE OF CERTIFIED AMBULANCE PERSONNEL

MEMBERSIDP OF THIS INSTITUTE IS NOW OPEN TO ALL THOSE HOLDING FIRST AID CERTIFICATES.

Enquiries are invited from all those who wish to see an increase in the standards of efficiency and training of ambulance and allied first workers, and who wish to increase their own qualifications by taking the Institute's Examinations.

• * *

The next Exan1inations will take place on October 17th, 1953, in Manchester and other centres according to applications received. Closing date for entry Sept. 1st.

Details of membership of the InsNtute, and applicationforms for the examinations can be obtainedfrom The General Secreta.ry, 5

London, N. W.5.

Be on the safe side!

Efficient FIRST AID can save much pain and many man hours. We hold stocks of Surgical Bandages, Dressings, Lint, Cotton Wool, and all first aid requisites.

Answered by Dr. A. D. Belilios, M.B., B.S. (Lond.), D.P.H. (Eng.)

2- Smear Balmosa on freely and rub in.

RABIES

(continued from page 9)

make easier future comparisons of the different results obtained in laboratories in different parts of the world.

The success of thiS' practical training, given on such a scale in so short a time, genuinely surprised many of the experts p resent who agreed that W.H.O. had pioneered a new conference technique which would prove of the utmost value in similar highly-technical meetings in the future.

One of the new advances fully dealt with at the conference was the re-evaluation of anti-rabies treatment using' hyper-immune' serum.

One of the shortcomings of the classical vaccination treatment was that in people who had recei ved a number of severe wounds from bites of rabid animals, the disease some times developed before the vaccine had time to do its protective work.

In Iran where it is not uncommon for rabid wolves to attack groups of 10 to 20 people at a time it was found that 30 p.c. of the people thu s wounded would die whether or not they received the classical vaccinations.

The use of hyper-immune serum has been found , in animal experiments , to give immediate, though relatively short-lived protection. When employed in conjunction with t he usual vaccinations, it makes antirabies treatment much more sure. In Iran limited trials of the serum treatment have shown promis ing results in wolf-bite cases. These studies are being continued.

Serum treatment is valuable also in cases of bites when the animal can be held under observat ion as it gives protection for the time nece ssary (up to one week) to discover whether the biting animal was really rabid or not. If not, there is then no need at all to begin the long and ex tremely disagreeable ser es of vaccinations hitherto prescribed in most ' su spect' cases.

Experts believe al so that the immediate use of serum injections may make it po ss ible to lessen the number of vaccinations usually given. Any reduction in the number of has the great advantage of mmlmlzmg the n sk of paralysis which is a known , if relat ively r are, result of the presence of ner ve ti ssue in the vaccine as usually prepared.

The res ults of fu r ther systematic trials of , hyper-immune' serum to be carried out during the ensuing year in some of the countries represented at the conference will presented to the W.H.O. Expert Committee on Rabies at its second meeting to be held in Rome in September 1953.

Another vitally important question discussed at the conference was t he use of a anti-rabies vaccine for rabies control through the mass vaccination of dogs.

In the past rabies has been successfully controlled and even eradicated In countries like Great Britain, and Sweden, by the registratIOn of dogs, strict quarantme measures for all pets entering the country , etc.

.recently, however , control by dog vacclOatlon had the serious disadvantage that yearly re-vaccinations were necessary vaccine employed gave only a ltmlted period of immunity.

(continu ed on page 14)

Crossword No.6

Compiled by w. A. Potter

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D.O.O.O.O.O.O.D EJOOOO.EJOOOOOOOO

0.0.0.0.0.0.0.0 EJOODOO•••EJOOOOO

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O.O.EJ.O.O.O.O.O EJOOOOOOOOO.EJOOD

O•••O.O.O.EJ.O.O

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O.O.O.EJ.EJ.O.O.O

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0.0.0.0.0.0.0.0 .EJDOOOODDDDDDDR

ACROSS

I. The complete first-aider makes sure his patient has the benefit of this

10. Inter-changed, becomes lifeless

11. You had twenty in your early years... ... ... ...

12. Sore throat from American gin and lime

13 Slap rna can be given in hospital treatment of burns and shock

... ... 16. Lough in N.W. Ireland ends in another direction

17. A knowledge of first-aider would be of little help to him

20. Study of the functions of the human body

21. Skin changed to coloured liquids

23. Chemists instrument is a nuisance and a French article

25. They are on the wall

28. Cause of industrial poisoning almost eliminated now :

29. Fractured, and no money

30. Cornmon injury to upper limb often not so simple as may thought

2. Call for which first-aider is always prepared

3. Purpose-appears under canvas

4. Limbs of war ..

5. Is in ill-health

6. If you have plenty of this you should enjoy life

7. Water plant rich in iron and vitamins A and C . . . . ..

8. May be found in nerve shock, head injuries, and alcohol poisoning

9. Cool and efficient in hospital, but at her street is upset

14. Joint formed by tibia, fibula and astragulus . ..

15. Must be avoided by shipping

]

8. A suture material is prepared from their tails ... .. .

]9. Double vision

22. Vertebrae characterised by large bodies

24. Form of clasp on the head

26. Swelling, deformity, or tenderness would serve as example

27. Disturbed dust for the collar

(Solution next issue) ACROSS SOLUTION TO CROSSWORD No. 5 DOWN

(Sopronol' for fungous infections of the feet

, SOPRONOL Ointment fulfils the criteria laid down" for the ideal fungicidal compound:

IT INHIBITS AND KILLS FUNGI

IT PENETRATES THE STRATUM CORNEUM, REA C HING THE DEEP SEATED MY C ELIA

IT NEITHER IRRITATES NOR SENSITIZES THE SKIN

This therapeutic efficiency derives from the use of Sodium Propionat e and Cap ry late -both originally isolated from concentrated human sweat. It is thi s physiolo gical kinship which enables' SOPRONOL to control the most chroni c case of Tin ea Pedis with a complete absence of the superadded skin sensitisations so liable to complicate treatment.

. Aid for the Brigade by BARNETT MITCHELL LTD.

MITCHELL HOUSE, 228 OLD STREET, LONDON, E.C.2 Tel: CLErkenwell 9274 (5 lines)

1953 PRICE LIST

Officers :-

JACKET .................................... from £7 9 9

TROUSERS................................. £2 16 0

OVERCOAT..... ........................... " £11 5 7

RAINCOAT................................. £12 11 8

CAPS , according to rank

Privates :-

in Black Woaded Wor s ted Ditto in Quality Sh een Gr ey M elt on in Black Wool Gab erdin e

TUNIC (L d C II ) from £3 18 3 in Black Tartan, N e IV Patt ern ay own 0 ar (Lined sleeves 5/6d. extra)

TROUSERS................................." £2 6 0 Ditto

OVERCOAT.... ........... ........... ...... £5 18 5 in Superfin e Gr ey Cloth

CAPS 10 5 Regulation

PRICES INCLUSIVE OF PURCHASE TAX

Vniforn, Contractors to H.M. 6over"".e"t ""d Public etc.

1, Indirect force; 10, earls; l1, tra.nsport; 12, violet; 13, scathe; ] 6, urut; 17, apoplectic; 20, sugar cubes; 2], 23, spouse; 25, atonic; 28, executive; 29, plugs; 30, internal organ.

2, Narrowing; 3, instep; 4, eats; 5, tray; 6, ossicles; 7, croft; 8, nervous system; 9, stretcher case; 14, spout; 15, spree; 18, tarantula; 19, pressure; 22, stupor; 24, ocean; 26, sign; 27, heel.

RABIES

(continued /rom page 12)

Untiring research has now developed a new 'living modified virus' vaccine which is known to give dogs immunity for at least two years, and possibly much longer. The vaccine is produced from the special • Flury' strain of rabies virus after it has been grown in chicken eggs. When processed according to \vell -established laboratory techniques, this yirus, tbough still living , is found to have lost tbe power of causing rabies when injected into animals , but is still able to produce lasting immunity.

Up to date , tbe conference learned. more than 150 000 dogs bave been inoculated with this living· rabies virus vaccine withom adverse effects

A mass dog-immunization campaign using the new vaccine and carried out with W.H.O. assistance in Israel in the last two years has resulted in the virtual eradication of rabies. Malaya is now to begin using the new vaccine in a demonstration programme of rabies control, also with help from W.H.O.

Thailand , Spain , Indonesia. Yugoslavia, Greece, Iraq , Southern Rhodesia Ceylon and Mexico , are other countries which have asked help from W.H.O. in introducing the newer methods of rabies treatment and control.

ot every country which sent delegates to the Coonoor conference has the same

rabies problem In T aiwan, for instance, rabies is a comparatively new disease. the first human cas e having been re p orted in 1948, and new health measures are being introduced to deal with it. Then there is Australia, which, togethe r with Zealand. H awaii and some of th e Caribbean islands, ha a ways been free from rabies The Australian delegat es came to Coonoor to keep themselyes up to date on rabies in order to make sure that their country is taking all reasonable p recautions to keep the disease out, or, at the worst, to know exactly how to deal with any outbreak which may conceivably aris e.

T he world authorities on rabies who were brought together at Coonoor seized the opportunity for long discussions during ,'>hich they planned future laboratory and field researches for the further elucidation of rabies problems

They were, however, agreed that rabies can now be controlled in countries where the disease is present through the compulsory registration and vaccination of all dogs and the d estruction of strays, combined with adequate quarantine measures for pet animals.

Since antiquity, rabies has centred around man and his dog, and there is evidence that the disease can be eradicated completely in most instances by centering attention on the dog.

As rabies in dogs becomes rarer, h owever it may be necessary to turn to t he littleexplored s u bject of ra bies in wil d life. In I ndia, for instance, 7 p.c. of the 100,000

Miscellaneo US Advertisements

people given anti -rabies treatm ent each year had been bitten by jacka ls. Cattle. sheep , goats a n d hors es, are frequently affected altho ugh t hey are n ot important as sp readers of ra b es, an d deaths from r abies i n such d omestic livestock represents a serious economic loss in many countries.

At the moment, however, the c ontrol of rabies among dogs , toge t her wi t h im pr o ved methods of treatme n t with vaccin es a nd serum produced and tested by new techniques, promis es victory for man ove r still anot h er of h is ancient scourges. Th e Coonoor conference has pl ayed a significant part in making it possible for many more countries to introduce th e new m e b ods.

(From W. H O ' Newslerie,.,' ol'ember 195 2 .)

PATENT

"PORTLAND"

AMBULANCE GEAR

The Gear IIlustrated(A.B.C.D.}

LEATHERHEAD, SURREY

A HANDBOOK OF ELEMENTARY NURSING

Arthur D. BeIilios, M,B., B.S., D.P.H., and Dorothea Duncan-Johnstone, S.R.N.

This handbook is the ideal guide for anyone who is called upon to carry out any form of emergency nursing. It describes in simple language the basic principles and procedures that underlie the science of nursing, and contains brief descriptions of the more common diseases, with general notes on the nursing required in each case. A complete chapter is devoted to the subject of home nursing, and the whole book provides for every first aider the essentials of nursing in a handy yet comprehensive form.

With 314 pages and 57 drawings, 75. 6d.

OF FIRST AID & BANDAGING

HANDBOOK

ELEMENTARY ANATOMY & PHYSIOLOGY

The most comprebensive and up-to-date book on tbe subj t, giving full details of tbe first-aid tment of medical emergencies as well as of injuries and accidents.

With 520 pages and 244 drawings. 6s. DALE, REYNOLDS & CO. LTD. 32 Finsbury Square London EC2 OR

A bandy, compact manual wbicb gives a complete outline of the anatomy and pbysiologyofthehuman body. 'A most straigbtforward, reliable little book.'The Nursing Times

With 194 pages and 116 drawings. 4s.6d. BAILLIERE, TINDALL & COX 7-8 Henrietta Street London WC2

{ copyjies of First Aid and Bandaging

Please send me :::::::::: : copy/ies of A Handbook of Elementary Nursing copy/ies of Elementary Anatom} and Physiology for wbicb I enclose remittance of. (Postage 6d. extra per volume.)

Name Address .. ................ ............. .

FA/253

Arthur D. BeIilios, M.B., B.S., D.P.H., D. K. Mulvany, M.B., F.R.C.S., and Katharine F. Armstrong, S.R.N., S.C.M.

GDYSME ORRH<EA

Bui t for Service in Jamaica

THIS is a dispensary and first aid clinic, capable of being used for the performance of minor operat ions , and for the treatment of diseases.

One of its two compartments is fitted for the dispensing of medicines, etc., complete with stills hot and cold water, refrigerator, and all the necessary compartments for the storage of drugs. The other section is equ ipped a surgery, again with hot and cold water, and cupboards specially made for the storage of surg ical instruments, microsccpes, etc.

The unit is completely self-contained with regard to electricity supply and water storage, and is specially constructed, insulated and ventilated for use in countries.

YOU ARE INVITED TO APPLY FOR FULL DETAILS OF MOBILE MEDICAL UNITS, AMBULANCES, ETC., BUILT TO YOUR PARTICULAR REQUIREMENTS FOR SERVICE IN ANY PART OF THE WORLD

ARE the stars in their courses any more mysterious than the recurnng cycle of the menses? As regularly and pred ictably as the phases of the moon, the average uterus sheds its endometrium every twentyeight days and the average ,yoman experiences discomfort, pain and depre sion. Measurable relief from these symptoms of dysmenorrhc:ea may safely be obtained at every period with ANADIN tablets. Anadin combines the benefits of two pain-relieving compounds with those of two mild stimulants. Anadin is not habit forming and is quite safe for self-administration by the patient in the prescribed dosage.

Two to four tablets, according to severity of symptoms, repeated every four hours as required.

If you are a logical person •••

Then you will follow this point-by-point argument and reach the same conclusions as so many doctors, nurses, hospitals and clinics have done.

DO YOU AGREE . that the causes of most skin infections are the common strains of STAPHYLOCOCCI, STREPTOCOCCI and B. PYOCYANEUS ?

IN THAT CASE . .. a treatment which is effective against all three will be indicated for cuts, abrasions, burns, scalds, boils and most inflammatory skin infections ?

THIS IS THE TREATMENT

ANTIPEOL Cutaneous Vaccine Ointment contains the sterile vaccine filtrates of the three micro-organisms mentioned. The filtrates destroy the actual micro-organisms and at the same time act as a local immuniser against re-infection. This is a

purely biological action and there is no damage to delicate tissues.

RAPID HEALING is further expedited by the ointment base of proved efficiency. For burns and scalds, ANTIPEOL has special advantages. It is microbicide and non-adhesive. Therefore dressings do not have to be changed every day.

AND HERE IS THE PROOF.

Antipeol Ointment is proving and reproving itself every day in dozens of surgeries, clinics, hospitals and homes. Letters from the medical and nursing profession bear convincing testimony to its effectiveness.

THERE is the logical argument for including ANTIPEOL Ointment in every First Aid kit. As a logical person, why not send for full details and a clinical sample ?

antipeol

cutaneous vaCClne ointment

Produced by the makers of: ENTEROFAGOS for intestinal complaints; RHINO-ANTIPEOL for nasopharynx infections; OPHTHALMO-ANTIPEOL for ocular infections; DETENSYL for reducing arterial tension.

NORWOOD, S.E.2S

First Aid & Nursing

Sept.IOct. 1953

In this Issue

New Uniform for the B.R.C.S.

Danger Signals of Nature 2

N.H.S.R. Challenge Cup 4

Diagnosis-3 6

Casualties Union 8

Editor's Opinion 9

National Gas Competition 9

Topical Notes for First-Aiders and Nurses 10

Burns & Scalds in the Home... 12

Readers' Queries 14

First-Aider's Crossword 16

New Uniform for the B.R.C.S.

The new Red Cross uniform, designed by Mr. Norman Hartnell, is shown in the pictures on this page.

Members of the Red Cross have been conscious for some time that their uniform could be brought into line with present-day needs. Their work calls for a dress that is smart without an apron, and at the same time practical. Mr. Hartnell has designed such a dress which fulfils all the requirements of those who will be wearing it.

The new dress, the blue familiar to thousands, a button through style, with buttons removable for laundering, has two large pleats giving greater freedom of movement. The detachable white collar-a special request- easily changeable and simple to launder, is another feature ; whilst the apron, indispensable on many occasions, now

buttons on to the dress, and the existing pattern can be easily adapted by members at home, and gives a much better fit.

The officer's uniform, which is red, is of a similar pattern, a special feature being the low sleeves which have been designed to turn up and tuck under so as to give the impression of short sleeves when worn without an apron.

The new Red Cross uniform has been designed to meet the needs of all its officers and members-and is thoroughly recommended as suitable for all ages, sizes and pursesofficer's dress costs only £3 12s. 6d., and the members £2 15s. 6d. For those who are good at dressmaking, 'Vogue' has cut an excellent paper pattern at 2/ 6d., whilst the uniform material costs 6/ - per yard.

MEDICO-BIOLOGICAL LABORATORIES LTD., CARGREEN RD .• SOUTH

Mr Norman Hartnell tne designer, shows the new indoor llnirorm. Members outdoor uniform. Officer s o utdo or u niform.

Danger Signals of Nature

By A. D. Belilios M.B., B.S. (Lond.), D.P.H. (Eng.)

EVERYONE who studies the human body from any anglefirst aid, home nursing or anatomy and physiology-cannot fail occasionally to pause and marvel over its perfection. It is wonderfully planned and constructed, its functions are adjusted to a nicety while its durability and powers of recuperation are almost incredible.

But Nature has done more than providing man with a perfect body; it has also supplied a system of warnings or danger signals' as they are often called; these call attention to the possibility that some organ or part of the body is not working satisfactorily and is in need of attention. The wise man takes immediate notice of a danger signal and unless he himself is perfectly of its significance seeks medical advice. Failure to act promptly on the warnings of nature is the cause of much suffering and many deaths every year.

While it is essential to observe danger signals, it is equally important to preserve a balanced outlook and not to become unduly alarmed when a symptom is noticed. In many instances it is only a doctor who can correctly interpret the meaning of a warning and often in an illness the diagnosis is made by considering a group of symptoms rather than one and by a medical examination. Unless this is appreciated, the reader may become like the character in Three Men in a Boat, who read a Home-Doctor in an attempt to diagnose his own illness and came to the conclusion that he was suffering from almost every disease except' house-maids knee' ! Attempts at self-diagnosis are often unsatisfactory and cause much unnecessary worry.

It is the object of this article to describe some of the commoner danger signals-it is not possible to mention all-and for this purpose , pain' will first be considered since it provides an excellent of a danger signal.

Pain

The value of pain as a warning cannot be over-emphasized and it is usually the first sign of ailments such as appendicitis, stones in the gal1-bladder or kidney, gastric ulcer, etc. Pain in the chest may signify pleurisy, pneumonia or diseases of the heart such as coronary thrombosis or angina pectoris. Students of elementary nursing will recol1ect that each of these pains have different characteristics which assist the doctor in making his diagnosis. Thus the pain of coronary thrombosis occurs over the heart and also radiates- or is , referred' as it is called technically, to one of the shoulders and down the arm or up the neck into the gums.

