First Aid Journal July 1946-December 1948 by Museum of the Order of St John

FIRS No. 625, Vol. LIII.]

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CONTENTS

OF TillS NUMBER.

EDITORIAL-

The Casualties Union Side Lights on First Aid

N ostell Colliery First Aid Society

S. J. A. B. Headquarters and District Reports

Railway Ambulance News

Letters to the Editor

The Thomas Splint

From Johannesburg

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Loading Spinal Cases Vomiting and Insensibility...

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Functions of Divisional Committee

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WHEN one reads the prospectus

The Casualties of ~he Casualties Union, the old Union. chlidhood fable of the boy who . cried" Wolf!" is irresistably called to mind. He called it so often, without c~use, .that when a real wolf appeared none ran to ~IS aSSIstance, and he was, in conseq uence, incontinently devoured; but there is all the difference and it is this in the case of the Union. Here w~ have a body of men and women preparing themsel~es for e~e~y ev~ntuality. It is an organisation :V~IC? s~ecIalIses In the "faking and acting II of InJurIes, In the production of realistic" accidents II and in the use of this method for traini~g purposes. It developed during 1942 in connecttOn with the Surrey County Rescue School (Leatherhead) as an answer to wartime training problems, but its technique is suitable for use in ~eac~time also, i.n co-~peration with any organisattOn Interested either In first aid or in the prevention and handling of accidents generally. It instructs its members in realistic faking of all types of injury. It uses staging both to indicate the history of the ,. casualty" and to produce graded problems of approach, treatment and extrication. In fact it provides a unique opportunity for the learning of first aid by personal service as a "casualty." First aid calls necessarily for immediate service, and while the crowd stands around hel pless and inert, the first aider steps forward and renders the necessary service, and it must be noted that it is this immediate service which marks, in many a case, the first step to recovery, The old adage that to be forewarned is to be forearmed is one of the first lessons inculcated by the Union. The man who has been through it (althougH only in a "faked" manner) will be more ready to give immediate assistance than one whose knowledge has been gleaned from a textbook or gathered piecemeal by attendance at a course of lectures, even although accompanied by actual demonstrations. He will exhibit no hesitation in setting about his work, and will be prompt and immediate in action. To quote the words of Sir John Hodsoll, Inspector General of

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Civil Defence, " I can think of no finer training. Not only are wounds accurately and most ingeniously simulateu, but the feelings of the casualty are studied and expressed, and those who are under training are very truly faced with just those problems which they encounter at an actual incident." We are led to these reflections owing to the 4th Annual Reunion of the Union at Eton last month, which was well attended, when several first aid societies took part in the first aid and diagnosis competitions. Particulars of the Union may be obtained from the Organiser, 64, Chilternroad, Sutton, Surrey. The movement is certainly capable of useful extension.

Side Lights on First Aid. By SIR HENRY L. MARTYN, K.C.V.O., F.R.C.S. A VERY heavy responsibility lies upon the first individuals who handle a patient with a fractured spine, since upon their correct diagnosis and treatment may depend, quite literally, not only the matter of life and death but also, if the patient survives, whether he recovers completely or remains a semiparal.y sed invalid for the rest of his life. A grave responsibility, my masters, serious enough even for a fully qualified and highly trained surgeon. Let us first of all get as clear an idea as possible of exactly what we are dealing with in such a case. I warned you to pay particular attention to the vertebral column when studying the skeleton, and you will remember that it consists of 33 bones. Each of them has a solid body in front and a bony arch behind. The b0dies are fastened together, one above the other, by strong ligaments, the bony arches thus constituting a continuous canal extending from the skull to the sacrum, Inside this canal lies the spinal cord, but, this is important, the cord does not occupy the canal completely but is slung, as it were, loosely within it with a well defined space containing spinal fluid around it. The cord itself is directly continuous with the brain above and terminates in t:he lumbar region. From it, throughout its entire length, emerge large numbers of nerves which, passing outwards to the muscles. convey to them motor impulses from the brain. Nerves similarly join the cord originating in the skin, joints and muscles carrying messages of sensation, touch, pain, heat and cold, etc., upwards to the brain. It will be readily appreciated, therefore, that if the cord itself be injured all communication between the body below the injury and the brain will be cut off, and the patient will be both paralysed and without sensation in these parts. If the injury is sufficiently low down the lower limbs only may be involved. If, on the other hand, the· lesion is situated high in the cervical region, the entire body, including the chest, m.uscles and diaphragm, will be paralysed, and the patient will die of shock and as]Jhyxia. There are one or two other points to bear in mind. Injury to the bony column may vary from the smallest crack to a complete smash up of several vertebrae, and mayor may not be associated with a dislocation of one or more of the bones. ~urthermore, an injury which starts only as a crack may, With the. greatest ease, be converted into a fracture dislocation as the result of had handling.

AID On account of the fact that the spinal cord does not occupy the whole space in the vertebral canal, but is surrounded by a cushion of Ouid, the extent to which · it is injured does not necessarily coincide with the bony injury. The cord may only be bruised sufficiently to produce a temporary paralysis. This may be recovered from, but once the soft delicate structure itself is really pulped recovery can never ensue, and the victim, if he lives, will remain paralysed for life. Hence it is clear that the utmost importance lies in the correct diagnosis and meticulously careful handling of these cases by the individuals first upon the spot. Diagnosis in a conscious patient may be easy since he will complain of severe pain at the site of injury, often radiating round the body like a belt, plus paralysis and loss of sensation below that level; in an unconscious individual, however, diagnosis may be impossible for the first aider. On account of this difficulty there was, during the war in most areas, a standing order that all patients who were found unconscious under debris were to be treated and handled from the first as tlzough they lzad aj1'actured spine. It would be a sound thing jf the same rule were observed for all similar cases in civil life, as, for instance, patients found unconscious in railway or car smashes,--Or those who have fallen from a height. No care can be too great if it can save life or, what is almost equally important, one patient from permanent paralysis. In the new supplement to the 39th edition of "First Aid to the Injured," the subject of the treatment and transport of cases of fracture of the spine has been at last modernised and brought into line with present surgical teaching. Some ten pages of script and illustrations 4"ill cause much heartburning both among students and teachers. No longer must a fracture in one position be transported face upwards and in another pusition be carried face down wards. In future, all cases of fracture of the spine will be moved on tile back. This view has been strongly supported by some of the leading authorities on spinal injuries for the following reason. Tbe bladder is paralysed in most injuries of tbe cord, and, sooner or later, a catheter will almost certainly be necessary. It is impossible to catheterise a person lying on his face while maintaining absolute sterility. If infection of the bladder does occur, infection of the kidneys and a fatal termination is extremely likely to follow. If therefore you are going to roll him over for catheterisation, wby not treat and transport the patient on his back from the commencement. Three methods of loading a stretcher with a spinal case are clearly and ably described, and will have to be practiced again and again. The student should note particularly that wbatever method is employed, and, even if only four bearers are available, two must invariably be detailed to maintain gentle extension of the body as a whole, one by traction at the head and the other at the feet. Note carefully the type of fractured thigh which occurs in old people fairly frequently. It is known as an intracapsular fracture of the neck, since the break is within the capsule of the hip joint. A common history is that of an old lady walking along on the pavement when by chance her foot slips over the edge into the gutter, perhaps only a matter of three or four inches. She falls and complains of severe pain in the hip. Since impaction is very common, she may even find it possible to get up with assistance and perhaps hobble homp., and this type of fracture may easily be missed without careful examination and X-Ray. In cases of fracture of both bones of the leg, a very common injury, a useful method of improvising a splint is as follows : Tie the ankles and feet together after straightening and placing the two legs side by side. Fold a blanket, rug or even a coat into a width sufficient to extend from the soles of

FIRST the feet to well above the knee. SI ip this beneath the legs so that they lie in the centre of the folded blanket. Roll the two halves of the blanket lying beyond the legs inwards towards them in two tight rolls until the latter are in close contact with the outer side of each leg and the two limbs lie in a gutter of blanket between them. Now pass bandages and make fast as usual, and you will find that the fractured leer is very thoroughly controlled. ;,., Compare carefully the differen(es between a di~location and a fracture. In both there is pain, loss of power, deformity, swelling and irregularity, but note that in a dislocation there is fixity of the part, not unnatural mobility and crepitus. The first time you see a dislocated finger or thumb you will probably diagnose it without difficulty, and you will equally probably experience an almost overwhelming desire to pull it straight and reduce the dislocation. It looks so easy as thou~h it needed only a firm pull to have the displaced bone back in place again. I beseech you not to give way to the temptation and to fall into the trap. You might be lucky, I agree, effect an immediate cure, and be regarded by the neighbours as one of the world's wonders, but by your fellow first aiders with horror as having taken upon yourself the duties of a doctor. On the other hand, you might find the simple loc.king dislocation utterly impossible to reduce, and having pulled vainly on the fing-er with no result whatever, save the production of agonised yells from the victim, you would be compelled to hand the case over to a doctor for reduction under a full anresthetic. The reason for the difficulty in some cases is that the head of the displaced bone may become caught by a neighbourin~ tendon, or prevented by some interposing tissue from finding- its way back into the joint cavity through the tear in the capsule.

Nostell Colliery First Aid Society. A section of N ostell Colliery Juniors (Boys') First Aid Society attended the Wakefield Mines Rescue Station allhe invitation of Supt. W. Riley, and they later spent two enjoyable hours at the swimming baths. The boys were accompanied by Mr. D. Makinson (secretary), whose desire is to see more and more young people attend the] unior Society meetings on Thursday evenings at the old canteen at the colliery. A mock first aid examination took place recently, and the lads showed great promise. A pleasing feature of the meeting was the opening of a canteen. The culminating point to a course of extensive first aid instruction was reached, when junior memhers, in company with members of the Senior Society, attended an examination in connection with the Crofton Evening School First Aid Class. Dr. W. \IV. Ballardie, of Wakefield, who conducted the examination, said he was pleased to note the quality of the boys' work and the keenness they had demonstrated in the tests. He urged them to continue their study of this allimportant subject. Roy Pease was adjudged to be the most proficient boy undertaking the examination, and was presented with £1, given by Mr. H. Hartley (manager of the colliery). B. R.C. S.-Sir John Kennedy, vice-chairman of the War Org-anisation of the British Red Cross Society and the Order of St. John, g-ave a farewell luncheon at Claridge'S on July 3rd to Mr. VV. L. Gower, American Red Cross, on the closing down of American l~ed Cross operation in this country.

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St. John Ambulance Brigade DISTRICT REPORTS. No. I (Prince of Wales's) District 135 (HARLESDEN}.-On June 22nd, a party of 18 members and their wives visited the Stoll Theatre, Kingsway, (0 see Ralph Reader's R.A.F. "Gang Show," a two hours show which was thoroughly enjoyed by all. After leaving thE" theatre the party adjourned to the Aldwych Corner Restaurant. The social side as apart from Brigade work is looked upon by this Division as being a part of the activities, since it is these social events which help to foster and maintain the friendly co-operation of all members and their wives, so essential to help maintain the efficiency of the members of the Division. These outings have been a regular feature of this Division for many years passed, and were carried on all through the war years, despite the fact that so many of its members were serving in the Forces. C89 (CHEAM).-This Cadet Ambulance Division held its first enrolment ceremony at 8 p. m. on Monday, July 8th, at its H.Q., Elmcroft Pavilion, Senhouse Road, North Cheam. At the ceremony, which was conducted by Area Cadet Officer Lowe, eleven cadets were enrolled and gave their promise to carry out the age-old Code of Chivalry. Following- the ceremony, the cadets gave a demonstration of their first aid work, and were warmly congratulated by e\'eryone present on the ability they showed. Colonel Russell Edmunds, of the Welsh Regiment, who has kindly consented to become President of the Division, was there to meet the boys for the first time. Also present were Ambulance Officer Luffman, of the Cheam Adult Division, to whom thanks are due for the use of their H.Q . ; Ambulance Officer Mrs. ·Watkins, of the Cheam Nursing Section; Cadet Supt. Hubbard, of the Epsom Division, and the girls of the Cheam Cadet Nursing Division, which meets every Monday at 6.30 p. m. at Chatsworth Road Girls' School.