The severity of the pain is not necessarily a guide to the danger of the condition. thus toothache which may be intense has not usually a serious significance but a slight ache in the 'pit of the stomach' occurring half to one hour after each meal may direct attention to a gastric ulcer.

Sometimes a pain has no organic basis which means that it does not indicate disease of an organ or structure in the body. Thus many people who develop pain in the region of the heart have in fact a perfectly healthy organ and the cause of the pain may turn out to be a nervous psychogenic' nature which complaint in itself may require treatment.

Occasionally, unfortunately, some diseases are characterized by absence of pain, at any rate in their stages.; cancer, for example, 1S often a SIlent complaint until it advances to a certain stage.

Bleeding

Bleeding from any part of the body apart from a wound may be a danger signal. Haemorrhage from the nose, for example, in elderly people may be a sign of blood pressure while in children it may

herald the onset of an infectious fever such as l11easles. More often than not, however, nose bleeding is not a danger signal of serious import.

Bleeding from the bladder, rectum, uterus (apart from natural loss) and nipple always requires investigation since it may be a sign of cancer in an early stage while the coughing and vomiting of blood, even if s11ght, may be warnings of tuberculosis and gastric ulcer respectively. In many cases, fortunately, simpler causes than the more serious diseases mentioned may be discovered on medical examination.

Coughs

Many coughs are due to simple causes, e.g., the downward spread of a cold into the throat or trachea, over-smoking and throat affections. Nevertheless, whenever a cough lasts for more than three weeks, a medical opinion should be obtained since it may be due to more serious conditions such as tuberculosis. Fortunately, in England, improved methods of diagnosis such as Mass Radiography and new treatments with drugs 11ke Streptomycin and P.A.S. ure producing a considerable reduction in the disease.

Shortness of Breath

This is normal when people undertake exercise which is beyond the limit of their capacity or training and every observant individual soon learns his standard which varies somewhat from one to another. When , however , shortness of breath occurs without undue exertion, e.g., on mounting a hill or one's own stairs, it must be considered a possible danger signal. It may turn out to be nothing more than lack of training or over-smoking; on the other hand, in middle age, it may be a warning of a raised blood pressure.

Indigestion

In perfect health, an individual should not be conscious that he possesses a digestive system except for the fact that he has a healthy

FIRST AID & SEPT. OCT. 1953

appetite and his bowels open regularly. There must always be a cause for indigestion and this should be investigated, most particularly if it begins over the age of forty. X-Rays and other tests may be necessary to exclude the more serious causes such as gall stones which incidentally are a common cause of dyspepsia characterized by flatulence in middle-aged patients.

Bowels

Every individua l learns to recognize his own bowel habit. Most people, for example, have a regular daily action while others perhaps throughout their lives suffer from a mild degree of constipation. A change in the bowel habit, particularly in those over forty, may be a danger signal. Thus a man who has formerly been regular may develop constipation, mild diarrhoea or phases of constipation followed by diarrhoea. Once again , the cause may turn out to be simple such as a change of diet but this must never be assumed without taking a medical opinion.

Similarly, changes in the shape or size of the stools may be of consequence.

Loss of Weight

Most people increase gradually in weight during the course of their 11ves; some remain almost stationary. Hence loss of weight, at any age, is a possible danger signal and the cause should be investigated. This may turn out to be lack of food, over-exercise or worry ; indeed some folk tend to lose weight without any obvious cause as they get older. But the possibility of diseases such as tuberculosis, cancer, diabetes and glandular complaints such as exophthalmic goitre have to be considered.

Urine

Many people attach too much importance to the colour and appearance of the urine which varies normally with the weather, sweating and the type of food eaten. Much unnecessary worry can be avoided by a few second's talk with a doctor. More important is the frequency of passing urine. Most individuals, for example, do not have to leave their beds at night while others are not so fortunate. Undue frequency in micturition calls for inves6gation particularly if it occurs at night. Once

again it may have a simple explanation, e.g., over-drinking near bed time or even' nerves.'

Some men, as they become older, develop difficulty in passing urine. This may be a warning of enlargement of the prostrate gland.

Growths

This is the common term applied to what the doctor calls a tumour. This generally shows itself as a , lump' in some part of the body, often within the abdomen where it can only be felt by a medical man. Many growths are almost harmless , others, however, may be cancerous. It follows, therefore, that whenever a lump is discovered, medical advice must be immediately obtained. The breast is a common site for tumours and some doctors advise their female patients over the age of forty to examine their own breasts at quarterly intervals. Even if a growth is found to be cancer, there is every chance of a complete cure, provided it is recognized and removed in an early stage.

Other growths are discovered in their early stage as a result of the danger signals that they produce.

Insomnia

This is only one of the numerous symptoms cau sed by ailments commonly known as 'nerves.' Other warnings include irritability, undue apprehension, depression, failure of concentration or memory, alarming dreams and inability to fit in with others in daily life. They provide the key to the diagnosis of disorders of the mind which are included in that important branch of medical science called Psychological Medicine. Most disorders of the mind respond to treatment satisfactorily, if the sufferer seeks professional advice.

There remain many other danger signals too numerous to describe in this short article. With some of these, those who have studied Elementary Nursing are already familiar. For example , alterations in the temperature, pulse and respiration all constitute warnings of nature.

The point to remember is that any departure from norma] standards may constitute a danger signal, and a medical opinion must then be obtained. Tt is essential to seek advice from a doctor and not take

the opinion of relatives and friends which may lead to disaster. a child recently developed swollen eyelids noticed only in the mornings when she woke up. Her parents erroneously concluding that the danger signal pointed to eye strain, arranged for her to be supplied with glasses which she did in fact req uire. But the true nature of her condition was only disclosed by a belated visit to a doctor; the disease of the kidneys from which she is suffering will take many months to cure. If only they had correctly observed the danger signals and the action to be taken!

REVIEW

'The War-Time History of the Scottish Branch of the British Red Cross Society,' by George Pratt Insh, c.B.E., M.A., D.Lit. PubHshed by Jackson, Son and Co., Glasgow, price 10 6.

This book gives a very comprehensi\e narr a tive of the work initiated and organized during the second world war by the Scott is h Branch of the B R.C.S.; but, extensive though these activities were, they do not represe nt the whole of Scotland 's contribution, for the work of City and County Branches is not included. evertheless, one is amazed by the extensive scope and the efficient organization of the manifold services that were initiated, covering every conceivable aspect of Red Cross work in war-time The book is written as a history , commencing in October, 1938, when international tensions revealed the necessity for training and establishing new detachm ents. It describes the progress and the developing pattern of the organi zation through all its phases until 1945 , when fighting ended. But there still remained much to be done in repatriation and rehabilitation. And then the whole of the war-time work of the Scottish Branch was crowned by the magnificent gift to the George Cross Island of Malta of a new hospital to replace the one demolished by enemy bombing in 1942 The King George V Memorial Hospital had been built in 1922 on one of the bastions of the Grand Harbour at Valetta. Two months after its destruction the people of Scotland decided to contribute towards its restoration. The £200,000 required for rebuilding and en· dowing the hospital came from penny-aweek funds collected by voluntary workers in mines, factories, shipyards and shops, in country cottages and farms and in the slums of big cities; from the most northerly islands and the Outer Hebrides to the Scottish border in the Lowlands. Organized collections on a larger scale and generous donations augmented the flow of pennies and sixpences. The new hospital was opened by Lady Louis Mountbatten on St. Andrew's Day, 30th November, 1948. This story forms a climax to a most interesting and readable narrative of Scotland's Red Cross work during the second world war.

N. D. S. R.

CHALLENGE CUP

EI.lield 6rOl'p " ·i,. Conlpetitioll for -,-'labile First ...4id Teams

THE Minister of M.T. lain !'1acleod, watched Enfield-the town m whIch he lIves and of which he is .a representative-win his Challenge Cup m the competitIOn for the most efficient National Hospital Service Reserve mobile first aid team in the four Metropolitan Hospital Regions in the finals held on the Horse Guards Parade on 19th September.

Over 30 hospital groups entered teams for the competition, first of it.s kind in the country, preliminary contests .bemg held m the four Regions to decide the 16. year it is hoped to run the on a natIOnal basis among the 14 hospital regIOns.

In to winning the Minister's Cup, the Enfield HospItal Group team also won the Cup for the NorthEast Metropolitan Region, presented by the Chairman Sir William Bowen.

The other winners of Regional Cups, presented by the Board Chairman, were Barnet Group (North-West) Bromley Group (South-East), and Salisbury Group (South-West).

Large crowds watched four teams at a time enter the arena set up their first aid posts in mock buildings, and deal ,wi,th six different types of casualties made-up most realistIcally to fit the role. They were impressed by the speed and efficiency of the teams, whose handling of both stretcher and walking cases demonstrated the of the first aid and home nursing trammg by the St. John Ambulance Brigade and the BntIsh Red Cross Society for those who enrol in the National Hospital Service Reserve as auxiliaries. Every team completed its competition tasks within the 25 minutes allotted to it and many included auxiliaries who had joined the Reserve only a few months ago, Points were awarded by the medical judges for the appearance and turn-out of the unit; the method of approach to the site; discipline of teams on arrival and apportionment of duties; method of unloadin a unpacking and laying out equipment; the lay-out of the unit; and treatment of casualties.

Each team consisted of a medical officer a trained nU,rse member, and nine nursing auxiliaries: including dnvers and a motor-cycle despatch rider.

New Recruiting Drive

Before the competition began the teams, including many of those who had been eliminated in earlier

The Enfield Group team, winners of the Challenge Cup and of the N.E. Regio nal Cup,

contests, were inspected by the Minister of Health. In a short speech immediately afterwards he complimented them on their smart turn-out and on their keenness and enthusiasm.

Teams like these, he said, would be an important feature of the expanded casualty and first aid services for which the Hospital Service vi ould be responsible in the event of war. While some 800 static first aid posts would be set up at or near hospitals, the essential element in the first aid service would be some 2 000 mobile units based on selected hospitals motorised 'and ready to proceed under the operational control of the local Civil Defence Controller to the scene of attack as required, In wartime, the role of these units would be to give uch primary treatment to casualties as may be necessary to save life before sending them to hospital; to deal with the more lightly wounded cases, thu preventing the hospitals being overburdened with minor casualties.

, But emergencies happen in everyday life too," said the Min.ister. 'We have had some pretty grim reminders of this at Lynmouth, in the East Coast floods and two terrible railway disasters in the last twelve months, Then again, it may not be generally realized that each year there are over one million serious accidents in our homes-serious enough that is to require treatment in hospitals-and I ask myself: should not every man and woman have some training in first aid and simple home nursing, and would not women gain in confidence and competence if they added practical knowledge of first aid and simple nursing to their many other accomplishments ?

If the Hospital Service was to be ready to meet the demands for a first aid and casualty service which war would throw upon it, the National Hospital Ser vice Reserve must raise its strength from the 33,000 volunteers so far enrolled to its peace-time complement of 100,000.

RECRUITli\G DRIYE

The Autumn recruiting campaign for the National Hospital Senice Resene was opened by the :\-linister of Health at the competitions reported on this page. He said that if the hospital senice was to be ready to meet the demands for a first aid and casualty sen-ice which war would throw upon it the Hospital Senice Resene must raise its strength from the 33.000 , 'olunteers so far enrolled to its peace-time complement of 100,000.

Local recruiting driyes are now going on, aided by national adyertising and pUblicity. The St. John Ambulance Brigade and the British Red Cross Society are responsible for the first aid and home nursing training of alLwiaries, and anyone who wishes to enrol may do so ·with either of these or at their local hospital.

In the next few month local conunittees throughout the country would be organizing recruitment dri\'es \\'hich would be supported by advertisements in the local and national newspapers.

Sixteen Finalists

The 16 finalists \;l,'ere :-

N. W. Metropolitan Hospital Region: Windsor, Barnet and Hendon Ho pital Group.

1 ,E. l'\t[etropolirall Hospital Reaioll : Enfield Group, \-Vest Ham, South-East Es ex and Epping Group,

One of the teams in action. The casualties were provided by tbe Casualties Union.

The Minister of Health, Mr. lain Macleod, presenting the Challenge Cup to the winning team.

The Chelsea team attend to a casualty.

S.E. J1etropolitan Hospiwl Region : Sidcup and Swanley. Bromley Group. Brighton and Lewes.

S. W. J;felropolitan Ho spital Region: Che1 ea Group. Redhill Group. Bournemouth and Dor et Group. and Sabsbury Group. Teams from two London teaching hospitals - Westminster Hospital and Hammersmith Hospital-entered the Final direct.

Winning teams were composed of the folJowing :Enfield Group Cup and 01".E. Regional Cup).-Medical Officer. Dr. P. W' S. Gray Anaesthetist. Enfield Group Hospltal). Tramed Nurse. Miss E. Harris (Casualty and Out-patient Sister. Chase Farm Hospital). Auxiliaries. Bickle n.fiss J. Catmore. Mr. Elston. Miss V. D. Healey. Mr. L. H. S. Hurd. yfiss B. Lawrence. 1rs. G. E. Ticholas, Miss M. Powell. Reserve. Mrs Clarke. Barnet Group ( .W. Regional Cup).-Medical Officer. Dr. W. D. Quirke (S.H.O., Barnet General Hospital). Trained Nurse. Staff urse Bedford (Clare Hall Hospital). Auxiliaries , Mrs. D. Cheason. Mrs. H. M. Perrin. Mrs. D. M. Pierce , Mrs. K. ewelL Miss K. L. Allen. Mrs. B. B, Stock. Mrs, Haslen Mrs. Crawley, Bromle). Group (S.E. Regional Cup).- fedicalOfficer, Dr. 1. P. Harte (Bromley Hospital). Trained Turse , Mrs, S. Wilson. Auxiliaries. Miss F. Hale, Miss A. Dolamore , Mrs. F. M. Shackel, Mrs. D. Jones, Mrs. J. Bolton, Mrs. J. M. Barnett, Miss Y. Froud, Mr. Woods. Salis bury Group (S.W. Regional Cup).-Medical Officer. Dr. Day. Trained Turse , Sister Morgan. Auxibaries Divisional Officer Muggleton , Mrs. Elsey, Mrs. Ford, Miss 1. Harvey, Miss M. Lister, Miss B. Caines , Miss S. Henbest, Mrs. Petts.

D iagnosis-3

LET us now turn to the unconscious patient who presents a much more difficult diagnostic problem. Have you trained yourself to obsenation ? This will prove to be a supreme test. There is, I think, much to be said for the American approach to this question. The American surgeon or first-aider does not ask' Is the patient conscious or unconscious ? ' 0, the question he puts to himself is this: 'Is the patient prostrate? Why can he not stand up ?' Now, many a prostrate conscious patient presents a far more difficult diagnostic problem than the unconscious patient, and by asking this question we are commencing our investigation one step farther

F1 RST AID & SEPT. OCT. 1953

During the competition four units were judged imultaneously. each in a separate competition arena. Each unit taking part 'was deemed to ha, e been called out from it ho pital by the Ci, il D efence Controller after an attack. and had been instructed to report to the Damage Control Officer at a specified pot a near a possible to the cene of the attack.

The nit proceed to unload and et up it equipment as speedily as possible to be ready to deal with casualtie

The doctor in charge finds that the building has three rooms and he ha to decide how he can be t et up the nit in this accommodation bearing in mind that he may have to deal with a large number of ca ualtie

The team ,\'ill be instructed to set up their equipment accordingly.

Casualtie come in: three stretcher ca es are carried in by stretcher -bearers and three walking cases brought in by a V, arden. The doctor and trained nur e member. aided by auxiliaries. examine and treat ca es and the doctor decides which should be sent to hospital by ambulance, making sure in each case that the casualty is in a fit state to stand \','hat may be a rough journey over damaged and debris-littered roads. Particulars of all casualties are recorded by a member of the nit.

Casualties requiring hospital treatment are loaded with the help of CD. personnel into the ambulance. \yhich drives off. V,Talking cases having received first aid , are. if in a fit condition, ent under the Warden's escort to their own homes or to a rest centre. Its job done, the Unit packs up reloads its equipment and returns to hospital.

For the purpose of the Competition. twenty-five minutes were allowed to each Unit for arrival. unloading of equipment, examination and treatment of casualties.

By F. C. Reeve F.Z.S. , F.R.E.S.

collap e foUo\\ing haemorrhage etc.).

Cold and Clammy: (ho k. collap e following haemorrhage. fainting pain, heat exhau-tion. etc.).

Cold Sh ear especially 011 forehead: (hock:. etc.).

Cold and Dry: (diabetic coma uraemic coma. etc.).

Dry and Burnil7g: (sun - or heatstroke).

J·loisl: (hypoglycaemic coma).

Perhap nothing furnishe more infom1ation in an unconsciou - patient than a tudy of the face. but to deal with thi que tion in detail would provide material for a whole "Volume. I will content my elf. therefore. with conden ing - into tabular form some of the more important appearances. \yhich. after all. rna be more convenient for ready reference :-

Pale: (concus ion. faintness. collapse followi.ng haemorrhage. -hock, infantile convulsions during earlier tages, alcoholic excess in later stage. hypoglycaemic coma, earlier tages of heat exhaustion. etc.).

Flushed: (compre ion. apoplexy. early stage of epilep y. early rage of alcoholic exce . later tage of heat exhaustion. excitement. sun- or heat troke. certain ga poi on exertion. certain fever etc.).

Cyanosed: (later tages of infantile con ul ion, heart di ea e, concussion if light. respiratory obstruction, certain gas and other poisons, a phyxia, etc .).

Pink: (CO poi oning).

Livid: (a phyxia electrocution, epilepsy, strychnine poisoning, etc.).

cu ion faintne collap-e foll wing haemorrhage. ale h lic ex e' . atropine or belladonna poi'oning. et .), contra ted (narcotic poi oning. ' uch a morphine or opium. compre ion or apoplexy if one or both are contracted). unequal lcompre--ion or apoplexy).

important than that \\ hieh include the calp. h.ull and nen ou vstem. We learn from that. during the la t \\ar. one-third of all imp'lrt-= am injurie - im oh ed the - e :rrUClUre '. [oreo\ er more than one-third (If all fatal ca -e - and one-half of all the permanent di abilitie re ulted from thi - of inj ury.