County of Bedford. W ARDOWN. -On Saturday, June 29th, at Beechhill Boys' Scbool, the Wardown Division Ambulance and Nursing Cadets held their competitions and enrolment ceremony. The cups competed for were the Slater for Am bulance Cadets and the Stevens for Nursing Cadets. County Officer \lVeatherhead judg-ed both competitions, the winner of the Slater Cup bein cy Cadet E. Ayres and of the Stevens cup Cadet J. Allen. ~Runners-up were Cadets R. Sadd and S. Wallace. County Cadet Officer 1\1rs. McCorquodale presented the cups, and also awards as Grand Priors, to Nursing Cadet.l\1. Seymour and Ambulance Cadet R. Sayers and 18 phYSical traininer and 19 first aid certificates. In ~an address, she complimented tbe cadets on their work. Others present included Corps Supt. V . .'1N. Slater, Acting Cadet Corps Officer Mrs. Lawrence, Div. Supt. \IV. A. Stevens, Div. Supt. Mrs. M. Stevens and Cadet Officer R. Godleman.

County of Cumberland. KEs\vICK.-On Monday, June Z.fth (St. John's Day) Mr. P. S. Todd retired from tbe position of Div. Supt. of the Keswick Division, having completed the remarkably long period of 52 years' service.

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senting Cpl. Coe and Cpl. Carter with G. S. medals, complimented them upon their long service. The Div. Secretary thanked Div. Supt. Allen for allowng the gathering to be held in his grounds.

Mr. Todd is the only active member of the Brigade left who joined on the formation of the Keswick Division on St. John's Day, 1894. He was promoted Sergeant and Secretary in September, 1898, Ambulance Officer in November, 1930, and has been Superintendent in charge of the Division for the past twelve years. He was awarded the St. John Long Service Medal in 1909 and has since been granted five bars to the Medal, surely a unique achievement. In recognition of his long and valuable service to the St. John movement he was made a Serving Brother of the Order of St. John. Mr. Todd attended Queen Victoria's Diamond Jubilee Procession in London and performed duty in the streets, and also the Coronation of King Ed ward V I I. Keswick is the fourth oldest Division in what was the No.4 District, which comprises the Counties of Lancashire, Cheshire, Cumberland and Westmorland. Mr. ]. W. Eggleston has been appointed Div. Supt. to follow Mr. Todd. Mr. Eggleston joined the Brigade in 1928, was promoted Corporal in 1933 and Secretary-Sergeant in 1937. He was awarded the Long Service Medal for fifteen years' service at the end of 1942.

OXFCRD.-The annual inspection and march past of the Oxford Corps was held on Sunday, June 23rd. This marked the last "turn out" in this annual event for Mr. John Rogers the Corps' indefatigable Superintender.t. After 38 years Mr. Rogf'rs has decided to retire from active participation. His service, no doubt, will go on record, for his name has been synonymous with all ambulance work in the City for many years. He is an Officer of the Order of St. John, and became a Capt., RA.M.C., in the 1914-18 war. There was a muster of 385, including 25 officers, and the inspection was carried out by the County Commissioner, Dr. C. Gardiner-Hill (Banbury). As usual, members of the Corps demonstrated by their smart appearance, the pride they have in their work.

County of Kent.

County of Sussex.

Fo.LKEsTcNE CCRPS.-The annual parade and church service in connection with St. John's Day was held on Sunday, June 23rd, at St. John's Church, Folkestone. A/Corps Supt. W. Smith, S.B.St.J., and Corps Officer L. B. Easton, S. B. St. J., were in charge of the parade. Among those present was the Mayor of Folkestone (Alderman W. Hollands, J.P.) . The service was cond ucted by the Rev. T. Howells, and the sermon by the Vicar (Rev. L. C. Hickin). Lessons were read by Corps Officer L. B. Easton. After the service, the parade was formed up outside the church, when the Mayor presented service awards. He commended the members on their appearance and expressed the hope that good health and strength would enable them to carryon their great service. The following were the recipients: Bars for 35 years service to Corps Officer L. B. Easton and Private W. Burden. Certificates and medal ribbon for 15 years service to H / Sergt. F. Coughlan and Corporal W. Clarke.

CHICHESTER.-The urgent need for an additional ambulance was stressed by Supt. H. H. Bridle, S.B . St.]., ana recent Sunday, when the dedication of a new ambulance for the Chichester Division took place in the Bishop's Palace garden, by kind permission of Mrs. Bell, wife of the Bishop. The service was abbreviated owing to the heavy downfall of rain. Reviewing the gradual growth in the work of the Brigade, Supt. Bridle said that during 1936, 6,479 miles were covered. The figure increased in 1939, and last year the total mileage was 22,000 miles. He said that owing to the difficulties of war, the existing ambulances had not been kept in' proper running repair. It. was, therefore, necessary to buy another, which made up a fleet of five. In a short address, the Dean of Chichester, the Very Rev. A. S. Duncan Jones, B. D., paid tribute to the work performed by the Brigade. The presentation of the new ambulance was then made by Alderman W. O. Stride, J. P. (President of the Chichester Division). The Dean then performed the dedication. Besides many notabilities, contingents from Horsham and Bognor Regis also attended.

County of Lancashire. LIVERPCCL.-On July 6th, the cadets from the five Liverpool Corps spent a pleasant afternoon and evening together at Raby Mere j 165 Officers and Cadets went by motor bus through the Mersey Tunnel-a thrill for the younger ones who had not been through the Tunnel before, and who had eagerly anticipated this experience. A half mile walk through lovely lanes after leaving the buses, brought the party to the Mere, and it was not long before some were on the water. Olhers played in the fields or walked through the woods, and all enjoyed their tea. An hour and a half was spent in games before starting the walk back to the buses, and another drive through the country and the Tunnel landed all safely back on the Liverpool side of the Mersey.