Perhap it \\".uld be ad\ i.:able. in oa " in2:, t mah.e cenain that Y'lU - onle lear idea of the ..matam, of the ' e parr Yer) thell. the sk.ull \\hich i ' formed If' fiat' bone - con - i ting of t\\\'1 layer or rabk-.· form a rote ring ca e for the brain. It i ' it -elf cO\ 'ered \ a layer of oft ti - ue. omet i me cailed th-e pericranium. which i \ery \'a that is. it contains a large number of blood \e :el -. The brain i not in direct contact \\ ith the in -ide of the k.ull. but i ' eparated from it bv a membrane consi - ting of three c"our- called the The outer one. called the d'Ura mater. i in conta t with the in ' ide of the k.ull. whih the inner coat. the pia mater. i in c nta t \\ ith the brain it elf. Between the e t\\o coat i an ther called the arachnoid. Filling the space between the pia mater and the i a fluid called the cerebro ' oinal fluid. which acts as a cu -hion.' and i - 0 ea lled bee-au e it i - continued. to!!ether \\ith the three coat ' of the throughout the pinal cord as \\-ell a coYering the brain. The b rain it elf con i , t of a ma of oft 'ub tan e or ti ue formed b\ nen 'e cell and fibre. the \\hole being di\ ided into two lobe or hemiphere

back- one step nearer the' cause,' for sooner or later we shall have to seek the cause. Think it over for yourselves.

gives least pain or is mo t comfortable? This the first-aider must try to decide for himself, and his power of observation should here prove of great assistance to him. You will first conduct a general' inspection, in which you will dispose of those three giants, Haemorrhage, Asphyxia and Shock. Perhaps the next thing to be noticed is the posture (decubitus) of the patient, and here two questions are presented :-

(a) Has the patient remained in the position in which he fell or was placed, being unable to change it ?

(b) Not being entirely helpless (in the first place) is he lying in the position which he has discovered

Having completed your general inspection and noted all possible clues to D iagnosis-torn clothing, marks of a struggle, convulsions, a broken bicycle, empty bottle, cough, hiccough, signs of vomiting, etc.-you can now commence your detai led examination, an d in this I do not think you could d o better than commence at the top an d work downwards. What is the condition of the skin? Let us examine some of the possibilities :-

Cold: (concussion, faintness,

Gre.r: (asphyxia).

Dusky: (alcoholic excess).

The features themselves may be anxious, drawn with pain, or they may even be convulsed, and the eye may be fixed and staring a in epilepsy, bloodshot as in alcoholic excess and some other conditions, or t hey may be congested. R apid b linking or upturned eyeballs may suggest hysteria, and a child pa sing th rough infantile convulsions 'Nill pr o b ably squi nt. I n asphyxia the eye b alls often protr u de.

Now examine the pupils which, t o the trained investigator, can d isclose so much valuable information. They may be dilated (con -

The mouth may be - tained. bli - tered wollen or burned bY corro - iYe poi on froth may appea-r at the lips a a re ult of epilep y. hv teria or infantile com'Ul ion. V"omiting may re ult from alcoholic exce shock (in which ca e it may be regarded a - a good -im. heralding reco\:-erv. a it doe. al o. in con-= cu sion), chemical and food poi oning. It often occurs in hildren upon the slighte pro\ ocation. Bright red blood coughed up is an indication of injury to the lung. or it may point to the presence of pulmonary tuberculosis. but hould the blood re emble coffee ground .' then it is from the ga tric r;gion and should be re2:arded a a seriou matter requiring urgent medical attention, for it may indicate injury to the upper inte tinal tract or bleeding from a peptic ulcer. Sometime blood i wallowed and afterwards vomited. Make certain. howeyer. before getting panicky that any blood seen i not from some local Ie ion in the mouth. Pa\' attention to the lip , al o. S\yollen or b1ue lip are often a ign of a phyxia or electrocution. \Vhil t the mouth i open look at the tongue. Toxaemia cau e furring and uraemic coma giyes it a dry appearance. It may be bli tered o and if the cau e of the trouble ha been epilep y it may ha\ 'e been bitten during one of the convulsion. In epilep y. also, the tongue often protrude, The nose and ears hould not be overlooked. Note particularly ifblood or erum is e caping sugge tive of a fractured base, but tr.. to ascertain if any blood seen i from a local wound.

Note particularly whether the lips or ears are cyanosed sugge ting asphyxia

lthough I have written quite a lot about the face the actual examination should not take more than a minute or t\-vo, e pecially if the above points have been thoroughl ma tered and memorized, and you can now pas to the head it elf.

From the point of view of the fir tai d er there is no class of injury more

The brain re t - upon a floor of bone which called the ba e.' This i a continuation of the occipital bone underneath. In this floor there are three depres ion or . fos ae' (plural of . fo sa '). known respectively a the anterior. middle and po terior fo ae.

Red Cross "ill In truct Holger Method

The Executi\ e Committee o f the British Red Cross Society ha agreed that the Society should gi\e first aid training particularl.. in truction in the Holger Tiel en method of artificial respiration. to members of the Girls Training Corp.

F IRST A TD & r-.ruRSING, SEPT. ocr, 1953

FIRST AID &

Casualties Union Celebrate Tenth Anniversary

Binner at Boyal College of

TRIBUTES to the great part played by the Casualties Union in training first aid workers were paid by representatives of St. John, the Red Cross, the Services and Industry, at the Tenth Anniversary Dinner of the Union held at the Royal College of Surgeons, Lincolns Inn Fields, on Saturday, 3rd October. The President, Dr. Glyn Hughes, C.B.E., D.S.O. , M.C., M R.C S ., L.R C.P., was in the Chair and he was supported by many distinguished visitors, among them Sir Heneage Ogilvie, K.c.B., M.Ch., F.R.S.C., Sir Ernest Rock Carling, F.R.C.S., F.R.C.P. (Adviser to the Home Office), Air Commodore H. A. Hewat, C.B.E., M.D. (Medical Advi.ser, British Red Cross Society), Brigadier T. D. Daly, C.B.E., M.C. (Deputy Commissioner-in-Chief, St. John Ambulance Brigade), Col. T. Woods, O.B.E., M.D. (Comma ndant, Depot and Training Establishment, R.A.M.C.), and Dr John Rogan M D. (Chief Medical Officer, National Coal Board).

After the Loyal Toast had been honoured , Mr. F. H. Lowe, Honorary Member, proposed The First Aid Sodeties, and said that they were honoured by the presence of many distinguished persons representing the highest level of First Aid Organizations throughout the country. It was a great comfort to know that they had at least reached this measure of recognition

It has been a hard and uphill fight,' he went on. 'Apart from other difficulties we have had to contend with suspidon and misunderstanding of our aims and ambitions. It should be understood that we have little opportunity of raising necessary funds. We have no opportunity of appealing to the General Public to aid us, as we have no uniforms to advertise our existence, an d we no substantial financial support from any direction whatsoWe have: no suitable headquarters, no trammg estabhshments, and there is not a paid official throughout the organizatIon.'

In spite of this, Mr. Lowe continued their distinguished visitors' presence that night was evidence that they had met with some success, but there was still much to be done.

He emphasised that the Casualties Union was not a o/st aid organization, and did not compete WIth the various first aid societies either [or membership or in technique: They dId not teach first aid. 'We are not married to anyone first aid society ' he said 'and our services are offered f;eely and willingly to all. We profess to be the means by which the end may be fulfilled. If m ethods are used by the first aid a new and exciting approach will be attamed to a subject which in the past has been comparatively dull and, if I may say so, dangerous '

The response was made by Air Commodore H. A, Hew'lt who spoke of the

gratitude the Red Cross owed to the Casualties Union for the great help it provided in training, especially in regard to the Stanley Shield. Brigadier Daly who also responded, said that St. John considered casualty faking so important that it was teaching it as part of the syllabus. St. John had had tremendous help from the Casualties Union, and it was now its policy to teach casualty representation to all members.

The toast of 'The Union' was proposed by Colonel T. Woods and seconded by Dr John Rogan both of whom spoke of the help provided by the Union in training first aid. Dr. Rogan said that first aid could not remain static, science was advancing and first aid must keep in step. The Casualties Union was playing an essential role in furthering progress and efficiency of the first aid movement.

Mr. E. C. Claxton, M.B.E., B.Sc., A.M.LC.E., A.F.I.C.D., Chairman of the Council, who responded, said that for more than ten years the members of the Union had faithfully portrayed to the best of their ability many thousands of casualties for Civil Defence, the armed Services, and the first aid organizations in routine practices , The Union is not a first aid organization' he continued, and does not teach first aid It trains its members, and those of other organizations who may desire it, to portray behaviour of an injured person as faithfully as may be possible, through the changing of being found, handled, treated and extrIcated from the accident in which they have been placed. By actmg, make-uR and staging, the complete problem which faces the first aid rescuer and stretcher bearers can be provided. The first-aider is able to observe with all his senses the signs and symptoms of many injuries, enabling him to make a sufficient diagnosis to determine what immediate aid should be given to enable the patient to reach the surgeon in the best possible condition under the circumstances

The introduction of the responsive had doubtless helped many firstalders to learn to handJe the 'injured person not merely the ' injured part.'

The Casualties Union, continued Mr. was merely training equipment first and rescue training to be earned out. WIth complete realism. Living human eqUIpment trained for its job-the means to the end, not the end.

He went on to give some details of the formation of the Union in 1942 which with the object to giving to CIvil defence training. When the war was over it was realised that the trained casualty was essential in peace as in war as a help to the first aid societies. From a small band operating in Surrey the Union had grown to groups in many parts of the and even overseas. During last the record was achieved of over 100 actIVItIes a month-more than three a day on average.

The tributes that had been paid to the Umon s work that evening would be a great encouragement to them, and they

would strive by their practical help to be worthy of that confidence and goodwill.

Our Guests' was proposed by the President, and the response was made by Sir Heneage Ogilvie and Sir Ernest Rock Carling. The toast of' The President' was proposed by Major-General L A. Hawes, C.B.E., D .S. O., M.C., B.A., vice-president and the President suitably responded. '

Annual Co"'petition

THE Eleventh and largest ever Annual Competition in First Aid and Diagnosis , organized by Casualties Union, was held on Sunday, 4th October, at Hendon R.A.F. Station , before an audience of 1,500 people, including as Guest of Honour, Air Marshal Sir James Kilpatrick, K.B.E., C.B., M.B., Q.H.P., Director-General Medical Services R.A.F.

From all parts of England, thirtyfive First Aid teams-a record number of entries-competed for three trophies.

The winning teams were as follows :-

The Buxton Trophy - I.C.!. Alkali Division of Northwich.

The First Aid Trophy - I.C.I. Alkali Division of Northwich.

The Diagnosis Trophy- TC.I. Alkali Division of Northwich.

The two highlights of the show were demonstrations by the R.A.M.C. and the R.A.F. Medical Service of realistically simulated casualties which grimly showed the competitors and the public what real casualties look like.

'Casualties Union is performing a wonderful service to the nation with its revolutionary technique of training first aid personnel in conditions that so approximate the real thing, as these demonstrations seen here today,' said Dr. Glyn Hughes, C.B.E., D.S.O. , M.C., M.R.C.S., L.R.C.P., President of Casualties Union. 'The trainee from the beginning of his or her training is familiarised with the gruesomeness of real life accidents, and each Casualty Union "victim" is not only made up as an injured person, but thinks and reacts in the exact way a person with his precise " injuries" would do.'

1953 OPINION

THE Casualties Union is this year celebrating its tenth anniversary. (It was actually formed in 1942, but the death in 1952 of its President at that time postponed the celebrations). To the many congratulations it has received we would like to add our own, for there is no doubt that first aid training is being brought to a much higher standard of efficiency by this method of providing trained casualties, complete with realistically faked wounds, to act the symptoms and effects of illness and injury. An idea which was started during the war to provide realism in civil defence training has now spread wherever first aid is taught, and the first aid organizations, recognizing the importance of the work, are now embarking on training their members in casualty faking.

The Union is not a first aid organization; its officers stress that the movement does not teach first but that it is an important part of that training. As Mr. Claxton, the Chairman of the Union's has recently pointed out, members of the Union are to be regarded as living human equipment trained to enable first aid training to be carried out with complete realism.

Everyone connected with training will know just how essential is the part they play. The comparison between the realism depicted by the Casualties Union and the older method of a casualty,' bored stiff by the whole proceedings or amiably doing his best to make everything as easy as possible for the competitors, leaves no doubt about the importance of the work. , You're not being very helpful' complained a first-aider in a recent competition where the 'casualties' were provided by the Union. He was treating a broken collar bone and had nothing but irritation for a patient who would not sit up and hold his arm straight out. That attitude can be dangerous, and it is being eliminated by the new realism in training methods.

The great help faking can give in training for rapid and accurate diagnosis is also an important point; so is its usefulness in getting recruits used to the appearance of an incident. Hardened first-aiders may smile at the recruit fainting at the sight of a mess of plasticine and red but it is far better to get that sort of thing over and done with on the training ground. In this and in so many other ways the Casualties Union is pro vi ding a new approach to realism in fil'St aid training.

Eastern Gas Board "rin National Competition

THE third National First Aid Competition in the Gas Tndustry was held at the Conway Hall, London, W.C.!, on 1st October 1953. Teams, chosen after 143 eliminating rounds in their own areas, represented all the area boards except the Southern Scotland competed for the first time.

The result was :-

1. Eastern Gas Board (339 marks Ollt of a p ossib e 400)

2 North Western Gas Board (307 marks).

3 North Thames Gas Board (302 marks). Other placings were: Fourth, South Eastern Gas Board (296 marks), Fifth, West Midlands Gas Board (275 marks), Sixth, East Midlands Gas Board (239 marks), Seventh, Scottish Gas Board (237 marks) , Eighth, Nortb Eastern Gas Board (214 marks) , Ninth, Northern Gas Board 213 marks), Tenth, Wales Gas Board (212 marks) , and Eleventh, South Western (184 marks)

A special trophy was awarded to the winning team and plaques of silver gilt, electroplate and bronze to the first, second and third team members respectively. The presentations were made by Col. Sir Harold Smith , K.B.E., D .L., Chairman of the Gas Council. The prizes were given by the St. John Ambulance Association.

The winning team will represent the Gas Industry at the competition for the Grand Prior's Trophy on 19th November, 1953, at the Porchester Hall, Bayswater, London, when they will meet teams from the Police, R ailways and London Transport, British Tra nsp ort Commission , General Post Office, Ministry of Supp ly, British Electricity Authority, National Road Transport, National Coal Bo ard, St. John Ambulance , and Fire Briga des , all of whom will be winners of their national competitions.

The Tests

The Team Test looked very severe owing to the cramped space in which the men had to operate The team was returning home from a first aid class carrying a first aid haversack. Suddenl y they heard a crash and a woman rushed out from a hOllse in a distressed condition. Her husband was mending the frame of a window and fell to the ground and was found lying between the wall of the house and the railings. On examination the patient was found to be suffering from severe multiple injuries. He was unconscious for five minutes. The team had to remove the patient from the (continued col 2 page 18)

The Eastern G as Bo ard Team of the Annual Gas Industry National FlISt Aid Competition. They now hold the Challenge Trophy, which was presented to them by Col. Sir Harold Smith, K.B.E., D L. (fourth from the left). In the group are SII John Stephenson. Chairman of the Eastern Gas B.oard (eighth from left). Mr. F. T. :qlvlslonal General Manager Tottenbam DIVISIOn (tbLed from left ) and Mr W . C. Squire (first from left), who co ached the team. Team members are: Leonard S. Davis (captain), William H. Baker. Albert H Mowles. John H. Whitm ell and C F WOTsdale (reserve).

NURSING. SEPT.fOCT.

TOPICAL NOTES FOR FmST-AIDERS & NURSES

'ViJIage Settlements' for the TubercuJous

The ation a l Association for the Pre vention of Tuberculosis has recently publ ished an illustrated booklet, entitled 'Village Settlements: which discusses the idea behind the establishment of these settlements describes the life there and gi ves particulars of the different settlements in England.

There is someth ing very attractive about the idea of a garden village where those who suffer, or ha ve suffered from tuberculosis will find a home and a job that will give them economic independence, and yet not o vertax their strength. One would hardly that the men and women in these settlements are not quite fit, for there is a remarkable sense of health and wellbeing everywhere Most of the people have had modem treatment for tubercuJosis and having been restored to partial good health and been pa ssed by the doctor as fit for a few hours work daily, they are interviewed by the personnel officer and a plan for employment is worked out.

Pre vious experience is taken into account. For example a carpenter would naturally work in the woodwork department, and a printer, a bookbinder, a shorthand typist or an accountant would continue the work for which they are already trained. Others need to undergo tra ining for a completely new job, for all suitable a venues of employment are de veloped in these settlements. The social and recreational side of life are also catered for adequately, and a doctor is there to see that each ex-patient is living within his physical limitations. Some people stay In the settlements for a few years only whilst others remain for life and, perhaps: marry and bring up a family; but under informed conditions that prevent the passing on of tuberculosis

The largest settlement in Britain is Papw<;>rth, near Cambridge, which was estabhshed 35 years ago and now has a population of two thousand people, who have been trained for various industrial and secretarial jobs. The British Legion Village, Preston Hall, Kent, was established in 1925 for the treatment, training and rehabilitation of tuberculous ex-Service men and women. Over 11,000 d isabled persons have benefited its services Training courses are gl,:en and employment found in carpentry, motor repairing, clerical work, and electr cal work whilst are afforded for ex-patients to m the hospital arid be trained for the Tuberculosis Association ursing Certlficate.

Hall Rehabilitation Colony, near Nantwlch, was founded in 1921, and forms part of the Cheshire County Council scheme for men Its present mclude market gardening, pouJtry farmmg, woodwork, brushmaking and !"fore recently established commurutles Include Sherwood Village,

and Enham-Alamein Village, HampshIre.

The East Lancashire Colony Great Barrow, CheShire, is a voluntary organization that was started after the 191418 war. Work in its industries include specialized tropical packaging of equipment for tbe Services and reclamation of precious metaJs from disused and obsolete equipment. Patients who wouJd like to enter one of these settlements shouJd speak to their own chest physician or tuberculosis officer ; for all recommendations have to come from the doctor in charge of the patient.

Christmas Seals

This year the ational Association for the Pre vention of Tuberculosis intend to issue on million Christmas Seals for use on letters and parcels. For twenty years these gay little Christmas decorations have reminded people that tuberculosis is not yet finally conquered, although tens of thousands of ex -patients have overcome the iJlness and are living healthy and useful lives, .and the spread of the disease is being effectIvely prevented by scientific research and methods of control. There are still however, about a quarter of a sufferers in Great Britain alone. All the acti vities the .A.P.T. depend largely on the finanCIal support of the Christmas Seal Sale. The 1953 Seal is a particularly gay and co)ourful design of a hom of plenty showenng Christmas gifts. Each Seal bears the double-barred cross- the international symbol of the fight against tubercuJosis.

Supplies of Seals, in sheets of 100 for 4 /and Christmas cards in two designs at a dozen (including envelopes) can be obtained from the Duchess of Portland Chairman, A.P.T., Tavistock orth, London, W.CI.