County of Northampton. DESBCRCUGH.-This Division held its annual re-examination ?-t. Glenki~die House, Desborough, recently. The exammmg officers were County Surgeon G. Gibbons, O. B. E., and Div. Surgeon W. E. Lock. In the c~urse of his remarks, Dr. Lock expressed pleasure at seemg the Division up to something like its old strength. He offered a warm welcome to his fellow examiner Dr. G. Gibbons. Dr. Gibbons suitably replied, and in pre-

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AID

County of Oxford.

County of Worcester. DUDLEY AND DISTRICT.-The annual Church Parade of the above Corps was held on Sunday, June 30th, at the Parish Church, Dudley. The parade, which was under the command of Corps Supt. J. A. Harris and marshalled by Corps Officer P. C. Bennett, formed up in St. ] ames' Road and preceded by T. W. Lenchs' Excelsior Band, marched to church. The service, which was of a very inspiring character, was conducted by the Vicar, Rev. John Waring, M.A., and opened with the singing of the hymn of the 5.]. A. B. and closed with the ancient benediction of the Order of St. John. After the service the parade reformed and marched back to the Town Hall, where Asst. Commissioner Lench pre. sented service medals and bars to some of the members. Corps Supt. Harris said that he wished to thank the Mayor and Corporation for allowing them the use of the Banquetting Hall for refreshments. LYE.-An inspection, by Corps Officers of the Central (Lye) Nursing Division, was held during the last week in June. The Inspecting Officers were Corps Officers Miss Wakefield and Mrs. Northwood. On parade were Div.

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Supts. Miss Jackson and Miss Tibbetts, Amb. Officer Miss Dovey and a good number of Ambulance Sisters. Both the Inspecting Officers expressed their satisfaction with the drill, uniforms, work and books of the Division. Apologies were announced from County Supt. Dr. Mrs. Porter and Corps Supt. Miss Ashton.

SOUTHERN

A most valuable week-end course for training in competition work, was held at a Cam p near Stourport on ] uly 6th and 7th. The course was attended by 29 Nursing Cadets representin g 7 Divisions. Mrs. Hugh Robinson, County Cadet Officer j Mrs. W. Lamb, Area Cadet Officer j and Miss Bidmead, Mrs. Brettle and Mrs. Maley, Cadet Supts. were present. Corps Supt. F. G . Price, M. B. E., was the principal instructor. Practice in viva-voce took the form of a quiz and other periods were given to stretcher work, the approach to a patient, examination of an unconscious and also a conscious patient, and to team tests. Most of the work was done out of doors in glorious weather.

~CNDCN AREA.-A most entertaining afternoon and evemng was spent by a gathering of first aiders and friends re.centl~, at .Dension £:I~1l, Victona, the occasion being a First Aid QUIZ CompetltlOn and concert. Drs. Sheila Niall and J. Cohen adjudicated, the result being : First Round.-Bricklayers' Arms "A" beat Basingsto~e "A," 26-21 j Waterloo No. 1 beat Welling, 27.20; BaslOgstoke " B" beat London Bridge, 25-24; Bricklayers' Arms" B" beat Basingstoke, 24-18. Semi Final.-Waterloo No. 1 beat Bricklayers' Arms " A," 3St-31t j Basingstoke "B" beat Bricklayers' Arms " B," 27-25. Final.-Waterloo No.1 beat Basingstoke "B," 45t-38]-. Mr. Merritt acted as Question Master. . Mr. Trott thanked the Doctors and competitors for their valuable assistance in connection with the competition.

H. M. the. King has been graciously pleased to sanction the following promotions in, and appointments to the Venerable Order of the Hospital of St. John of Jerusalem : For the promotion to the grade of Officer (Brother).Mr. T. Lench of South Bank, Blackheath. For admission in the grade of Serving Brother.-Mr. J. H. Watkins, of 61, Adelaide Street, Brierley Hill. For admission in the grade of Officer (Sister).-Dr. Mrs. Porter, 27, Church Street, Kidderminster. For admission in the grade of Serving Sister.-Miss E. C. Jeakes, Taynuilt, Lansdowne Crescent, Malvern; Miss D. W. Jones, Dalston, \Vorcester Road, Malvern; Miss H. M. Walton, Cowleigh Road, Malvern.

West Riding of Yorkshire. SHEFFIELD.-We regret to announce the passing of Dr. F. S. Hardy, Corps Surgeon, Sheffield. Dr. Hardy joined the Brigade as Divisional Surgeon in February 1923, and retained that position until a few months before his death. In 1931 he was admitted to the Order of St. John as a Serving Brother, and in 1941 was promoted to Officer Brother of the Order. During his period of service as Corps Surgeon the number of Amb. Divisions increased from 8 to 15 and the number of Nursing Divisions recorded a similar increase. Dr. Hardy was devoted to his St. John work and endeared himself to the many colleagues and friends he has left behind to carryon with the good work. The funeral service at Pitsmoor Church and the interment at Burngreave Cemetery were attended by a large number of Officers, Surgeons and members of Ambulance and Nursing Divisions.

INDIAN RED CRcss.-The year 1943 was marked in black with a terrible famine in the province of Bengal j six million people were most seriously affected. The Indian Red Cross did its utmost to rescue women and children and was greatly helped in its efforts by the Indian Gnvernment as well as by several national Red Cross Societies. An article published in the current bulletin of The League of Red Cross Societies shows what a Red Cross Society can accomplish when animated by the desire to help.

Railway Ambulance News.

No.. 3 DISTRlcT.-The Ambulance awards gained in No.3 district were presented at Ashford recently, by Mr. J. E. Bell (Works Manager) and Miss F. M. Hunter. The gathering was presided over by Mr. George White, Ambulance District Secretary, who said that owing to the unfortunate death of Mr. E. Uzzell (Welfare Officer) he was presiding. Mr. White thanked the Class Secretaries for the unfailing way in which they all worked for the Centre. He also thanked the members and said that as a result of their efforts the Centre had been able to hold its own, and he was pleased to report that a certain amount of progress had been made. The Doctors were thanked by Mr. T . Down of Folkestone who said the result of their efforts was evident by the number of a wards presented. A very successful evening was brought to a close by an excellent concert given by London artistes under the guidance of Tom Jeffery. No.. 38 DISTRIcT.-The Southern Railway Ambulance men of this District, gathered recently at the Chatham Town Hall to take part in the first big event of its kind held since before the war. Areas represented, covered Folkestone and Dover in one direction, and Tonbridg-e and Gravesend in the other. Mr. P. Nunn, Divisional Traffic Superintendent presided, and prizes were kindly presented by Mrs. Nunn. More than 500 awards were made, including certificates for long service and special duties during the war. Approximately600 Ambulance members and their friends enjoyed the concert provided by Mr. Tom] eff<!ries of London, and the cabaret show presented by Mr. Norman Williams.

THAMES VALLEY.-The awards gained by the members of the above Ambulance class were presented by the Mayoress of Twickenham at a concert held in St. Mary's Hall. This class has had a large membership for some time past, and of the 78 members who entered for the examination all were successful. During the speeches of the evening, the Mayor conD'ratulated the winners, saying there was no nobler work in fhe universe than that of rendering first aid to the injured. He also said he admired the persistency with which railwaymen adhered to the work." You don't get fed up" he said. The oldest member of the class, Mr. A. Brazier, Twickenham, was presented with a cheque from the Railway Company in recognition of his promptitude displayed, dealing

FIRST

with a woman passenger and her child, who had fallen from a trai n near Clapham Junction. The concert, given under the direction of Mr. Tom Jeffery, was thoroughly enjoyed by a large audience.

Letters to the Editor. We are in no way responsible for the opinions expressed, or the statements made, by Correspondents.-EDITOR. THANKS. DEAR SIR,Many thanks for the very fine report of our activities in your April issue. Best wishes for the success of your Magazine; we hope to see a large circulation in Australia.-Yours, etc., WM. LESLlE. 16, Leyland Parade, Belmore, N. S. W. June 15th, 1946.

FIRST

AID In 1933 one ambulance was owned, 300 cases being attended and 4,000 miles covered. In 1945 four ambulances were owned, 1,300 cases being attended and 20,000 miles travelled. In 1946 already our fleet has increased to five and 699 cases have been attended up to the time of writing. Up to 1933 I held various posts in Church and Social activities, but what with my own business (Newsagent, etc.), and St. John, I had a full time job, so resigned all these posts in favour of the Brigade and have never regretted it. I hope to serve St. John many more years yet. -Yours faithfully, HERBERT H. BRIDLE, S. B.St.J. 28, South Street, Chichester, Sussex. June 30th, 1946. [Several other readers have sent along some interesting "Service Records." We hope to publish more as space permits. -EDIToR.l

-------.---.-----. The Thomas Splint. By J. W. SCOTT.

PUBLIC DUTIES. DEAR SIR,Once more the various London Divisions have done a good job of work among the crowds lining the streets. This time, to see the Victory Parade. One cannot help thinking what a grand gesture it would have been, had these duties been shared amongst the rest of the Brigade, a few of each to represent the effort all had made, throughout the past six years.-Yours truly, A. F. BARrolEs. Bedford. June 23rd, 1946. SERVICE. DEAR SIR,Your correspondent J. D. Nuttall's record as shown in FIRST AID for June, although a fine one, is by no means a " record." Many members of the Brigade known to me, hold similar and better ones, I think you will agree my own beats his-here it is : Passed first aid, No vember 1914, though not old enough to join, assisted with "removals," my first case attended being in Decemher 1914. joined S.J . A. B., April 1915, voucher, !'1?vember 1915, medallion 1916, home nursing, March 1916, J01ned H. M. Forces, May 1916, demobbed, March 1920 rejoined Division, March 1920. ' Division disbanded, April 1922. I continued to serve with the Chichester and District Motor Ambulances under the Home Service Ambulance Committee for 12 years, 19201932, attf.nding over 1,800 accident and removal cases. .. I. wa.s partly ins.trumental in re-foqning the Chichester Dlv1slOn 10 1932, helng appointed Hon. Sec. on reformation on March 4th. Promoted Sergeant from that date March 4 air raid. precautions and anti gas certificate, Feb. 9, 1936: A. R. P. IOstructor, grade 2, May 13,1936, long service medal, 1936 (12 years with H.S.A. counting as 6 years for Brigade purposes), promoted Supt., Oct. 15,1937, A R. P. instructor, grade 1, May 24,1938, first aid party leader, 1939-1945. Appointed Serving Brother of the Order of St. John, No,v. 21, .1938, bar to long service medal, 1941, lay instructor s certtficate, February 21, 1943, appointed Area Transport. Officer, Hospital Car Service, 1946, second bar to long service medal due April, 1946. Since 1933, I ~ave. been r~sponsible, day and night, for al~ ambulance servIces 10 the city and large surrounding distnct, the" ambulance" telephone being ' at my house.