S uppl y of Expensive Medical Equipment in the Home

A Ministry of Health Leaftet-R.H.B. (53) 81-extends the circumstances in which equipment may be lent by hospitals for use in patient's homes. Such equipment includes oxygen tents, breathing machines and gas-operated atomizers and inhalers. In normal circumstances they should be lent by hospitals for the treatment of patients at home only on the recommendation of a hospital specialist after examination of the patient; but. in an emergency they may now be supplIed, on the application of the general practitioner attending the patient by :",hatever means are quickest, and without waltlllg for a visit by a specialist. General practItIOners have been informed of this extensi<;>n of facilities, and they are to the hospital when the eqUIpment IS no longer needed. Hospitals are reminded of the need to arrange for prompt collection.

The Heating Appliances (Firegua rd s) Act, (1952)

This Act was introduced as a P rivate Members Bill, and it came into force on Jst October, ] 953. After that date no gas, electric or oil heaters may be sold or let for hire unless they have guards complying with certain prescribed standards. The Act gave the Secretary of State powers to issue regulations and to decide when the Act should come into operation. It is a measure which will be especially important in helping to protect the very young and the very old against burning or shock and will lessen the risks of clothing catching fire or being scorched. But it does not go far enough , for It takes no account of the four to five million gas or electric fires already in use, or of the twelve million coal fires in homes, offices, hospitals and other buildings in Britain. It is the responsibility of the public to see that these are safe, fOT the Government cannot do it. Many people have impro vised guards from cake trays, wire netting and similar substances; and firms have designed new guards and put them on the market; but these are not yet widely known. Another aspect of the battle against injuries from fire in the home is concerned \vith the fireproofing of children's inflammable clothing. In this connection, mothers should demand safe materials; and more research should be done by manufacturers and by the Government.

A Pageant of Nursing at the Festival Hall

A Pageant, entitled 'They Carry the Torch ' was given on 6th and 7th October at the Royal Festival Hall in aid of the Educational Fund Appeal of the Royal College of ursing. In 18 beautifully staged scenes it portrayed nursing from the time of iEsculapius to the present day; sho\'{ing how the torch that was lit in the dim and distant past has been carried all down the ages the nurses. of the world , who have kept it alIght by theIr servIce to mankind. One of the most impressive scenes depicted the Kn!ghts Hospitalle:s of St. John taking theIr v.ows at Acre, m 1187, and wearing the volummous black cloak with its eightpointed cross At the end, they suddenly flung off their cloaks and stood smartly to attention in immaculate modern uniform. In a later scene, members of the Red Cross wore their new uniform, designed by orman Hartnell, for the first time in public. A meeting between Charles Dickens and Sairey Gamp provided a touch of comedy: but the highlight of the production was the building up of the final tableau, with men of the South African and the First and Second World Wars marching with nurses in the uniforms of theil periods: contingents of nurses representing the variety of careers that nurses follow today, and a cavalcade of all the characters appearing in the Pageant. The cast of 750 was drawn from every type of hospital and nursing service. The Pageant was produced by R alph Reader the United Festival Choir was by Co}m R atcllf!e and the script, which was wntten by MIchael Barsley, was narrated by John Snagge. H.M. The Queen, who is P atron of the Royal College of Nursing, sent a telegram of congratulation and good wishes from Balmoral.

(continlled on page 12)

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IT PAYS TO STANDARDISE 0

Burns and Scalds • In the Home

ALTHOUGH the Heating Appliances (Fire Guards) Regulations, 1953, require that after the 1st October this year all gas and electric fires and oil heaters suitable for use in the horne must be made with a securely fitted guard, it will not be until October next year that prohibition against the sale of unguarded fires takes full effect. Furthermore, in millions of bomes there are now fires which were made without guards conforming to any standard of safety, so it is no less vital this year, than it has been in the past, to draw people's attention to the winter danger of unguarded fires.

Although people of all ages suffer from the crippling and disfiguring accidents caused when the hem of a garment touches the element or flame of an unguarded fire, the heaviest toll of life and the greatest proportion of accidents occur amongst the under 5's and the older people. We ask, therefore, all those who have it in their power to warn mothers and housewives that particularly in households where there are very young people or aged, frail or infirm members, all fires should be protected by effective and securely fixed fireguards. This, of course, also applies to open grate fires, which it is not always appreciated are responsible for a large proportion of burning accidents.

More chlldren under 15 die from accidents in the home than from any single infectious disease, and more are killed in their own homes than by accidents elsewhere, including road accidents.

Many of these fatal horne accidents are the result of burns or scalds, which are also responsible for hundreds of maiming and disfiguring accidents every week, involving long stays in hospitals and perhaps misery for life.

At one accident hospital a survey showed r that 90 p c. of the burning accidents from r coal, gas or electric fires happened when r no guard was in use at the time, and most of the remaining 10 p.c. amongst children who had removed the guard which was not securely fixed.

Precautions against Burning Accidents

See that fires, particularly where there are children or the elderly or infirm, are adequately protected by a seclIrf'ly fixed fire-guard. Fixed mesh screens are considered by experts to be the only real safeguard.

The open grate fire-guard should be hooked on to staples driven into the wall on either side of the fireplace. I/ it is only hooked on to the bars 0/ the fire it can easily be knocked off. Replacement of the guard after putting coal on the fire is a thing to be remembered. Clothing can easily catch fire if there is no guard and the wearer leans over an open fire to reach something on the mantel-piece.

Electric and gas fires if not properly protected can be highly dangerous. A single rod or even several bars in front of such stoves do not prevent contact with the element or with the flame, and a mesh

guard should bc fixed to secure this. Unguarded oil heaters should also be protected. Many accidents happen with these stoves in bedrooms, when people are convalescing or in dressing gowns, particularly when children play too near the fire and lean over it. Cotton materials, especially flannelette and winceyette, are very inflammable, and dressing gowns or nightdresses standing away from the body at the hem, create a draught and rapidly fan flames. A child is often unaware for the first few critical seconds when the material catches fire. Tnterlock material clings closer to the bodv and does not swing out so mlich when children run about. Pure wool and pure nylon are less inflammable than flannelette.

If somebody's clothing does catch fire, snatch up a blanket, coat, or even floor rug and smother the flames with it on the floor.

Precautions against Scalds 67 p.c. of those suffering from scalds who were treated at the Binningham Accident Hospital were children under five, and half these accidents were considered easily preventable with ordinary care. The kitchen is the scene of most accidents from scalds, which can be quite as serious as burns. A playpen in a safe corner of the kitchen can keep a child out of harm's way, but other precautions against scalds which should be taken include the following :-

1. All hot liquids should always be carefully handled and placed.

2. Saucepan handles should be turned inwards over the stove: protruding handles prove tempting to toddlers who reach up to them and tilt the saucepan down to see what is inside. Kettle spouts should also be turned inwards.

3. Stockings (or cloths) should not be left hanging to dry from handles of utensils as they may be pulled. Where cloths are used on tables they should be smaller than the table top so that they do not hang over the edge. Otherwise the child can clutch the dangling cloth and upset the scalding liquids from the teapots and cups on to itself.

4. Adults should be careful about handling or carrying hot things over a child's head in case the child suddenly moves, and when carrying things they should see that the child is not likely to get under their feet.

5 Flexes of electric irons and kettles should be kept out of reach.

6. Matches should be kept out of reach and candles and night-lights safely placed.

7. BoiUng bath water is a further cause of many scalds, and when getting a tub of water ready the cold water should always be put in first, so that if the child plays with it or falls in it while the mother is out of the room, no harm is done.

Treatment

Tn the event of a burn or scald, no attempt should be made to pull the clothes

off the skin. A doctor should be summoned at once; if the doctor is not immediately available an ambulance should be called and the burn or scald described to explain the urgency.

While waiting for the doctor (or ambulance) the patient should be kept warm and as comfortable and calm as possible and given a hot sweet drink. If the burn or scald is on a hand or foot or lower leg it may be held under the cold water tap to relieve the pain, and then covered with sterilized (or absolutely clean) linen or cotton. Nothing should be put on a burnt or scalded area except sterile (or absolutely clean) linen or cotton to cover it from the air, and whoever applies the material should wash their hal/ds before so doing.

Much original infection of sLlch wounds is caused by dirty-handed first-aiders.

Every horne should have a packet of sterilized linen or cotton material ready in a cupboard. To sterilize material wrap it in stout brown paper and bake it in the oven. A piece of white paper should be put in the oven at the same time and when this begins to turn brown, sterilization has been achieved. The brown paper packet should be put in a convenient, dry place, unopened unless an accident occurs. If no sterile linen or cotton is ready, clean laundered handkerchiefs, towels or pillow-cases, etc., may be used to cover burns or scalds. Besides burning and scalding, other serious home accidents occur from falls, electric shocks, gas and other poisons, and suffocations. The Home Safety Department, Royal Society for the Prevention of Accidents, Terminal House, Grosvenor Gardens, London, S.W.I, has some leaflets on precautions which can be taken.

TOPICAL NOTES

(continued/rom page 10)

Courses and Conferences at National Training Centre

There are four very useful courses arranged for November at the B.R.C.S. National Training Centre, Wonersh, near Guildford. They are :-

No. 280. Accident Prevention Course.6.11.53 to 9.11.53. This will be run with the help of the Royal Society for the Prevention of Accidents, and is intended as an introduction to new Junior Red Cross Accident Prevention Courses, to help those who are arranging such a course.

No. 281. Section Leaders alld Members COllrse.-13.I1.53 to 16.11.53. This Course is intended to give a wider knowledge of the Red Cross.

No. 282. Commandants Course.20.11.53 to 23.11.53. Intended for more experienced Commandants and Assistant Commandants. The programme will cover the wider aspects of the Red Cross and will include discussions.

No. 283. Intensive We1fare Coursf'.23.11.53 to 29.11.53. The programme is based on the Welfare certificated syllabus and will also include advice on how to organize and present the Course. There will be the usual Welfare Certitlcate Examnatiion at the end of the course,

for First Aid treatment of Wounds and Burns

, Furacin' is an entirely new chemical compound * for the treatment and prevention of infection in wounds, burns, etc. It is as powerfully antibacterial and as harmless to living tissues as the antibiotics, and yet is as stable and easy to handle as the older antiseptics. 'Furacin' is widely used in hospitals, factories, and general medical practice. It is available as an ointment, 'Furacin' Soluble Dressing, in I-oz. and 2-oz. tubes, 4-oz. and 16-oz. jars; or as a liquid, 'Furacin' Solution, in 2 fl. oz., 4 fl. oz., and 16 fl. oz. bottles.

*Nitrofurazone

the potent l1evV antibacterial specifically for local application

Wound by Pen Nib

N. M. (Felixstowe) writes ;-

Please tell lIS holV we should treat a patient who accidentaITy pushed a pen nib into his finger? The lvound was smeared with ink. Your kind reply wi ll be much appreciated.

Answer

The ingredients of writing ink consist of certain derivatives of iron, together with the addition of colouring agents and of a little gum which prevents the liquid flowing too freely. These substances are not in themselves poisonous, and are not likely to have harmful effects. Wounds caused by pen nibs, therefore, fall within the category of , punctured wounds' and should be treated as laid down in the Textbook.

* * *

Treatment of Poisoning

R. M. (Yarmouth) writes ;-

Please tell me what treatment you could recommend if, on being caITed to a case, you had good cause to suspect poisoning by mouth, but could not definitely state whether the poison taken was a corrosive, an irritant or a narcotic?

Answer

The classification and treatment of poisoning by mouth are based in the Textbook on the condition of the patient's mouth. If, therefore, you are called to a case such as you describe, you would at once examine the mouth for signs of burns. If these are present, you could at once treat for corrosive, whereas, if they are absent, you could treat for noncorrosive poisoning. This done, you would watch the patient and continue treatment in accordance with the General Rules.

* * *

DHatation of Pupils

W. G. (Stoke) writes :-

According to the Textbook the pupils of the eyes in Nerve Shock are usually dilated and yet, in Haemorrhagic Shock (which is more seve re) it is stated that the pupils may be

queries

normal or dilated. As this is a problem which puzzles our chaps during their diagnosis, we should be pleased to have you views on this matter?

Answer

The dilatation of the pupils arises from loss of control of the eye muscles by the higher centres of the brain. The greater the shock, the wider is the dilatation. In Nerve Shock the effect on the pupils is rapid but in Shock due to Haemorrhage the dilatation usually comes on gradually and in proportion to the extent of the haemorrhage At first the loss of blood will not be <)ufficiently severe to produce any effect but with continued bleeding the shock increases.

* * *

Paralysis of Muscles

W. G. (Stoke) writes :-

We at our class would appreciate your ruling as to whether it is possible to recognize paralysis when the patient is unconscious. It has been suggested that the limb, if hfted a little, would fall more lifeless than 1V0uld a normal limb. We should be pleased to have your opinion.

Answer

To the doctor this sign of' lifelessness' in a limb to which you refer is important , but to the first-aider it is likely to be of little use as the difference in the rate of movement may be so small as not to be observable.

The reason for this sign is in the fact that when a limb is raised and then allowed to fan the patient will, either consciously or subconsciously, use his muscular power to prevent the limb striking the ground with too much force. If, however, the patient is insensible this control is absent and the first-aider would probably see no difference in the rate of fall.

* * *

Fractures of Humerus and Clavicle

P. N. (Harrow) writes :-

Please tell me holV we should treat a patient who is suffering/rom simple

We regret to say that Dr. A. D. Belilios has been ill, and has been unable to answer recent queries sent by readers. We hear that he is making good progress and join with his many friends in the first aid world in wishing him a speedy recovery.

In this issue we are republishing a number of queries from our files.

fracture of left clavicle and compound fracture of left humerus?

Answer

With such a combination of injuries shock will almost certainly be marked; and the patient will require removal on stretcher. Of the two injuries the compound fracture of the humerus is the more serious from the first aid point of view and demands priority in treatment. In these circumstances, if I were the first-aider, I would concentrate on its treatment, contenting myself with dressing the wound, with keeping the patient recumbent and the left upper limb in close contact with the body whereby the danger of aggravating both fractures is eliminated.

* * *

Treatment of Tar Splashes

S. G. (Bourne) writes :-

The Textbook tells us to make a soothing lotion of a dessert spoon of baking soda to a pint of warm water for treatment of burns and scalds. Please tell me if this lotion could remove tar splashes from the skin?

Answer

The application of this lotion would not remove tar splashes from the skin. In first aid it is not necessary that this should be done before the patient arrives at the hospital, as no further injury can arise. Further, you may cause damage to the skin if you try to remove the tar as this should be done very carefully by the use ofliquids such as chloroform and ether. Incidentally, road-menders use diesel oil for removing cold tar which has got on the skin.

* * *

Dislocation of Joint

P. B. (Cardiff) writes :R ecent ly [ had to treat a man who had dislocated his right shoulc1er,

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Q A RAN C

HOUSEHOLD PHYSICIAN

and diagrams

The COMPLAINTS OF MEN, WOMEN AND CHILDREN

Their Cause, Treatment and Cure

A few of the Subjects treated:

First Aid

What to Do in Emergencies

Influenza, Colds, etc.

Measles, Mumps, Catarrh

Corns and Warts

Physical Culture, Self Defence

Treatment for all Skin Diseases

The Lungs, Pleurisy

Hygiene, Anatomy , Pharmacy

Fevers, Bladder, Kidneys

Pregnancy, Childbirth

Home Remedies, Diet

MOVABLE MODELS OF

Principles of Nursing PRESCRIPTIONS

Eye, Ear, Nose 375 proved remedies

Throat, Liver MOTHER AND CHILD

Chest, the Heart teaching pictures

Stomach, Duodenum BEAUTY TREATMENT

Teeth, the Muscles how to bring out your best points

Child Welfare SELF DEFENCE

Homceopathy, Arthritis what to do if attacked Neurasthenia

Rheumatism, Poisoning COMPLETE INDEX

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Readers' Queries

(continued)

He )vas complaining of numbness in the joint and of pins-and-needles below the joint. I shall be grateful if you will be kind enough to explain how these signs and symptoms arise with dislocation of shoulder joint.

Answer

The head of the displaced bone presses on nerves and blood vessels in its neighbourhood with the result that, consequent on irritation of the nerves and interference with the local circulation, there may be numbness at the seat of injury and tingling (or pins-and-needJes) sensations below the joint.

Action of Carbide

G. J. (Cinderford) writes :-

At a recent meeting of our Ambulance Brigade (of which over 90 p.c. are colliers), we were discussing , Foreign Bodies in the Eye,' and the question was asked, What would be the treatm ent for a person (1) with a piece of carbide in his eye, (2) if the carbide JIIas swallolved.' (We lVo rk in naked light mines.) As f've were unable to agree what treatment )lie should apply, it was agreed to write to you for advice. Thanking yo u in anticipation of your kind reply

Answer

When water is added to dry calcium carbide, heat is evolved and a gas given off which is inflammable. Should a small piece of carbide come into contact with the moist surface of the eye, these effects would commence immediately but would soon pass. The probabilities are that beyond slight inflammation no serious effects would result. The first aid treatment is to wash out the eye freely with water in order to remove products of inflammation and also any particles of carbide which may be undissolved. It is difficult to appreciate how calcium carbide can be swallowed; but, should this occur, and should symptoms arise, as described in paragraph (a) on page 169 of the Textbook, treatment should be as for a non-corrosive poison.

CrosswoI·d No. ?

Compiled by W. A. Potter

Subjective warmth alld glow

'ALGIPAN', the smooth non-greasy HISTAMINE cream, relies upon methyl nicot;nate to ensure swift penetration of the cutaneous barrier.

Simple inunction suffices to shepherd the Histamine content through the epidermi , to the deeper tissues, where the resulting dilatation of arterioles and capillaries promotes a local increase in blood supply, accompanied by a reflex cessation of aching in underlying muscles. To the patient, this is evidenced by a circumscribed surface' flush' and warming glow, rapidly followed by disappearance of pain.

'A Ig ip all ' is of proven value in fibrositis and other manifestations of the 'rheumatic' syndrome.

ACROSS DOWN

1. Dangerous type of haemorrhage (8)

5. Congenital defect of the palate (S)

9. Compassionate part of the nervous system (11)

10. Departmentally associated with nose and throat (3)

11. In first aid, they may be given by doctor (7)

12. Digestive Enzyme secreted by small intestine (7)

13. Salt water puts end to sick feeling ." (6)

14, Neuritis marked by pain in rup and leg (8)

17. They go by sea (8)

19. Epithet applied to work of B.R.C.S. and S.J.A.B (6)

22. Useful for bleeding from the scalp '" (4-3)

24. Attacked from without (7)

2S. Means of propulsion on water (3)

26. Type of hernia liable to become strangulated (11)

27 Makes more comfortable (S)

1. Cause of insensibility-must be considered in diabetics (7, 8)

2. Clock watching by the Industrial psychologist (4-S)

3. Casualty for which we prepare at practice (4, 3)

4. Struck with sudden terror (6)

S. Important organ in 1 across and 10 (7)

6. Rectal injection (5)

7. Useful means of transport for ankle injuries (S, 6, 4)

8. Much abused organ has pain at last (7)

IS. Cannot be perceived by 10 (9)

16. Variation of pure dry behaviour (7)

18 They confuse G.1. spies (7)

20. Beginners-without faults? (7)

2]. A small one often has to be removed from the eye (6)

23. Saner form of nostrils (S)

28. Growing (red in Moslem states) (8) (Solution nex t isslIe)

Aid for the Brigade

MITCHELL LTD.

(S lines)

1953 PRICE LIST

Officers :-

JACKET fro 111

TROUSERS , , , "

OVERCOAT , " ,

RAINCOAT , "

ACROSS

SOLUTION TO CROSSWORD No. 6 DOWN

1, Medical advice; 10, Inert; 11, milk-teeth; 12, angina; 13, plasma ; 16, erne; 17, undertaker; 20, physiology;

21, inks; 23, pestle; 2S, murals; 28, lead paint; 29, broke; 30, sprained wrist.

2, Emergency;

£7 9 9

£2 16 0 £11 5 7

£12 11 8

CAPS according to lank

Privates :-

TUNIC (Lay down Collar) from £3 18 3 (Lined sleeves 5/6d. extra)

TROUSERS................................." £2 6 0

OVERCOAT.. ................" £5 18 5

CAPS ............. . ...... ..................... 10 5

h1 Black Woaded Worsted Ditto

ill Quality She ell Grey Meltoll in Black Wool Gaberdin e

ill Black Tartan, New Patt ei'll Ditto

il7 Superfine Grey Cloth

R eg ulation

PRICES INCLUSIVE OF PURCHASE TAX

lJ"ifor"f, COI,tractors to H.hl. Gocerl"I,el,t ""d P"blic etc.

3, intenl; 4, arms; S, ails; 6, vitality; 7, cress; 8, dilated pupils; 9, theatre sister; 14, ankle; IS, bergs; 18, kangaroos; 19, diplopia ; 22, lumbar; 24, scalp; 26, sign; 27, stud.

S.l.A.B. and ( The Sleeping Prince'

fotevervonerealizes that the v. onderful and ever-increasing work of the St. John Ambulance Brigade is entirely voluntary. The members not only give their services free, but they also have to pay for their uniforms.

They have to pass an examination every year in order to maintain their high standard of efficiency, and they have to attend weekly practices. They sacrifice many hours of their free time to the service of their fellow men.

Funds are urgently needed to help members in the purchase of their uDiforms and also to meet the increasing cost of medical supplies and surgical equipment.

Owing to the generosity of H. M. Tennant , the Pre-view of Terence Rattigan's new play , The Sleeping Prince,' which takes place on Tuesday, 3rd ovember at the Phoenix Theatre, is to be given in aid of the St. John Ambulance Brigade. H.R.H. The Princess Margaret has graciously consented to be present, and the occasion will also mark the welcome return of Vivien Leigh to the London stage. as she and her husband are acting in the play. Tickets are from 7 6d. to 10 guineas, obtainable from Lady Beddoe-Rees, 20a 140, Park Lane, W.l. Telephone: Grosvenor 2521 and 1141.

National Gas Competition

(continued from page 9)

area to a more exposed place where the correct treatment could be given. Medical aid was not available. First Aid had to be rendered in 15 minutes.

The individual tests (for which 7 minutes was allowed) consisted of first aid to a patient suffering from a fractured left forearm, sprained left ankle, and shock (a limited amount of first aid material was available) and to a case of scalds on the left leg, a fracture of the right patella and shock. A first aid haversack was with the competitors.

Tributes were paid to the' acting' of the distressed wife, the first time a woman has taken part in the team test.

Spectators of the Team Test thought there was little to choose between Eastern and orth-Western. Their judgment was correct for both teams scored 164 marks each out of the possible 200 for it, but it was in the individual work that Eastern, with 175 marks, pulled ahead of North-Western, with 143, and won their first and popular victory.

Lt.-Col. E. C. Croft, Deputy DirectorGeneral of the St. John Ambulance Association , presided over the proceedings and with him on the platform were Mrs. Stuart Roberts, Lady Principal, and the Judges, Drs. G. M. Shaw Smith and J. L. Fyfe.

Misce]]aneous Advertisements

Advertisementswith remittance should be sent to Firs! Aid & Nursing, 32 Finsbury Square, London, E.C.2. Rate 3d. per word, minimum 45. 6d. Trade Advertisements 4d. per word, minimum 6s. Box numbers s. extra.

SCE T CARDS, 250 17 / 6, 1,000 52/6. Tickets, Poslers, Memos. S.Jmples free-TlCES, I I Oak· lands Grove, London, W.I2. HOLIDAYS. Excellent food, feather beds, H. & C. bedrooms, reduction to S.J.A.B. members and families Hunter, 'Lynton,' Marine Rd., Prestatyn, N. Wales, Phone 639.

F OR SALE: 40 / 50 RoLls Royce Ambulance, recently overhauled. Resuscitation Apparatus. Five positioned stretcher, electric heater. Noreasonable offer refused. Being disposed of, as new ambulance given to Corps. Offers to St. John Ambulance Brigade, Sheffield Corps, Psalter Lane, Sheffield.

on tbe 40tb Edition S.J.A.B. Book. Send 1/ · for sample copy to Selby & Plowright, 135 Russell Street, Kettering, ortbants.

Monoxide.' Owners desire to meet all demands for the utilization of tbis Patent and invite enquiries from manufacturers and others in Great Britain prepared to assist in its commercial exploitation. Address in first instance Messrs. Pollak, Mercer & Tencb, Chartered Patent Agents, 134 Cheapside, London, E.C.2.

S.l .A.B.

Ideal presentation gifts.

PATENT

"PORTLAND" AMBULANCE GEAR

The Gear IIlustrated(A.B.C.D.} carries two stretchers on one side of Ambulance, leaving other side clear for sitting patients.

The UP AND DOWN action is qUick and easy for loading or unloading.

A. Shows the two stretchers in position.

B. Shows the top stretcher lowered ready for loading.

C. Illustrates the same Gear with the top .tretcher frame hinged dcwn for use when only one stretcher case is carried.

D. Shows the same position as in C' only with cushions and back rest fitted for convalescent cases.

Where Ambulances are required to carry four beds two Gears are fitted, one on EITHER SIDE. and the same advantages apply as described above.

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HANDBOOK OF FIRST AID & BANDAGING

ELEMENTARY ANATOMY & PHYSIOLOGY

This handbook is the ideal guide for The most comprehensive and up-to-date A handy, compact manual which gives anyone who is called upon to carry out book on the subject, giving full details a complete outline of the anatomy and any form of emergency nursing. It of the first-aid treatment of medical physiology of the human body. 'A most describes in simple language the basic emergencies as well as of injuries and straightforward, reliable little book.'principles and procedures that underlie accidents. The Nursing Times the science of nursing, and contains With 520 pages and 244 drawings. 6s. With 194 pages and 116 drawings. 48. 6d. brief descriptions of thdmore common

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Built for Service In Jamaica

T HIS is a dispensary and first aid clinic, capable of being used for the performance of minor operations, and for the treatment of diseases.

One of its two compartments is fitted for the dispensing of medicines, etc., complete with stills, hot and cold water, refrigerator, and all the necessary compartments for the storage of drugs. The other section is equipped as a surgery, again with hot and cold water, and cupboards specially made for the storage of surgical instruments, microscopes, etc.

The unit is completely self-contained with regard to electricity supply and water storage, and is specially constructed, insuiated and ventilated for use in tropical countries.

YOU ARE INVITED TO APPLY FOR FULL DETAILS OF MOBILE MEDICAL UNITS, AMBULANCES, ETC., BUILT TO YOUR PARTICULAR REQUIREMENTS FOR SERVICE IN ANY PART OF THE WORLD

Treatment of' Colds and Chills' must be prompt if it is to be effectil'e.

Most of us know the first signs only too well. The prick!) feeling in the back of the throat, the cold queasy sensation in the abdomen . . . . these are the signals which say 'bed, bot water bottle, bot drink, and ANADIN.'

a If yo ogica

Then you will follow this point-by-point argument and reach the same conclusions as so many doctors, nurses, hospitals and clinics have done.

DO YOU AGREE . .. that the causes of most skin infections are the cornmon strains of STAPHYLOCOCCI, STREPTOCOCCI and B. PYOCYANEUS ?

IN THAT CASE ... a treatment which is effective against all three will be indicated for cuts, abrasions, burns, scalds, boils and mo st inflammatory skin infections ?

THIS IS THE TREATMENT

AmIPEOL Cutaneous Vaccine Ointment contains the sterile vaccine filtrates of the three micro-organisms mentioned. The filtrates destroy the actual micro -organis ms and at the same time act as a local immuniser against re-infection. This is a

a e erson ...

purely b iological action and there is no damage to delicate tissues.

RAPID is further expedited by the ointment base of proved efficiency. For burns and scalds, has spec ial ad'vantages. It is microbicide and non-adhesive. Therefore dressings do not have to be changed every day.

A HERE IS THE PROOF.

An peol Ointment is proving and reproving itself every day in dozens of surgeries, clinics, hosp itals and homes, Letters from the medical and nursing profession convincing testimony to its effectiveness.

THERE is the logical argument for including ANTIPEOL Ointment in every First Aid kit. As a logical per 00, \yhy not send for full details and a clinical sample?

a 01

cutaneous vacczne ointment

by the makers of: E lTEROFAGOS for mtestmal, RHINO-A lTIPEOL for nasoOPHTHALMO-A TIPEOL for o c ular rnfectIOns ; DETENSYL for reducing arterial tension.

LTD .• CARGQ.EEN RD" SOUTH NORWOOD, S.E.2S

Dec. 1953

In this Iss ue

Casualties "Cruon-Thefirt ten years ., .

Fractures

D iagnosis-+

Grand Pr ior Tr ophy

Indu "trial Firt Aid

Casualt ie- "C nion

Re<Jders' Queries

First-Aider's Cross\yord

3 5 9 10 12 16

Do yo" 1;"011/

tl.at . • •

A drop of blood. circulate at a rate of 1 ft. per econd. complete tbe circuit of the body in 30 econds '?

Rubber hot-" ater-bottles retain the heat longer than metal one

Starch stains '? effectiYe in remo,ing blood-

In mixing a Seidlitz pO\,der it ad,isable to use a large glass to allow for the resulting foam '?

Drinking tubes hould be handled in such a manner a to prevent the fingers coming into contact with either end '?

Typhoid patients may carry the germs for many years after reco, ery ?

By Helen l\J. -ic.hols on

Casual ies Union-the fil-st ten a

THERE ,can be no dou t th t the e tablishment of a national bod\' which pec ializ in the PI' du.:tion of cting casualue- h - been a timuI - not only to fust aid tr.1ining but to the formation of specialli group \vithin the ranks of the first aid I' achin g -ietie, During the ele\'en years of it organized existence

C ualtie L mon has onsolidated ip ition as an illdependeor organization e'tisting purely for the funherance of the direct method of first aid and nursinc instruction by cre3ting a eD-1Ce of trained -lin g casualtie-' or patienrs. W hile making no claim to ha\'e been the instigator.:; of the an of c ualty fakin!!, it has est:1bli-hed a precedent in -being the first organiz:Hion to pecialize in the technique. to have published the on'_ - periodical dealing with this and to offer a comprehensl\"e tralillDg ourse to tho e eeking qualifications in subject. -

Since irs inspired beginnings in 19·C. Casualties Lmon h gathered momentum from the suppo n It has recei\'ed from all ranks of the meJ,h :al profe -ion and from the eyer-increasing e\idence that it iills a longfel t need, Fro m being a mall group of enthusiastS sef\ ing :1 Count\' area of Civil De fence in Surrey it hai developed a technique which - pra tised by branche and study circle" all oYer this country and in Canada and South Africa , W ithin the s 'cpe of enain principle developed through om iction and e'\perience. C a ualtie "l' nioo seek to ef\e a t eyeD' Stage of first aid training b\ prm-1dllg the \I.ml aid and tangible experience which can ne\-er be gained from text - ook or wall hart, Though the teaching of first aid is entireh' outSide irs terms of reference. it cannot be demed that the use of the realistic method has in no mall measure been re ponsible for the ad\'an e- in pI<lctical ability gained by first aid studenrs dunng the la t decade, While creating a progre i\'e technique and prm iding a eD-1 e of rrained personnel. Casualties Lilion ha impos ed upon itSelf the moral and financial limitations of being simply a mean to an end. Such a seD"ice pans the gull between knowledge and experience, but aero this bridge there is a two-way traffi , Through training as casualtie man\' have found the way to better first aid, - and experien ed first-ruders ha\'e discoyered in the rudy of the beha\-iour of injured people a deeper understanciillg of hunlan nature ::md a fulfilment of purpo e in a new and a,:i\"enturou form of ef\-1ce, By identifying them dYe with rea II) injured people in all but actual change in phy ical condition, ca ualries in training experience a ch a nge in point of view which materially enhance their own knowledge of first aid, - 1 ot only do they ha\ e to -tudy the correct treatment for each injury or condition, but they de\'elop a high sensiti\'ity to all kinds of approach and handling o that they may adjust their own beha\10ur to variable treatment. The most effective first aid is done by tho e who have learned

w thirt}- and feel from the -: u3.1tie· point 01 \'1e\\'.

"COlon ha- mit i poLi,:\' on c that ta!,ing me pl:ice oi' the lOJured et me tmille 3. re-poru-i ilit\' to e entrusted only to fully -lt-,lined me-n a.nd women, Casu3.lty represent3.tion has its danger.:; as well a- - and not the least of th -e is that fi -t aid- tudentS mkht be gi\en a false impr " ion of inlUf\ condiuons Ji rea-:tio - were ill:! -cluate'\portT3yed. -

The training of a '3,'ualt\" :hffiS at de\eloping the irn:J.gmadon to -uch an extent th3.t 'oncentrauon on a giyen decree of pain and di a ility, .:;upponed a briefing n the patient': beha\'1our m a panicular et of circumtance produ.:e, the a,;--ur te lmubuon of the relati\ e symptoms, igns other than p ture and the demeanour of the casualty c.iO be, uperimp? ed \\ith ma. but except tor pro\'1d.ing addi:10n3.1 JIagno.tic points. m -e-up i quit _ 'ond3f\' ill imponanc e to the acting and of the -3 ualty and the ruston' and -ta.nn: of the incident, - - -

:\Iuch controwrsy ha ari en oyer the realistic staging of accidenrs, Tho -e who appreciate realism in a -ting and make-up have not al\\'ays been 0 ready to al: 'ept the prin iple ')f re:ll' 'm in 'taging, Ca ualtie L nion behew that the onh-":Iv ro prm ide the full complement t theoi-etic:il first aid is to give. tudent - opp rtunitie.:: of pracu_jng in the :lcmal conditions where ca ualtie- may be found, An armo.phere of danger or urgency -:alling for protection or peed)' a tion need oewr be dependent on artifi ial stamg when both' C1 U:llt\, and first-aider -are willing £0 meet in' a natural settin!!. \\'het her- the um aid tea bing ocieue will e\er agree to this principle in the organizing of their competitions is a matter which lie' bet\\ een expedien -y and the demands of their member.:;, The in -reasing intere-t .hown in the Ca ualtie l.:nion \llnual Open Competition prm "ides a pointer to\\ 3rds the demand for ab olute rea.li m in the etting of uch conte de igned as it is to bring the first-aider to the -cene of the accident. rather than the 3ccident to an audience, Inspired by the ne-ed f I' omplete realism in Ci\il Defence training during the :lir-raid period of the World \\ ar, Ca ualtie Cnion technique ha been readily accepteJ by the organizers of the new Ci\il Defence programn1e, 110re than a dozen in England and 'Olland h;ne upon 10 al branche of the enton to proyide completely trained' ca ualtie to help them when taging large- cale e,er'i es in conjunction \\ith the Home Office E'perirnental lobile Re cue Column, E tablished Schools at Ha\\k Hill', Ea ingwold and at Taymouth are regularly ef\'ed by pers nne I trained by C a ualtie C"nion. and a demontration was gi\'en at the opening of the London Count\- Counc il Re cue 'h 01 at Bully Fen. Li\ e ualtie" ha\ e taken (c0111illued on page 10)

MEDICO-BIOLOGICAL LABORATORIES

By A. D . B elilios M. B ., B .S . (Lon d .), D.P .H . (Eng.)

THE cour e on elementary fir t aid \\ 'as interrupted in our last through unavoidable cause but is this month when \\ e con ider the diagnosis of fracture

The diagno -i of a fracture i comparati\:el y easy if the first-aider IS prepared to jump to conclusion and assume that the more serious injury is present although later. on further inve tigation. it may turn out to ce one that is less erious such as a train or a sprain.

The hi ton of the accident i often suggesthe. Thus the patient may ha\ e heard or felt something give way : e\ en the bystanders may ha ve heard a snap or crack. The patient will himself describe how after the accident he noticed evere pain in the affected part and that there "as loss or limitation of use. The symptoms and signs of a fracture must ce considered both as general and local. The general symptoms and signs are those of shock and will not. therefore. be described further in this article except to emphasize that if after an accident the patient is obviously shocked and complains of severe pain in a bone the probability of a fracture should be accepted.

Local symptoms include pain which is quite severe and requires drugs administered by a doctor in order to relieve it. Limitation in use of the injured part is always present. Often the patient is totally unable to use the injured limb but sometimes he is able to move the affected part to a limited extent.

TO first-aider should ever allow a patient to demonstrate the sign of limitation of use. By attempting to move the affected part, the patient may produce complications. The writer of this article was somewhat horrified recently to notice two ambulance men in charge of an ambulance asking a patient who had just been knocked down by a motor car, whether he was able to walk.

The remainder of the physical signs of a fracture can well be

di, ided into tWO gro.lps. namely:

(a) those that can l')e seen. and

(b) those that can be felt. If a fracture can be diagno ed by sight alone. there i no need ,, hatever to feel the affected bone. It is only when visible i2:ns of a fracture are absent as occu; in the les eriou cases. that it i permi ible to touch the bone \\ 'ith a \'iew to di covering physical signs.

Yisible Ph ys ica l S i gns

(1) Deformiry.-The injured part often appears deformed \vhen compared with its fellow of the oppo ite side.

(2) Swel/ing.- This does not always appear immediately. and again in the early stages can only be detected by careful comparison with the uninjured side.

(3) Shortening and Erersiol1.Shorterun2: is genc:rally onI; noticed i'fi cases 01 a fractured femur when the injured lovyer limb may be obviously shorter than its fellow of the opposite . ide. In hospital work a tape measure may be used to compare the lengths of the lower limbs: this. however. is never necessary in first aid . Another sign noticed when looking for a fractured femur is rollir:g over of the foot on to its outer side (eversioQ), and the combination of these two signs-shortening and eversion of the foot-supply adequate proof of a fractured thigh.

S igns that can be f elt

If the fracture cannot be detected by visual methods, the bone suspected to have been injured must be carefully felt throughout its length. Students should practise on their own bodies feeling thelr own bones in order to discover the best method of app r oach . It is only by frequent practice in this manner that the first-aider learns how to feel a bone in a real casualty.