WHILE I feel that this splint, and its application hardly comes under the heading of "First Aid," I do think, that in view of the very wonderful results arising from its application, it is well worth bringing to the notice of those who contemplate its inclusion in their training, or for the purpose of debate in discussion groups, etc. So often I have heard it referred to with feelings of both awe and dread by many, and this can hardly be wondered at when one looks at the somewhat formidable list of components that are required for its application, as outlined in the Textbook. I can quite understand anyone gaining the impression that the whole affair is complicated, and to say the least, difficult to apply and to learn. I can assure you, however, that a studied reference to the instructions, and a little practice with a competent and willing team, will soon remove any such deductions, and teams who have made a successful application will agree with me. Once this is accomplished, the efficiency and benefits of the splint will be readily seen, and the manner in which it really does all that it is supposed to do will convince any class of its value, and warrant the praise it has received for its many merits during the First Great War, at which time it came rapidly to the fore perhaps for the first time. and has certainly maintained its position-that of being the most efficient limb fracture splint to date, upper or lower. As far as first aid is concerned, the extent of its purpose may be classed under the heading of "fixing." A little beyond first aid perhaps, comes its further purpose, that of " extending," by means of a further twisting of the windlass, such action only to be performed under the direction of a doctor or trained nurse. Splinting the femur fracture by means of the wooden splint and the eight triangular bandages, as shown in the Textbook, is almost perfect in its efficiency, and any fear of movement is almost negligible, until the question of transport arises. Complete with all the latest patents and gadgets to avoid jolting, even the" de luxe" type of ambulance still can manage to jar a patient occasionally. Also during the process of loading and unloading patient, one or two jolts are unavoidable. (We will try and forget the old converted type of A.R.P. Ambulance-corne-box wagon days!) But with the Thomas Splint correctly and properly applied, the windlass with just sufficient tightness to "hold" the limb, all fear of movement or motion is entirely removed-it just cannot move, either backwards, forwards, sideways, upwards or downwards-it has been" fixed,"

In the course of its application, one or two" do's" and " don'ts" arise, and while they are all really quite obvious, they are very often overlooked. For instance, you will have already padded the ring at the head of the splint (some are issued already padded and covered with leather), but a few extra folds of some soft material is required, on the part of the ring that comes in contact with the groin, also on the part that presses against the part that we sit on (let's go all technical and say" tuhera ischii.") When the splint is adjusted and the limb is fixed there is considerable pressure on these parts, and when extension is applied, this is much increased. It is also important that the splint fits firmly in these parts. Another point to be considered is the application of the " Gooch," and the bandages that fix it. There is not much space between the side rails of the splint and the limb, and care must be taken when applying [he Gooch, or any dressings, that the limb is not jolted. Next, with regards to the 3 in. flannel bandages, try to avoid getting the rope-like effect when forming the clove-hitch. It will tend to press into the flesh even through the thickness of the boot when the pull is applied. A certain amount, of course, cannot be avoided. With regard to the slings that form the cradle, often one or two may be slack, and not actually taking any weight of that portion of the limb, under which it is place·d. This happens when a little more tightening is applied to the other slings. Equal adjustment to all of them in turn will avoid this. It will be an advantage if the practice of the application is made on an uncovered limb. It does bring out the points to be avoided, aha it clearly explains the action of the windlass, and how the pressure is made on the groin and buttocks, how it is important to have the "pull" of the windlass, made in a central position on the ankle, not too near the lower portion, or too near the instep. Finally the uses of the 3pliot are as follows : The Thomas Splint is used for all fractures of the femur unless there is a wound in the upper part of the thigh or buttock, which would interfere with the fitting of the ring, also for fractures about the knee (including the patella) and fracture of the upper -~ of the tibia; if there are extensive wounds of the fleshy part of the thigh or leg, it is of great use. The main thing-s of note are, keep the metal bars in good condition by smearing them with soft vaseline. If the ring is covered with leather as mentioned above, keep it soft and clean with saddle soa p. If there is too strong a pull on the foot, and it i~ kept like it for some time it is liable to interfere with the circulation in the foot, which may cause gangrene. Traction on the foot has the same effect, therefore make doubly sure the boot laces are loose. It may be interesting- to knClw the great uses the Thomas Splint was put to in the 1914-1918 War. . The introduction of the splint to the front line reduced the mortality of the gunshot fracture of the femur, from 80 per cent. to 20 per cent. The rule was that "when a man with a fractured femur was found on the battle field, the splint was to be applied before the trousers were cut open or the wound dressed, also the boot was to be left on the foot in order to immobilise the fracture without loss of time and before the limb was much handled." The Splint is named after the surgeon who introduced it, namely Mr. H. O. Thomas. So now, have a go, and convince yourselves that the late Mr. H. O. Thomas, really had something there! F.A. IN ElRE.-Area competitions in connection with the President's trophy were held in 21 St. Stephen's Creen, on June 15th. The following areas participated-Dublin City, Dublin County, Meath and Wicklow. Area competitions will be held simultaneously in Dundalk, Galway, Kilkenny and Cork.

AID From Johannesburg. THE need for first aid training in factories is illustrated by the prompt and efficient first aid assistance given in the following case : A short while ago one of the girl workers in a factory cut her right thumb off in a machine. Majorie Williams, who is em played in the same factory, and is a member of the Orlando Nursing Division, came along, stopped the bleedin g and dressed the wound. It was a very neat and efficient piece of work. Other workers fainted when they saw th e severed thumb on the Aoor, but Miss Williams took it all calmly and went on with her job of attendin g to the patient. Her calmness and efficiency in the situation is indeed praiseworthy, and it is gratifying to note another example of th e fine work done by the non-European members of th e Brigade.

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FIRST

Queries and Answers to Corresponden ts. Queries will be dealt with under the following rules : i.-Letters containing Queries must be marked on the top left-hand corner of the envelope' I Query," and addressed to FIRST AID, 46, Cannon-street, London, E. C.4. 2.-All Queries must be written on one side of paper only. 3.-All Queries must be accompanied by a" Query Coupon ., cut from the current issue of the Journal, or, in case of Queries from abroad, from a recent issue. 4.-The Textbook to which reference may be made in this column is the 39th (1937) Edition of the S.J.A.A. Manual of First Aid to the Injured.

Fractured Base of Skull. ]. N. (Bessbrook, Ireland).-I notice that in your answer to the query, which was published under the above he.ading in the May issue of FIRST AID, you name the only condition in which insensibility is invariably present, viz., Epilepsy. Also, I note that you state that there are four variations in insensibility-complete, partial, delayed and absent j and that all these four may be present with fractured base of skull. Please tell me how all four variations can be present at once and accept my thanks in appreciation of your explanation. I take it that anyone of the four can be present. If you re-read my previous answer you will find that I did not write that the four variations of insensibility can b~ present" at once" but that in any given case of fractured skull one of the four varieties may be present. It is obvious that for instance, insensibility could not be complete and absent at the same time; and that it is impossible for all four variations to operate simultaneously.-N. CORBET FLETCHER.