The most important signs discovered by feeling a

(1) Tenderness.-This means that an area on the bone is obviously painful when gently touched by the

fir - t -aider' finger. It i- a golden rule in first aid that if tenderne i found alon!! the cour -e of a bone a dia2:no i ofa fracture hould a!\\av be 'i"nade. no matter hO\v few other ;mptom and ign rna} be found. In thi connection reference may be made to the common injury called a prained ankle \\ hich will be decribed later in the -e arricle - If. when examining an ankle uppo ed to be sprained the fir t-aider dico\ er tenderne s 0\ er the lower end of the fibula he hould a!\,'ay dia!!nose a broken ankle. ver\, number of -uppo ed sprained ankle turn out on - Ray e:-.amination to be fractures.

him -elf into a more omfortable po ltwn. or quire im oluntarily through the action of mu-cle in a -tate of -pa -m.

Often the limb \\ ill e found to be in an awkward po ition and the next . tep. therefore, i- gently to mo\ e it until it i in a -uitable po-irion for examination and treatmem, Conrinuou uppon mu t accompan> any mo\ ement. and whene\ er light e:\.ten ion of a limb should be applied. Till means that the limb hould be drawn geml}' down: exten ion pre\'ents further mO\-emem. relie"es pain and tends to draw the fragments slightly apart, It must be maintained until the fracture ha been ecured.

Examining the cal p

By F. C. Reeye F.Z. S .. F .R. E .S .

hard periphery which ' often mistaken for the ed!!e of the 1'ra If. then. the forefinger i' found meet with a re+tance at about the arne le\ el a' the surf;] of the skull. then that i- either a 120ntu ion or -uperficial haemaroma. but if the finger can be depre.:: -ed u elO\\ the le\'el of the urrounding bone. then \ ou can afelva ume that it i a depressed fractu;e.

(

) Irregu/ariry.-Thi - means that the urface of the bone i irregular \l;hen gently felt. There may. for example. be a sharp edge at the site of the fracture not pre ent on the oppo ite side: sometimes a bump on the bone will be noticed.

(3) CrepiTUS and · Cllllatural Jlo\'ement.-The two [oUO\\ ing ign are positive e\ idence of a fracture but are not alway pre ent. If noticed, there is no need to make any further examination of the patient, but it is equally important ne\ er to make a special earch for the e signs.

Crepirus.- Thi i a creaking sound-rather like a crunching ' heard or felt when the injured part is being examined. It is caused by the sharp jagged end of the fragments moving on each other.

Unnatural l\1ol'emellt.-If a bone such as the femur has been broken completely across the pull of the mu de on the fragment may cau e the limb to move unnaturally; thu a limb may appear to bend at its middle where there is no joint.

Principl es of T r eatment

The first step to take on arrival at a case when there is a suspected fracture is at once to support the injured part so that no f urther movement is possible. Such further movement may take place voluntari ly b y the patient on attempting to ge t

Fixation of a fracture by a more permanent mea ure mu t be adopted oon a po ib1e. 1; ually thicon i t of body -plinting, i.e - ecuring by mean of bandage the broken bone to an uninjured and firm part of the bod), i.e .. the upper limb to the trunk. a lower limb to it fello\\ - of the oppo ite side. by which thi i done are de cribed in standard text books on first aid.

T he patient must be treated awell as the fracture: the ooner that treatment for shock i begun the better and when assistance is available. the fir t-aider can quickly gi\ 'e instructions a to the simple treatment for ho::k while he himself i continuin!! that for the fracture.

Compo'Und fracture are treated in a similar manner. After supporting the injured part. bleeding must be controlled and a dre ing applied. 1 0 attempt whatever should be made to clean e the \vound owing to the ri k of carrying infection in. 0[01' is it wi e to apply extension in compound fractures particularly \",hen one of the fragments is protruding through the skin.

The Editor and Staff of ' First Aid & N ur sing ' wish all their readers a happ y Xma s and good health and prosperit y in 195 4 .

T HE examinat ion of the - alp inot quite a - e:r) a the e\amination 01 other -uperfi ial part- in \ 'ie\\ o f the fact that it i-. nom1ally. o\'ered b\ hair. \1 reo\er. the hard nature- of thi surface pre -em many pitfall - in diagno is. Injur) to the head does not nece-sarily indicate a fractured - kull. There ma\' be a great deal of blood flowin2:. ,:et the dama2:e may be no - rhan the thickne - - of the pericranium. But it may still be a -eriou matter. for a large quantity of blood can be lo-t from the pericranium. e-pecially in the regi n of the temple. where the blood vessels are most thicklv di tributed ot only will s1- ck and its associate conditions have to be treated. but mea ures ta ken to counteract the eriou effect of dehydration. For practical purpo -es \, e can divide fracture of the skull itself into two main group. depres ed and fi sured. A depre sed fr " :ture is one in which a portion of the bone has been pushed belO\\" the surface of the sk.-ull. in which case there is gra\'e danger of injury to the brain. either by pressure, laceration of the brain ub tance or d3mage to one of the cranial arterie or nerves. Should ' a blood vessel be evered it rna\' in turn. due to the re uiring haemorrhage. cau e pre ure on a part of the brain and lead to unconsciou ness by concussion or compression. It is not always eas> to distingui h a depre sed fracture from a contu ion or superficial haematoma resulting from haemorrhage from the pericranium. Before. hmvever. attempting the following method of examination, make quite certain that your hands are perfectly clean, for it mu t be remembered that one of the greate t danger you haye to face is that of infection, which may result in either absces or meningiti. Having crubbed up thoroughly. place the tip of the forefinger in the centre of the welling and apply firm but gentle pressure. Now the centre of a contusion is oft, with a comparatively hard periphery, and it is thi

Fi sured fral2ture- are some\\'hat more difficult ro diagno e Sometimes a line of -ubcutaneou haemorrha!!e or a ma '- of blood under the will afford a clue. although the pO -' ibility of e\.tril\'a 'ation of blood from injury to the soft pan mu "t not be overlooked.

TOt only an the yault of the skull be fractured but the base al - o iliable to the arne type of injur). but this cannot be di"tin!!ui -hed b\ physical examination. Yo; will t rely entirely upon indirect' igns and ymptons, and we ha\ e already dealt \\lth the-e in di-cus -ing the eximination of the face. It must not be forgotten. howe\ 'er, that the finding of; fra ture of the \ -ault doenot the pos-ibility of a fractured base a well. a nd \ ersa. Briefly the signs and -ymptoms of fractured ba e fall into three group' :-

(a) Signs of severe injur) to the brain.

lb) Blood or C.S.F (cerebro'pmal ft.uid) from ear. nose or (after having been s\\ allowed) mouth.

(c) Symptom cau 'ed by injury to any of the cranial nerves. This is to be uspected if signs of paralysis appear in any part of the body. the pan affected corresponding to the parti -ular cranial nerve whIch !!overn t ha t particular pa rt. ote e pecially the limbs.

It is interesting to note. in passing. that a new theory to explain the cause of unconsciouSllcs in the case of head injurie i' no\\' being e:\amined and te ted by our ' cientist. Although we kno\\' that in some cases unconsciou "nes i due to increased pre ure when the brain is

DIAGNOSIS

(continued from page 3)

damaged, it is believed that a sudden change in the velocity of the head is responsible for a much greater number. As examples of this sudden change I would quote the case of a patient falling from a height and the movement (fall) being suddenly arrested when the head strikes the hard ground, or, on the other hand , the stationary head of a person being suddenly put into rapid motion by the impact of a car with which it may be in collision. However, we are at present awaiting the results of further experiments which are being carried out by two of our leading neurological surgeons, D r s. Denny-Brown and Ritchie Russell.

On our way from the head to the trunk we must pause to look at the neck. If this appears to be rigid it might tend to confirm subarachnoid bleeding due to laceration of the brain. Swollen veins in the neck often point to asphyxia, and swollen glands should always be noted, as there are many possible causes of these, e.g., Hodgkins' disease, an anaemic condition often prevalent in earl y life. If the swollen glands are in group s or chains near the sterno-mastoid they may indicate tuberculosis.

There are so many things to note in examining the trunk , but I will deal with the two most important, muscles and bones.

I do not think I could do better in dealing with the morbid conditions of muscles than adopt the practice which I have already adopted in some cases above, and that is to tabulate the various possible conditions.

Muscles

Flaccid : (concussion, faintness, collapse following haemorrhage, shock, etc.).

Spastic : (compression, apoplexy, epilepsy, infantile convulsions, etc.).

Limp, unilateral: (apoplexy, compression).

T witching: (infantile convulsions).

Lo ss of ton e : (shock).

There appear to be few first-aiders who know exactly how to seek for fractures in the long bones. Passing the palm of the hand or the palmar

aspect of the fingers along the bone, as is often done, will furnish no information whatever. Palpating a fracture is a knack which has to be acquired, but the following experiment will, I hope, help you to do so. Place two pencils together in alignment on the table, making certain that the end of one is quite in contact with the other. Now, with the tips of your fingers and thumbs, take hold of each pencil in the centre and raise it 1 in. from the table, but keeping the two pencils together and still in alignment. If you were to do this with your eyes closed, despite the fact that you had kept the two pencils in alignment, you would feel that you were holding two pencils and not one. When you have done this ask a friend to blindfold you. Having done so, ask him to place near the two pencils ONE pencil equal in length to the total length of the other two. Let him then guide you to the one pencil and the two pencils alternately, and each time you win pick up the respective pencil or pencils in turn. Although you cannot see, and you still keep the two pencils together and in alignment, you will , sense' the fact that in one case you are holding a single entity and in the other case two separate entities. This, then, is how you palpate for fracture of the long bones, except that you do not actually lift the bone. You have been taught that the firstaider must never seek crepitus or unnatural mobility, and do not forget -the Golden Rule If in doubt, treat as a fracture.'

Although fractures cannot be discovered through a thickness of clothing, remove as little clothing as possible, and do not expose more than is absolutely necessary.

In examining the groin do not overlook the possibility of inguinal hernia, which is usually marked by a swelling in this regiQn, and, if vomiting should occur be sure to try to obtain a specimen for the inspection of the surgeon.

I will conclude with a word to all officers of divisions. For goodness' sake get a patient down on the floor more often. Give no clues to commence with but let the operators find everything out for themselves by asking you questions, but let me utter this word of warning. No test should be set without careful preparation. When you have de-

cided upon the nature of the test you propose to set, study it well beforehand, for you will be amazed at the unexpected-and unorthodox-questions you will probably be asked. Make certain that you know your subject thoroughly or you may be made to feel embarrassed, and the full value of the test will be lost.

I sIncerely trust that this article will be the means of drawing attention to the need for concentrating more closely upon this badly neglected subject, and if it leads to a raising of the standard of work in first aid organizations I shall feel that the time spent in writing it has been well worth while.

B.C.G. Vaccination for School Children

In view of the Minister of Health s recen t announcement that he is prepared to approve schemes drawn up by local health authorities for the giving of B.C.G. vaccine to children before they leave school, considerable interest is likely to be shown in the purpose of the procedure and in the meaning of the local reactions. It is well known that ·most people become infected by the tubercle bacillus at some time durin g their life, but they overcome the infection without developing the disease. As a result of the infection the body reacts differently to a skin test than in a person who has never been infected ; so that if one has no clinical signs of tuberculosis, and an X-ra y of his chest confirms this, the obvious inference from a positive reaction is that he has successfully fought infection by the tubercle bacillus and has thus acquired a certain degree of immunity. A negative reaction suggests that the person has not yet encountered tubercle infection and, therefore, has not demonstrated his ability to fight it successfully

The Bacille Calmette Guerin vaccine s prepared from living bovine tubercle bacilli which have been grown on a special medium for several years and have, in consequence, lost their power to cause the disease; but when injected into an uninfected person have the power to develop in that person a degree of immunity to tuberculosis. In recent years B.C.G. vaccination has been recognised as a means of protection from the hazards of a first contact with tuberculosis, and it has been widely used in many countries. Britain showed reluctance to use it on a large scale until about two years ago, when it was offered to students in our hospitals who showed a negative reaction to a tuberculin skin testknown as the Mantoux test. It is still under controlled trial in this country, but many authoritative workers are convinced that it is of definite value. There are still difficulties in obtaining adequate supplies of the vaccine. It must be used within fourteen days of its manufacture and there is, as yet, no centre for its manufacture in Britain ; all our supplies being imported from the State Serum Institute in Copenhagen directly to the Ministry of Health, which is the only distributing source in this country.

GRAND TROPHY

The month of N ovem be r was, as us ual , a bu sy one in th e competitio n world, but undoubt edly the highlight of th e m onth was h e s t rugg le for the Grand Prior 's Trophi es , organi ze d by Th e St. John Ambulance A ssoc iation. Th e co mp etitions were held in th t- Por chest er Hall, L ondon, on 19th N ove mb er, when 11 m en's eam s and 6 wom en's team s fou g ht for th ese coveted awards

The competitions commenced shortly after 9.30 a.m. and continued, except for a short break for lunch, until 4 o clock in the afternoon, the following doctors , all thoroughly exper ienced in this class of work , kindly und er taking the task of judging:

F. L. Richa r d , M.B., Ch B. , of Walsall (men's team tests), F. H. Taylor, O .B.E., M.D., B.S., D P.H., of London (men' s individual tests), F. M. Hanna, M.B ., F.R.C.S., of Weymouth (women s team tests), and J . Trefor Watkins, B.Sc. , M.B., B.Ch , of Nottingham (women's individual tests). A marked feature of the competitions was the simple, straightforward nature of the tests, with an entire absence of 'traps.' This is , certainly all to the good , for they then represented the typical accidents of everyday life with which firstaiders are repeatedly being called upon to deal. The standard of efficiency displayed by the teams, both collecti.vely and individually was, undoubtedly hIgh.

The six tests were as follows :-

Men's Team Test

The team is on its way, by van on a lonely moorland road to a competition at a town 20 miles away The team leader is the driver and having time to spare, the team decide to stop and stretch their Jegs

They are now returning to the van, in which first aid equipment , including a stretcher , blankets and a water bottle, is being carried, when a boy comes up to them

Two boys were cycling along the road when one of them hits a large stone with his front wheel and crashes into a ditch alongside of the road with his cycle on top of him. The other cyclist, who is deaf and dumb , indicates to the team by signs that the r e has been an accident. The boy is rather agitated but is in no way hysterical or irrational , and will co-operate in any way in which he can be instructed.

On examination the patient is found to be suffering from a depressed fracture of the dome of skull wi th wound , a compound fracture of middle of right radius and ulna with large wound , bone protruding and arterial haemorrhage, and a fracture of the fifth and sixth r ibs on the left side with abrasions.

The weather is dry, cold and windy.

The nearest telephone is 200 yards away, nearest house 1 mlle nearest village 5 miles, nearest doctor and ambulance IO miles, and the nearest hospi tal 20 miles away.

First aid to be r endered in 15 minutes.

Men's Individual Test, Nos. 1 and 4

Nos. 1 and 4 ha ve been attending a competition an d on their way home have had to change trains at a small country station. They h ave some time to wait for the train and so decide to have a walk as it is a fine, wa rm d ay. Taking their haversack with them , there being no 'left luggage office,' they are crossing a meadow when they hear a cry for help. They see two hikers, one of whom appears to have fallen whilst climbing over a barbed-wire fence

On examination the patient is found to be suffering from a Colles s fracture of right arm and a jagged deep laceration of right thigh.

The nearest telephone is at the station, now 1 mile away , but each of the hikers have a groundsheet with them, also a vacuum flask of tea.

First aid to be rendered in 7 minutes.

Men's Individual Test, Nos. 2 and 3

Nos. 2 and 3 are on their way to a first aid competition when a woman rushes up to them in a distressed condition. Apparently lier husband has swallowed an overdose of sleeping tablets and in falling to the floor has knocked over a freshly made pot of tea. There is no telephone in the house; it takes four minutes to go and telephone

H.R.H. The Du k e o f Glou ces ter p r ese nting the a wards

The winning Metropolitan P o lice (L D ivision) team with the trophy.

The struggle for the Grand trophies

Competitors have a first aid haversack with them, and blankets, etc., can be supplied by the woman.

Examination reveals patient is not breathing and scalds on the left hand and forearm. Patient begins to breathe after two minutes artificial respiration and regains consciousness after five minutes. Medical aid does not arrive before completion of test.

First aid to be rendered in 7 minutes.

Team Test

Members of the team are calling on Dolly Gray who is a member of their class, but has been unable to attend for a week or so as she has been looking after her mother who is convalescing after an attack of hronchitis.

As they approach the house Dolly calls to them from an upstairs window saying • Hello, girls, please go into the front room.

I'll be right down to see you.' The team enters the house and goes into the room.

As Dolly is descending, carrying a tray, she faIls down the stairs and lies at the foot of the stairs on the floor. There is broken erockery about and also a broken banister rail.

Investigating the noise the find Dolly on the floor and after examination find she is suffering from a deep incised wound of the right arm about 2 in. above the elbow, a compound fracture of centre of shaft of right tibia, bone protruding, slight haemorrhage, and shock.

First aid equipment is available, also blankets, hot and cold water, tea, etc., and a telephone. Doctor will not arrive before completion of test but the ambulance will come at 8 minutes after being called.

First aid to be rendered in 15 minutes.

Women's Individual Test, T\os. 1 and 4 Nos. 1 and 4 are returning home one summer's evening and are asked if they can give assistance to a man who has met with an accident.

On enquiry they are told .the man was standing on a plank which had been placed between two ladders, when the plank collapsed and he was thrown to the ground. Examination reveals he is suffering from fractures of both clavicles, a dislocation of the left knee-joint, and shock. A limited amount of first aid equipment can be provided by the woman, also hot and cold water, tea, hot water bottles, blankets, etc. A telephone is available, but medical aid does not arrive before completion of test.

First aid to be rendered in 7 minutes.

Women's Individual Test, Nos. 2 and 3 Nos. 2 and 3 are sitting in their home when a crash is heard outside the front door.

On investigating the noise they find a cyclist has mounted the pavement and crashed into the front of the house.

Examination will reveal the patient is suffering from concussion, a contusion over right orbit, simple fracture of left ulna and wound in palm of left hand.

The competitors have first aid equipment and there is also available blankets, hot water bottles, bot and cold water, tea, etc., and a telephone. Medical aid does not arrive before completion of test.

First aid to be rendered in 7 minutes.

At about 4.30 p.m., after witnessing the last men's team test, the Grand Prior of the Order of St. John of Jerusalem, H.R.H. The Duke of Gloucester, came to the platfom1 for the Presentat ion Ceremony. The gathering was presided over by Mr. Horace Parshall , Director-Gen eral of the St. John Ambulance Association, who was supported by Lord Wakehurst, The Lord Prior of the Order; Sir Henry Pownall, Chancellor of the Order ; Mr. C. T. Evans, SecretaryGeneral of the Order; Sir Ernest Burdon, Rece iver -Gener al of the Order : Lord Webb-Johnson, Hospitaller of the Order; Sir Otto Lund, Commissioner-in-Chief of The St. John Ambulance Brigade; Mrs. Stewart -R oberts, The Lady Principal of the St. John Ambulance Association; Lt.-Col. E. C. Croft, Deputy Director-General of The S1. John Ambulance Association; Major A. C. White-Knox, Principal Medical Officer of the St. John Ambulance Association; the Mayor and Mayoress of Paddington (Col. and Mrs. W. Parkes), and the four judges.