Examination Bowler. M. R. (Cannon St. }.-In a recent examination a candidate was asked what he would think was the matter with a woman who was clutching at anyone near her, kicking, crying and laughing alternately. Without hesitation he replied "I should think that she had gone quite FIistorical." At this reply the examiner smiled a broad smile j but the rest of us who overheard the question and answer could not refrain from laughing:. Good!

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

Fracture of Spine. E. R. (Paignton).-Will you please tell me why I had to turn on her side, when she vomited, a lady who had a tubercular spine and had fractured it? I had already turned her head to one side to prevent her choking. In the Supplement to the Textbook (p. 11) it is definitely stated that all cases of fractured spille must be transported face-upwards; and that, if found in any other position, such a patient must be slowly and evenly rolled on to his/ her back. In view of these instructions I am unable to appreciate why

AID you were to place a patient with fractured spine on her side. N.C.F.

Layers of Skin. E. R. (Paignton). -Also I should so like to know how many skins we have. Half of our Division say two and the other half seven! There are two layers of the skin-namely the epidermis (cuticle or outer layer) which is constantly being shed and is devoid of blood vessels and nerves and the dermis (true skin) in which are found blood vessels, nerves, hair roots, sebaceous and sweat glands.-N.C. F.

War-Service Medals. W. W. (Ealing).-In a recent issue of FIRST AID you mentioned that M. H. R. personnel are entitled to the War Service Medal. As I have recently completed six years war service with the R.A.M.C.(T.A.), I would be grateful if you can tell me whether I am entitled to this award. If you have completed six years war service with R.A.M.C. you should by now have received your ribbons. If these have not come to hand, we suggest that yo u communicate with the O / C of your Depot. - EDITOR.

Fractured Arm at Elbow. M. E. (Harrow). -In its instructions for treatm ent of fracture of arm involving the elbow joint the Textbook (p . 84) tells us to secure the angular splint by bandages round arm, round forearm and as figure-of-eight round hand and wrist. Please state if the instructions mean that we are to use three or only two bandages, the lower doing the work of controlling forearm, wrist and hand. Three bandages are to be used because the Textbook tells you to apply bandages (1) round arm (2) round forearm and (3) round hand and wrist.-N.C. F.

Team Competition. C. M. (Exeter).-Do you think that a team test only in a competition is sufficient to judge the best team? Would it not be much better to have both team and individual tests? Meanwhile I thank you for your ans",·er. In a competition it is, in my opinion, better to have both team and also individual tests, the first of which demonstrates the ability of the team to work together in a co-operative effort and the second of whi ch proves the knowledge of the individual members when they are called upon to work alone. That this is the correct answer to your query is proven by the fact that most judges of experience can remem ber cases in which teams have gone to pieces in competitions when for some reason the team leader has been taken from them and the remaining members were left to carryon without the help and guidance of their leader.-N.C.F.

Loading Spinal Cases. A. B. (Bedford}.-After two hours of serious practice at the method of loading spinal cases as set out in the Supplement to the Textbook we came to the conclusion that it is impossible to apply a steady and even traction to the spine while moving over the stretcher. We t.ried several ways, but could not prevent the I I p~tient)) feeling the tension vary as each step was taken. We wondered therefore, whether or not, other teams were having similar experiences with this tift, i. e., six or four bearers.

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It is fully realised that during the loading of spic: al cases traction on patient's head and feet cannot be maIntained at an exact and constant force during the whole operation. To me it would seem that the object of the instructions, which you quote from the Supplement to the Textbook, is to warn against careless movements and above all to prevent the spinal column being further displaced at the seat of fracture. Provided that this is understood and that all movements are made steadily and carefully, the small amount of difference in traction is not likely to incur the risk of further complications.- T,C.F.

Vomiting and Insensibilitv. E.S. (Shinemoore).-In a recent competition the patient who was suffering from fractured base of skull and other injuries suddenly began to vomit. The judge at once asked what was the significance of this change in patient's condition which was, I presume, a sign of returning consciousness. Afterwards the question arose whether or not an unconscious patient can vomit. To clear all doubts in our minds) therefore, we submit the question for your kind ruling and we await your valued advice for which we thank you. The Textbook in the opening paragraph of Chapter XI I I tells you that insensibility is loss of consciousness due to interruption of the action of the brain brought about by some interference with the functions of the nervous system or, in other words, that in insensibility the functions of the brain are in abeyance. Normally the action of vomiting is reflex and may occur as a result (1) of overdistension of stomach, (2) of the presence of irritating material in its contents, and (3) from abnormal conditions of the brain. In the act of vomiting the first event is a deep inspiration which is succeeded by closure of the glottis and followed by a strong contraction of the diaphragm and abdominal muscles, with the result that the stomach contents are forced upwards along the food pipe. From all this it follows that while the functions of the brain and nerve centres are in abeyance, vomiting cannot occur and that, when it does, it may be the first sign of returning consciousness. -N. C. F.

Negative Pressure. R.C. (Milford Haven).-May a regular and enthusiastic first aider have the temerity to question the accuracy of the reply which was published under the above heading in the February issue of FIRST AID and in which the statement was made that there is air between the two layers of the lining membranes which enclose the lungs? I have been looking for the correction of this statement in subsequent issues of FIRST AID but I have seen none. As you do not tell me wherein lies your difficulty in accepting my previous answer which was quite correct, I regret that I cannot be of assistance until you do so.N.C.F.

Functions of Divisional Committee. B. H. (Catford).-l wonder if any readers of FIRST AID would be able to inform me what is the function and composition of a " Divisional Committee" in the St. John Ambulance Brigade. In matters of discipline and conduct what is its authority and scope? Are the rank and file

AID represented in its composltlOn and are members of the Division entitled to appear before the Committee in cases of indiscipline or of charges being made against them? Can an appeal be made from its decisions (in the absence of "accused") and are they subject to District and Chapter Confirmation ? Finally, are they elected by popular vote of Divisional members (in good standing) or appointed by personal preference of the Divisional Superintendent ? Specific answers to your several questions can be found in Brigade General Regulatz'ons, and to deal with them in this column would necessitate copying out several pages therefrom. Unfort unately lack of space renders such action impossible. So we suggest that if you have no copy of Brigade Regula/£ons, you should approach your Divisional Superintendent who will doubtless be pleased to let you read what is contained in Section XVI.-EDITOR.