Mr. Parsh all opened the proceedings by saying that it was his honour and privilege to welcome H.R.H. the Duke of Gloucester. the Grand Prior of the Order, who had graciously consented tv present his own Trophies, which were regarded as the blue riband of skill and art in first aid in this country. His Ro yal Highness had always taken a great interest in the maintenance of a high standard of efficiency by members of the organization. This was the fourth annual competition for the Grand Prior's Trophy for Men and the third for the Grand Prior's Trophy for Women, and as no previous winners were competing this year a new name would be added to the list of winning teams in section. Each team competing that Jay had won the Final Competition of their own organization, run under the auspices of the St. John Ambulance Association, and thus every team was in the championship class. It was estimated. that over 8.500 competitors, representmg some 1,700 teams, took part in the preliminary rounj:j. The previous winners were :-

Men:

1950.

1951.

1952.

Women:

Brighton Police Division, The St. John Ambulance Brigade. Horsham Division, British Railways and London Transport (Railways). Great Yarmouth Division, National Fire Brigades.

1951. Bro adway L.T.E., British R ailways and London Transport (Railways).

1952. Palmers Green Nursing Division, The St. John Ambulance Brigade.

After thanking the Associated British Picture Corporation Ltd. for their cOlJtinued generosity. in supplying and erecting the settmgs for the competitions, the MedIcal ProfesslOn for their untiring efforts and aSSIstance in acting as judges, the Stewards, D?any: of had given up much of therr leIsure tIme, the patients who had co-operated so enthusiastically and had undergone an intensive training by the St. John Ambulance Association, and the teams for their enthusiasm in the first aid

movement, the Director-General asked the two team judges to say a few words on the Competition.

Judges' Comment

Dr. Richard, who had judged the men's teams, then said that the objects of the B.B.C. constitution were said to fall under three heads, viz., (a) to inform, (b) to interest, and (c) to entertain, and he thought that the objects of such competitions as had been witnessed that day could well be said to be the same. It had given him much pleasure and satisfaction to note the high standard of efficiency which had been attained, but there had been faults. He emphasized the importance of observing the three Golden Rules, which were to enquire: (a) Is the patient breathing? (b) Is the patient bleeding? (c) Is the patient conscious? One or two teams, he said, fell down on control of haemorrhage. The patient must not be moved until this had been successfully dealt with. He would like to have seen a more methodical examination of patients made, and concluded with an expression of appreciation of the wonderful spirit of sportsmanship which had been exhibited throughout the competitions.

• What happened to Dolly Gray? " asked Dr. Hanna, in opening his remarks on the women's team tests. Well, he was • pleased to say that, although she had fallen downstairs half-a-dozen times that day, she was still alive, thanks to the excellent treatment she had received at the hands of the teams who had attended to her injuries. He, like Dr. Richard, felt that some improvement might be made in the treatment of haemorrhage. Immediate direct pressure was most vital, and he felt that had shown a tendency to wander awa) from the teachings of the little black book.' He emphasized the importance of scrupulous cleanliness in dealing with open wounds. , Wash the hands and don't forget the nailbrush,' he said, Building up' around a compound fracture or foreign body must be done properly or it was useless, Do not waste first aid material. Often towels pieces of material, etc" could be used instead of orthodox bandages which might be in short supply. Finally, he did not like to see the transverses of stretchers being straightened by shapely ankles. Always use the heel for this purpose, Then came the moment for which everyone had been waiting. Mr. Parshall called upon Lt.-Col. Croft to announce the results, which were as follows :-

Men: (Total marks possible 400)

1. ational Police; Metropolitan L Division 305

2, The St. John Ambulance Brigade; Wolverton Ambulance Division ,.. 28'3

3. Exmouth Junction No. I (British Railways and London Transport) 267

4. Plymouth (National Road Passenger Transport Ambulance Association) 249 J

5. Worthing (British Electricity Ambulance Centre)

6. Cardiff (National Fire Brigades) 244-

7. S.B.D. Acton (Genera Post Office) 217

FIRST AID & NURSI G , 10V.IDEe. 1953

8. Dover (B ritish Transport Commission Police) 210

9. Victoria Colliery (Miners' ational First Aid Competition)... 2074

10. R .O.F., Glascoid (Ministry of Supply)

11. Eastern Gas Board (Tottenham Division) 191}

Women: (Tolalmarks possible 400)

1. Brighton (British Railways and London Transport) 331

2. Spalding Division (The St. John Ambulance Brigade) 307

3. I.O.S.S.D., Elstow (Ministry of Supply) 298

4. Mid-Sussex (British Electricity Ambulance Centre) 274

5. Chiswick L.T.E. ( ational Road Passenger Transport Association) 270

6. Birmingham P.O.A.C. (General Post Office) 257

Then, amidst tremendous applause, the Grand Prior of the Order, H.R.H. the Duke of Gloucester, rose to speak. He was very glad, he said. to be there that afternoon. He noted, with pleasure, how the movement was growing and developing, and a token of this was to be seen in the ever-increasing number of teams competing, which, in 1952 was larger than ever before. But we could not afford to remain satisfied. The everincreasing popularity of the competitions was evidenced by the number which had entered this year-II men's and 6 women's teams, and this must surely be an inspiration to all those engaged in the work. He asked his audience to join with him in congratulating the winners upon their successes, although the efforts of all the teams had been worthy of high praise. He was most happy to accept the invitation of the DirectorGeneral to present the Trophies, but before doing so he received the winners of last year's competitions.

The Director-General then thanked His Royal Highness for so graciously consenting to present the Trophies, and so another milestone on the road of the Association was passed.

Association of Civil Defence Officers in Government Departments

Mr. C. Walsingham of H.M. Treasury was in the Chair when an enthusiastic gathering of the Association met at Treasury Chambers on Tuesday, 1st December, to witness a demonstration of • casualties' by Mrs . Brenda Whiteley, Miss ancy Budgett and Mr. Cyril Wallis from Casualties Union Headquarters. The demonstration took the form of illustrations to a talk on the use of , casualties' in Civil Defence Training, by Mr. Eric Claxton. The speaker explained that the role of the Union was to assist the Voluntary Societies and Civil Defence to teach First Aid and Rescue Work by providing trained 'patients' for practice exercises as required. Cases of internal haemorrhage , severe bums, nose bleed, fractured leg and shock were included and the behaviour of each case was studied.

Considerable interest was shown in the closed fracture of the tibia which under careless handling became an open injury.

Fro,,, a sellt ;n the ""d;Pllfte SO:lfE ON

rvren's Teams

The deaf and dumb boy certainly created a problem, and many were the amusing incidents when members of the team attempted to speak to him to give him instructions.

One team appeared to carry bandages in their pockets.

How many appreciated the full significance of the fact that the weather was cold and windy?' This would indicate the necessity of covering the blankets with a mackintosh or something similar. Blankets are not, in themselves, sufficient protection against a ' cold wind' which will penetrate them. The large number who remembered the blanket under' was gratifying.

The ditch certainly presented some difficulties, and it was interesting to note the various methods adopted to lift the patient out. I wonder if the 'fractured spine lift' of a few years ago would have sunnounted difficulty better?

Although it will be conceded that often some explanation of procedure may be required of a captain, there was, in many cases, far too much talking to the judge. Perhaps this may have been responsible for the fact that there appeared to be a tendency to forget that a human being was being treated and not piece of machinery being repaired. However, for some years past there has certainly been a marked improvement in this respect, and it is to be hoped that this improvement will be maintained.

'Speak sympathetically to your patient.'

On the other hand, in m,)[e than one case the handling was rather rough. Because the patient appears to be unconscious, that is no reason for exercising less care in handling.

In general the treatment (prompt) of arterial haemorrhage was to be commended. Perhaps a word of comment upon training methods may not be out of place here. It appeared obvious that some teams had been in too great a hurry to get on to practising tests before mastering the basic first aid, both practical and theoretical. I do feel that more attention should be paid to practising slings and certain bandage (fractured ribS, for instance) in the recumbent and other awkward positions.

One team was very careful to stop oncoming traffic by resting one end of a long branch on the lorry and the other end on the boulder which had been responsible for the accident and covering it with blankets. So far, so good, but what about traffic advancing from the other direction ?

More than one team lifted the casualty out of the ditch before the fractured ribs had been discovered, and one team did so before attempting to exanune the patient at all. One team, I believe, missed the fractured ribs altogether.

I have never before seen three helmets placed one inside the other (it was a police team) used to raise the feet of the patient.

Why did one learn carefully cmer the patient at first and afterwards remove the blankets, e xpo ing him to the cold \\'ind ?

A good example of taking too much for granted was provided bv tbe team which assumed that the deaf and dumb bo\ was the casuaJt) and proceeded to coyer him \\ itb blankets. only to realize aftem ard that he was unhurt.

Quite a lot of tIme \\ as \\ asted to some cases in blanketing stretchers A. lirtle study will reveal that this can be reduced to a drill and performed in two mmements thus avoiding the' Addling' so often een in competitions.

Some teams, in their aTI\.iet, to get the patie!lt away, left the bicycles -standing b} the SIde of the road. whereas, as was sho\\ n most teams. there was plent) of room 10 the lorry.

May suggest to some captains that this was not a military e'\ercise. and that the sergeant-major staccato tone. \ery effecti\ e on the parade ground. might with ad\ antage be modified when dealing with a di tre sed patient ?

Smelling salts should ne\'er be applied in the cases of head injuries or artenal haemorrhage. [n the former case theIr stimulating effect may tend to increase pressure \\ ithin the sk.ulL and in the latter case they stimulate the action of the heart. thus retarding coagulation, or they ma.\' cause the re-commencement of bleeding. -

Women's Teams

Perhaps it was no more than might have been expected, due to the make-up- of their nature. but the bedside manner' of the women was in strong contrast to that of the men. However, I would like to see ome variants from the stereot)ped' [m\, don't you worry' and' [m\, you'll be alright: somethmg more com incing to a distressed mortal.

lt ",as unfortunate that the Women's Individual Tests had to be staged at the opposite end of the hall in which the Women's Team Tests were being held, for on more than one occasion I noted a moment of di traction upon hearing applause from the other end. This arrangement. however, was, unfortunately. dictated by questions of limited pace. Respond quickly to calls for a sistance,' says the text-book, but haste must not be confused with flurry. In one of the indi\ idual te ts I sa\\ one nur e trip mer the leg of her patient in her fluster.

In the Women's Team Test I saw more than one torn or laddered tocking. If these competitors would only bear in mind that it is more th.an likely that they would be called upon to kneel upon a bare floor, or, worse still, rough gravel. 1 feel sure that they would select stocking of a more suitable texture. But there, women will be women !-F.C.R.

The medical and first aid services 0/ one 0/ the largest motor manufacturing organizations in this country are described in this article, first 0/ a new series dealing with the organization and practice 0/ first aid in industry. The assistance 0/ Vauxhall Motors Ltd. in compiling the article is grate/lilly acknowledged.

INDUSTRIAL FIRST AID-I

Lool.;ing after elnployees at a large motor works

VAUXHALL'S medical and first aid services are mainly undertaken by the Medical Division of the Personnel and Welfare Department , which is under the managership of Mr. R. R. Hopkins, but a lot of 'field-work' is done by members of the st. John Ambulance Brigade.

The Medical Division, which is in the charge of two whole-time medical officers, Dr. A. R. Thompson and Dr. P. M. Bennett, has a staff of twelve female nurses, two male first aid attendants (on nightshift), three clerks and an ambulance driver. This Medical Division therefore looks after the first aid requirements of the 13,000 Vauxhall employees, 12,600 of them at the 257-acre factory in Luton and the rest at a 33-acre branch in Dunstable.

The Division is founded on the precept that prevention is better than cure, and most of its policy is directed against unhygienic conditions, fatigue and all forms of physical defect which might lead to accident proneness.

For its work in connection with accident

the Division co-operates closely With .Safety Engineer, Mr. H. E. Phillips, 18. ill charge of the Safety Division, which is also part of the Personnel and Welfare Department.

The Medical Officers perform many examinations for different purposes. These examinations include pre-employment and after-sickness, those required by the State example, chrome workers) and those rnstituted. by the Company (certain types of crane. davers). The Division keeps confidential records of a medical nature and it maintains a close liaison with the National Health Service. Injuries or illness occurring during work are given free treatment the empl.oyees being encouraged to use' the Service for the.smallest.cut or abrasion.

These first aid cases are undertaken in the six surgeries (five at Luton) all of which are fully equipped to deal with emergencies. even during holidays. There is one staffed continuously at Luton, while are day and night, the remamIng two bemg for day-shift only. A twenty-four hour ambulance service is available. Rest rooms for both sexes are provided at each surgery.

The Medical Division also notifies the employee's family in the event of serious illness or accident while at work.

There are several services available for employees who meet with accident or illness requiring follow-up treatment. The largest of these is the Rehabilitation and Retraining Shop where work of a remedial nature is devised and selected for individuals to assist their recovery. This is in the charge of a superintendent, Mr. H. H. Newell, who carries out his duties under the specific advice of the Company Medical and a visiting orthopaedic surgeon. This workshop maintains continuity of employment as far as pos sible or in the of incapacity, return to of a suitable nature in the shOflLst possible time.

A Physiotherapy Division is fuUy eqUipped to deal with cases recommended for treatment by the Medical Officers. Here, under a trained Miss J. Glendon, all forms of electric stimulation ultra-short wave diathermy wax baths' ultra-violet light and infra-red ray treatment are available.

In addition there are visiting ophthalmic and. orthopaedic surgeons to deal with specIal cases.

First Aid at Shop Floor Level

There are upwards of 120 qualified first-aiders in the factory, seventy of whom belong to the Vauxhall Corps of the St. John Ambulance -Brigade, which consists of three ambulance divisions and one nursing division.

.1.0 each shop or office a board is displayed glVlng the names of the nearest first aid men and women and the position of the nearest stretcher and first aid equipment.

First Aid Stations

The Medical Officers are responsible for placing and maintaining First Aid Stations in key positions throughout the factory. They contain stretchers, blankets and first aid dressings. This equipment is provided for the use of the nearest first aid man in an emergency. The first aid man is briefed to see that this eq uipment is kept in good order, although periodic inspections are arranged by the Medical Officers. Wooden cabinets are supplied to keep the blankets and dressings from becoming soiled.

FIRST AID & NURSING, NOV./DEC. 1953

Each First Aid Box contains the following :1 dozen large wrapped dressings, 16 small wrapped dressings, 6 trianguJar bandages, 2 pieces of cane, 6 safety pins.

Regular S.J.A.B. Drill nights are held for lectures and demonstrations, whilst the Corps is active and very often successful in local, county and national competitions.

The Company's Senior Medical Officer acts as Divisio nal Surgeon to each of the five units. He co-operates closely with the Corps Superintendent, Mr. R. McEvoy, in ensuring that everyone meeting with a serious accident in the factory or its precincts receives proper preliminary treatment and rapid transport to one of the surgeries. First-aiders deal only with major accidents within the shops until such time as the patient is handed over to one of the surgeries.

A case based on an actual experience gives an example of how the first aid service works.

A maintenance man working On a baling press in an isolated corner of the factory had his leg trapped and crusbed One of the operators rushed for the foreman and he telephoned the surgery. While one operator worked to release the man another ran to the nearest first-aider, who was quickly on the spot and effectively controlling the serious arterial bleeding in a matter of seconds. There were soon three first aid men working to get stretchers and equipment in position. One of tbe Company's doctors was soon in attendance. The baling press was, by the nature of its construction, in an inaccessible position and the ambulance couJd only come within 35 yards of the scene. Nevertheless, the patient was removed to the surgery in a matter of minutes and after further medical treatment was transported to the Luton and Dunstable Hospital. The patient subsequently lost a leg, but prompt first aid undoubtedly saved his life.

Preventing Hazardous Situations

While the Medical Officer is called upon to act in instances where processes might be dangerous to health and to see that proper

precautions are taken, the Safety Division ]s responsIble for carrying out the Company·s accident prevention programme. While there are no accident hazards to the motor industry tbe Engmeer works on the assumption that all situations where human beings work have a potential dangerous element! His work is, therefore, limitk:ss, but in particular his division devises guards for all moving parts

NElV

'Practical Preparations in Common Use,' Completed, revised and edited by P. J. Cunningham, B.A., S.R.N., H.V.Cert., Faber & Faber, 4/6.

This book, originally written by Miss N. W. Powell, is stated to have been entirely rearranged and rewritten in order to conform with modem requirements.' It still, however, perpetuates several examples of Ullsound teaching that have crept into nursin g education in the past. Surely no nursing school teaches the use of a Higginson syringe in the giving of an enema, or the giving of saline with glucose as a nutrient enema. The amount of opium usually ordered for a starch and opium enema is not stated; and why is the nurse directed to wash her own hands in the bath prepared for the baby before commencing to wash the baby? Enveloping the patient's head in a Turkish towel during the giving of an inhalation with a Nelson inhaler surely serves nO purpose except to cause an uncomfortable steaming of the patient's face and eyes by tht expired air; and it prevents the nurse from observing whether or not the patient is breathing in through his mouth and out through his nose- a necessary instruction which, incidentally, is omitted. The absurdity of arranging gauze or jaconet to catch drops as they condense from the spout of a steam kettle must be obvious ; and not all authorities would agree that a blanket should form part of the canopy of a steam tent. However, the size and general lay-out of the book is convenient, and much of the · infomlation it contains is useful;

of all kinds of machinery, from bench latbes to 480-ton presses, he advises and provides special protective clothing where necessary and conducts educational safety cla,sses for supervisors and public ity campaIgns for the' general public.' In fact his Division is organized for the prevention of accidents according to most modem practices, and using up-to-date techniqu('s.

BOOKS

but it needs a more critical revision before it can be unreservedly recommended.

'Public Health for the Student.' P. H. Cunningham, B.N., S.R.N., H.V.Cert., and H. IV£. Cousens, S.R.N., S.C.M., R.S.C. N., H.V.Cert., Diploma in Social Science, Faber & Faber, 6 /-. This book, in which Miss Cunningbam collaborated, is much sounder than , Practical Preparations' ; perhaps because both authors really do know, and are intensely interested in, their subject; an d from their wide background of knowledge and experience they have selected just that outline of the social services that the student nurse needs in order to appreciate the personal and economic problems of the patients she meets in hospital. Most nursetraining schools arrange visits by student nurses to various sections of the public health field during the preliminary school period, or subsequently. The hospital almoner usually gives one or two talks on social services. Most of the knowledge thus imparted could, however, easily be forgotten in the stress of hospital life and training. This little book supplies just wha t is wanted to keep the social aspects of disease and the part that public health services play in prevention and home care before the mind of the student nurse , and to maintain her interest in this wide field. The specimen interviews at tbe end of the book are interesting and most enlightening, and makes it a welcome addition to student nurse literature. - A.E P., S.R. ., Diploma in Nursing (University of London).

The Vauxhall Motors Lomas-built Works Ambulance on a Bedford chassis

Vauxhal.l First-aiders in action during a local competition Left to fight: H. Harrison, H. Waterhouse, H. Somers and R. P. Barker.

viscitor is interested in of the visiting orthopaedic surgeon in the 1 a Ion entre. The RehabIlItatIon Superintendent Mr H H Newell on extreme left, and Ph.ysiotherapist Joyce Glendon are in

Surgeries are well equipped to deal with every kind of works' accident. Here is Nurse McGrah bandaging an injured finger.

The most modern in the larges and newest factory workshop m Vauxhall Motors Limited.

CASUALTIES UNION

Yorkshire Electricity Board

Nurse Browne of St. John Ambulance Brigade, Cottingham has been the Board's area giving lectures to first-alders of the Electrical Industry. Each of the lectures has been illustrated by casualties' from the Cottingham Branch of Casualties Union and there is no doubt that the type of live demonstration which Miss Browne demands is very popular with the men Nursing Superintendent Celia Bailey, S.R.N. of the Yorkshire Electricity Board in expressing th a nks paid tribute to the casualties' a nd referred to the 'very excellent wa y Nurse B rowne is teaching (their) men

An 'Accident' at Penzance

An incident was s ta ged at the Treriefe Cross Roads in Pen zaoce as part of a training evening for young Scoutm a sters and Rover Scouts o f the 1st Newlyn Crew

A cyclist had come into collision with a pedestri a n while riding in the dark

I ights The result produced conCUSSIon with gra zed face a nd bruised ribs for the cyclist a nd an op en fracture of the tibia for the unf ortun a te elderly pedestrian. Casualties Union Study Circle No 173 from Pen zance s a ged the accident with s ufficient re alism th a t it was at first thought to be a rea a ccident. The c r ew expressed the view that it was th e best wa y of learning to be prepared

N.H.S.R. Exercise' Mobility , Eastbourne Hospital Mana gement Committee st a ged a demonstra tion at Civil Defence Headqu a rters Eastbourne, on Sund ay 1s t No vember, on behalf of the N a tional Hospit a l Ser vice Reserve The arrangements were in the hands of Col. Byrne a nd the ' casualties' were provided by the Ea s tbourne members of he Casualties Union Study Circl e 89

Well o ver 100 p e rsons a ttended to see a mobile First Aid Pos t a t work after a bomb incident. Eight casu alties were dealt with by the Po s t as the y were brought in by the wardens a nd stretcher beare rs. Afterwards their dressings were r emoved and the injuries were touched up so th a t the spect a tors might see a t close quarters the cases that h a d been dealt with. Special interest was shown in casualty (Mrs. Best) who was s uffering from a crushed knee There is no doubt th a t the demonstration pro ved useful from both the instructional a nd recruiting angles. Dr. Brown of St. Mary 's Hospital , Eastbourne, stated afterwards: The presence of such realistic looking casu a lties made all the difference a nd was a material factor in t he Success of [he demonstra tion .'

From the' casu alties' point of view this demonstration was most helpfully planned. Dr. Brown provided each casualty with a wri tten briefing a week before rehearsal, including their' histories and he went over very carefully the acting at the rehearsal and aga in before the actual demonstration This advance preparation is of great assistance to the' patient to think himself into the part he has to portray.

Safety, Health and

There is established at 97 Horseferry Road, near Lambeth Bridge, an interesting museum that does not appear to be as widely known or used as it deserves; for it is of interest to all concerned with safety health or welfare. It is under the direction of the Factory Department of the Ministry of Labour and National Service and although its appeal is primarily to those affected in one way or another by the Factory Act , it is also o f much general interest to first -aiders and nurses. It was originally set up by the Home Office. Since its use, during the Festival of Britain, to illustrate various aspects of the work of the Ministry of Labour it h as been entirely rearranged and extended. The exhibits are now in sections, amongst which are those dealing with guarding the dangerous parts

W elfa re M use um

of machinery, hazards in the chemical industries, venti ation , lighting, electrical equipment, protective clothing, canteens, seating, and industrial diseases. Wax models which show industrial rashes and skin lesions are most life-like, and the section on first aid is of particular interest. It is the aim of the Factory Department to show the latest practices in addition to those welltried methods that have proved efficacious in preventing accidents, controlling i n dustrial disease and improving working conditions. The Museum authorities specially welcome parties, which are shown round by one of H.M Inspectors of Factories, but it is advisable to book a date and time. Admission is free , but persons under eighteen years are not admitted except in parties.

The First Ten Years (continued from page 1 )

part in recrUItmg drives for the National Hospital Service Reserve, and members acted in all the Eliminating a nd Final Rounds of the Ministry of Health lnterRegion Mobile Unit Competition with its spectacular Final on the Horse Guards Parade in mid-September. For the fighting services (medical branches) Casualties Union has helped to train people in the technique so that they could provide routine practices at the training establishments. The Union works closely with the Police Force by · staging training exercises and competitions in Exeter , Glasgow, Co. Durham , Northumberland , Newtongrange, Stirling a nd Southampton. Senior officers in the Fire Brigades are beginning to see the possibilities in the live training methods. Industrial concerns, and particularly the Nationa l Coal Board are gaining ground quickly in reducing the number of fatal accidents by ensuring that their first aid training and competitions are conducted with complete realism. All the trophies at the Casualties Union Annual Open Competitions this year were won by an industrial Team representing the I.e.I., Northwich, Cheshire, who were helped in their training by the Casualties Union Branch at Warrington . The first aid societies are making increasing demands on the services of the Union , and recognizing service as a casualty' towards efficient membership of their ranks.

As far away as Capeto vVn a branch of Casualties Union has assisted the St. John Ambulance Brigade with recruiting drives, and at home the Study Circles have been active in Regional and County Competitions in South Wales, the Home Counties, the provinces and in Dublin, not to mention countless routine practices leading up to the larger events of field-days and inspections.

Work for the British Red Cross Society brought the first appearance of acting casualties' on television in a series on first aid and nursing in the home under the direction of the Societies' medical officers Courses at the national training Headquarters at Barnett Hill have their live illustrations and all the rounds in the contest for the Stanley Shield are staged with realism for teams who now take it for

granted that they will have to handle responsive people who will react to their treatment.

During the twelve months following their own Annual Open Competitions in October, 1952, Casualties Union has assisted in staging over 150 competitions, and during 1953 their activities have averaged over 100 events each month All this entails thousands of individual performances, very often a single casualty to test the first aid ability of a Boy Scout seeking to win his ambulance badge or a simple illustration to a lecture. The possibilities of using its methods in teaching medical students and nurses have been explored and accepted in more than theory

To achieve its aim that wherever first aid is taught there shall be a group of trained casualties to assist, Casualties Union offers prQbationary periods of instruction in its branches and through the Study Circle scheme to interested individuals or groups wishing to reach proficiency standard. The Honorary General Secretary, 29, Whyteleafe Hill, Whyteleafe , Surrey, will send particulars of training facilities upon application. Its annual proficiency certificates are granted unconditionally to candidates who satisfy the examiners but full membership of the Union opens the gate to its higher awards and to the privileges and responsibilities of its service.

Casualties Union has reached adolescence and seeks to take its place among the humanitarian movements its growth depends to some extent on [he measure of co-operation accorded to it by kindred societies, and on the wholesome spirit of vicarious service which engendered it. Let us hope that a happy blend of the two will bring to maturity a movement which will ensure that the injured of the future may suffer less as a result of their misfortunes

Open Competit o n Wanted

Mr. W. Fan·ington, trainer of the works first aid team of Messrs. Birkett & Bostock, Ltd. (Transport Dept., Springfield Mill, Longshut Lane W., Stockport) would be interested to hear of open first aid competitions held within 50 miles of Stockport which his team could enter.

SOMETHING ·EN TIRE LY NEW

for First Aid treatment of Wounds and Burns

, Furacin' is an entirely new chemical compound * for the treatment and prevention of d b It l S as powerfully antibacterial and as harmless to living infection in woun s, urns, etc tissues as the antibiotics, yet is as stable and easy to handle as the older antiseptics.

, Furacin' is widely used in hospitals, factories, and general medical practice. It is available as an ointment, 'Furacin' Soluble Dressing, in I-oz. and 2-oz. tubes, 4-02. and 16-02. jars; or as a liquid, 'Furacin' Solution, in 2 fl. oz., 4 fl. oz., and 16 fl. 02. bottles.

"'Nitrofurazone

FlIRA CIN "'d''''''' J

the potent ne\v antibacterial specifically for local application

NOTE.-' Furacin Soluble Dressing is now available in a convenient I-oz. tube. LONDON,

S E.5

q"eries

Answered b y Dr. A. D. Belilios

J. T. R. (Coventry) writes :-

-RepresentaTives of local ambulance organizations and industrial ( Safery Officers recently attended a meeting called to investigate the possibility of forming a local 'first aid league.'

The suggestion was received with unqualified approval and I was instructed to write to you in connection with any advice you may be able to offer on the organization of such a , league,' or the names of any other organizations who may be able to assist us in this malleI'.

The fundamental object of the , league' as in ' all competitions is to raise the standard of first aid, and I lrould appreciate any assistance you may be able to offer in this connection.

Answer

An excellent idea, but a big problem to answer and organize. The first step is to get together a small committee of representatives or organizations likely to be interested, e.g., S.J.A.B., B.R.C.S., Police, etc. Include at least one doctor interested in first aid and, if you desire to stage your competitions, a representative of a local dramatic society willing to assist. Decide on the scope of your activities, i.e. , teams only, men and women, individual, etc., and also the area from which competitors may enter. The judges sub -committee-doctors, artistes, etc., will draw up the tests. If the tests are well staged an entrance fee will pay expenses. Many other details have to be considered but the work involved will be well repaid by the results.

A. J. M. (Dagenham) writes :-

When apply ing pressure to femoral pressure point do we face the patient's head, or feet? The bearer's hands in Fig. 73 (SJ.A.A.) do not seem to (continued on page 14)

First-Aiders Crossword No. B

Compiled by W. A. Potter

LOCAL GOVERNMENT NEED

ACROSS

1. Hoped for praise in bandaging practice

5. Dandruff

9. Applied to skin in electrotherapy

10. Anatomical in runner vein

11. Proverbial early riser

2. Has important part in ankle and knee joints

13. Eye condition in first-year nurses

16. Form body-fluid from blood (in part of Mediterranean island ?)

17. Natural Environment

18. Surgical instruments compel post-script

20. Come in followed ninetytyphoid

22 Untidy eating?

23 . Should be given to casualty for his doctor or hospital

24. Laceration, appears to be from the eyes

stomach (5)

28. Payment pending final settlement (2, 7)

29. Mild type of dysentery (5)

30. Epithet for experienced and qualified nurse (7)

DO"'N

1. Surgical instruments in the English Channel (7)

2. Sincere season's greeting to all (1, 5, 9)

3. May be made into rope (4)

4. Photographic sedative? (7)

5. Germ free (7)

6. The head of this bone is at the lower end (4)

7. Causes painful redness of the skin-but no blisters (5, 6, 4)

8. Serpent provides a gift now ... (7)

14. Pyrexial illness (5)

15. For mastication of food (5)

18. Large artery has virtuous end... (7)

19. Faint contraction (7)

20. Pull out-perhaps 15 (7)

21. C.I.D. rota supplies blood to the head (7)

25. Soon (4)

26. Coat turned this way implies 8 (4) ACROSS

27. Strange beginning to cow's

SOLUTION TO CROSSWORD No. 7 DOWN

1, Internal; 5, cleft; 9, sympathetic; 10, ear; 11, lessons; 12, maltase; 13 Nausea; 14, sciatica; 17, voyagers; 19, unpaid; 22, ring pad; 24, invaded 25, oar; 26, irreducable..: 27, eases; 28, crescent.

I,

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IT PAYS TO STANDARDISE

J C

Insulin overdose; 2, time study; 3, real one; 4, aghast; 5, cochlea; 6, enema; 7, three handed seat; 8, stomach; 15, inaudible; ] 6, prudery; ] 8, gypsies; 20, novices; 2 I, cinder; 23, nares

READERS' PROBLEMS

correspond lvith the instruction on page 104 10 'Grasp the thigh lI 'i th both hands.'

Answer

This is largely a matter of opinion and both positions are correct. The most important point is that every first-aider should be so familiar with the pressure point that he can find it first shot. Personally, if anything, I prefer the 'Facing the feet' approach as shown in Fig. 73.

* * *

T. H. H. (Newark) writes :I was interested to read in the Sept.jOct. issue your reply regarding the action of calcium carbide when swallol1'ed, and as a foreig i1 body in the eye. In the July/A ug. 1952 issue, when answering a query regarding calcium carbide in the eye, .1'ou said , If olive oil or liquid pm affin is available ;r should be used liberally,' and in an issue in 1947, dealing with calcium carbide poisoning, it was s tated,' ' Glycerine is regarded as the ideal first aid treatment, and should be administered freely.' I should appreciate your opinion as to

which is the most appropriate treatment.

Answer

Both answers are correct 0 far as the eye is concerned, depending on the facilities that are available. The olive oil method is designed to prevent burning of the eye through the heat generated, but the tears themselves will activate the carbide hence unless an oil is readily available, the water method should be employed.

* * *

E. M. B. (Epsom) writes :Recently I successfully removed a bit of grit from the eye of one of the lvorkers in our factO/yo He still complained of the sensation of grittiness afew hours later. J could not see an)' more grit, so I advise d him to go to hospUal where he lvas diagnosed as a 'corneal abrasion .' Should I hav e been able to re cognize this condition; (f so, hall' ?

Answer

A scratch of the cornea or abrasion as it is called technically, must always be suspected if a patient complains of the symptoms and signs of a foreign body yet none can be found. Sometimes the abrasion can actually be more

usually it can only be suspected by the fact that light is not evenly reflected from the surface of the cornea, i.e., the surface of the cornea does not appear absolutely smooth when closely examined from all directions. It follows, therefore, that a first-aider is not expected to recognize an abrasion but must always appreciate its possible presence under the circumstances you describe and act promptly as you did.

Miscellaneous Advertisements

Advertisements with remittance should be sent to Flfst Aid & Nursing, 32 Finsbury Square. Lond ln, E C 2 Rate 3d. per word, minimum 4s. 6d. Trade Advertisements 4d. per word, minimum 65. Box numbers Is. extra.

SCENT 250 17 6. 1,000 52 6. Ticke s, Posters, Memos. Samples free-TICES, II Oaklands Grove, London, W 12.

H

CLOCKWORK REGULARITY

Normal bowel action is a fine thing to posses s. It is, perhaps, the most sought after talisman against ill-health in the world. No wonder, then, if its temporary suspension leads from a mild despondency even to black despair. But in such a crisis panic measures are to be avoided-the taking of harsh purgatives eschewed. Success in the restoration of the much-cherished habit lies in regubr persuasive stimulus of soft bulk-such as is provided by ( Gently and unobtrusively, ' PETROLAGAR' arranges for normal physiological evacuations and secures the return of 'clockwork regularity.'

'PETROLAGAR'

r A c

JOHN WYETH & BROTHER LTD., CII/tOIl H ous(t !Just :n Road, N.H7.1

PATENT "PORTLAND" AMBULANCE GEAR

The Gear illustrated(A.B.C.D.) carries two stretchers on one side of Ambulance, leaving other side clear for sitting patients.

The UP AND DOWN action is quick and easy for loading or unloading.

A Shows the t wo stretchers in position.

B. Shows the top stretcher lowered read y for loading.

C. Illustrates the same Gear with the top stretcher frame hi.nged down use when only one stretcher case IS carried

O. Shows the same position as in "c' only with cushions and back rest fitted fo r convalescent cases.

Where Ambulances are required to carry four beds two Gears are fitted, one on EITHER SIDE, and tne same advantages apply as described above.

Full catalogue of Ambulance Equipment No.1A will be sent on rcqu@st. 65, WIGMORE STREET, LONDON, W.I

Phone: WELbeck 0071 (Late GREAT PORTLAND STREET)

UNIFORM CLOTHING AND EQUIPMENT MANUFACTURERS

154 -164 TOOLEY STREET

'Phone:

A HANDBOOK OF ELEMENTARY NURSING

Arthur D Belilios, M.B. B.S., D.P.H., and Dorothea Duncan-Johnstone, S.R.N.

T his h andb ook is the ideal guide for anyone who is called upon to carry out any form of emergency nursing It d es cribes in simple language the basic principles and procedures that underlie the science of nursing, and contains

ELEMENTARY ANATOMY & PHYSIOLOGY

Arthur D. Belilios, M.B B.S., D.P.H., D. K. Mulvany, M.B., 'F.R.C.S., and Katharine F. Armstrong, S.R.N., S.C.M.

A handy, compact manual which gives " This str a ightforward and reliable little a complete outline of th e anatomy and book is to be warmly recommended for physiology of the human body. It i s all who maybe contemplating taking up simply wri t ten and fu lly illu str a ted. nursing of any kind. " -Th e Nursin g Tim es.

DALE, REYNOLDS & CO_ lTD.

32 Finsbury Square london Eel OR BAllLiERE, TI NDAll & COX 7-8 Henrietta Street london WC2

With 194 pages and 116 drawings 4s.6d. brief descriptions of the more common _________________________________ I di sea ses, with general notes on the nursing required in each case. A complete chapter is devoted to the subject of home nursing, and the whole book prov id es for every first aider the ess entials o f nursing in a handy yet comprehensive form.

With 314 pages and 57 drawings, 7s. 6d. BAILLIERE TINDALL ..,-. AND COX LTO.

PI d { copy/ ies of A Handbook of Elementary Nursing ease sen me copY/ les of Elementary Anatomy and Physiology for which I enclose remittance of.. (Postage 6d. extra per volume.)

Name Address FA/3S3

Built for Service in Jamaica

THISis a dispensary and fi rst aid clinic, capable of being used for the performance of minor operations, and for the treatment of diseases.

One of its two compartments is fitted for the dispensing of medicines, etc., complete with stills, hot and cold water, refrigerator, and all the necessary compartments for the storage of drugs. The other section is equipped as a surgery, again with hot and cold water, and cupboards specially made for the storage of surgical instruments, microsccpes, etc.

The unit is completely self-contained with regard to electricity supply and water storage, and is specially constructed, insulated and ventilated for use in tropical countries.

YOU ARE INVITED TO APPLY FOR FULL DETAILS OF MOBILE MEDICAL UNITS, AMBULANCES, ETC., BUILT TO YOUR PARTICULAR REQUIREMENTS FOR SERVICE IN ANY PART OF THE WORLD