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comprISing 3 Finger, 16 Fore Arm, 16 Upper Arm, I Set (3 sizes) Angular Arm Splints, 6 Assorted Leg and Thigh ranging from 24"-54", (44 SplInts in all) - - - PRICE 21/-. (Post and Packing 2/- ) Tunstall Bandage Winder each 6/6 Splinter Forceps. pair 3/6 St. John's Pattern Tourniquet 1/9 each Solid Steel Scalpels 4/6 each N.P. Scissors from 7/6 pair Artery Forceps, N.P. 6/- pair Fitted Pouches and Haversacks always in stock. Let us quote for your First Aid requirements.

A. D. (Leicester).-As a member of the Brigade I hold the Service Medal of the Order of St. ] ohn and 3 Service ledal Bars. Now I have received the ribbon of the D efence Medal. So I ask you to tell me which takes priority on Brigade uniform, if you please.

45, OXFORD STREET, LONDON, W.l. ·Gram.: "Bayleaf. London ." 'Phone: Gerrard 3185 & 2313.

The ribbon of the Defence M~dal is placed after that of The Order of St. ] ohn and before that of its Service ledal and Service Medal Bars.-EDITOR.

By N. CORBET FLETCHER, O.B.E., M,B., B.C., M.A.(CantabJ, M.R. C.S,

FIRST AID" QUERY and REPLIES COUPON. H

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7/ 6. Posters, Hats, Memos, Rubber Stamps. 250 Tickets " A " TIeES, 11, Oaklands Grove, London, W.12. CHALLENGE CUPS. Open AmbuDONISTHORPE lance Competitions for Seniors and Cadets, Donisthorpe Church Hall, Saturday, August 31st, 1946. Entry forms, Sgt. J. Finch, Day-Bell, Moira, Burton-on-Trent. AID Competition and Practice Tests. No.2 series FI RSTTeam, 6 Individual, 6 Oral. Price 2/- postage 1d.

G From: Robinson, BCM / Superb, London, W.c.1.

Colliery Ambulance Division. Annual ComH ARDWICK petition for the" Graham" Cup will be held in the Holmewood Miners Welfare on Saturday, September 14th, 1946. Apply for entry forms to the Secretary, J. Cocking, Haslemere, North Wingfield, Chesterfield. bath chair fitted Windscreen, Hood, Electric MOTOR Light. Tiller steering. Licensed. Tyres perfect. Condition excellent. Nearest offer £120. Box 101, Dale, Reynolds & Co. Ltd .. 46, Cannon Street, London, E. C.4.

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PENETRATING It is the penetrating power of Germolene which enables it to sink right in through the top skin into the true, living skin below-and so to reach the tortured nerve endings-which brings such wonderful relief.

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ECRETARIES and Typists will welcome this book. It solves over 7000 difficult problems, anyone of which may call for an immediate solution. A book which is outstandingly useful both to the beginner and to the experienced secretary. The book does not set out to give simple grammatical rules, or the elementary principles of typewriting practice, and only for the more difficult words are definitions supplied.

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A One or other or all of the three races of germs, Streptococci, Staphylococci and B. pyocyaneus are found in every skin infection common to this country, and ANTIPEOL OINTMENT contains the antibodies (antivirus) of these germs. ~ealing. is expeclited by the proved ingredients of the ointment, and septic development is stopped or prevented by its antivirus sterile vacctne filtrate~. ANTIPEOL OINTMENT is unsurpassed for BURNS and SCALDS, for it is microbicide and non-adhesive, and dressings do not requtre to be changed every day. WOUNDS, BURNS. etc., WILL NOT WRN SEPTIC if treated with ANTIPEOL OINTMENT.

OPHTHALMO-ANTIPEOL is a semi-fluid ointment, more convenient than the ordinary Antipeol ointment for ocular infe~ti?ns and lesions. Eyes affected by. smoke and dust are soothed almost immediately by the application of Ophthalmo-Antipeol, and the anttVlrus prevents germs from developtng.

RHINO-ANTIPEOL

ge:m

s common ~o affords rapid relief of COMMON COLDS, INFLUENZA, AND CATARRH. Containing. the antibo~je~ of the infections of the nose and pharynx (Staphlylococci, Streptococci, B. pyocyaneus, pneumococcl~ pne~mobacill1, .enter~occ~, M: c:ata1:I~l1s. B. Pfeiffer), Rhino-Antipeol is not just a palliative, but is a remover of the couse of the infection. Durmg epidemics It IS the Ideal preventive of microbe development.

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"SANOID" RESPIRATOR FRAME Registered Design No. 806838

This frame has been designed especially for the purpose of secu rely locating and thus preventing slip of Cotton Wool Filters or other Masks when used as Respi ratG>rs In safeguarding workmen against dust arising from Industrial operations. It possesses many advantages over other articles of a similar character Inasmuch as:

" -JlIeanz"ng? ... "

" Wiry, don't you, know? It's the smile Mu m says I've always got when I clean my teeth twice a day." Only the use of Phillips' Dental Magnesia can g ive you the Magnesia Smile, because it is the

Prices of Respirator Frames and of Filter Masks (Respirator Refills) on application.

one toothpaste containing *'M ilk of Magnesia,' which dentists advise to check the action of mouth-acid - often the cause of dental decay.

It Is rustproof and smooth, being flexible It readily conforms to contour of the face thus ensuring correct positioning of the Mask. It Is light, easy to adjust, and the lower portion fits comfortably under the chin thus anchoring both frame and filter.

FIRST AID is published on the jloth of each month. Annual Subscription is 48. post free; single copies 3 d •

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* ' Mil k of Magnesia' is the trade mark of Phillips' preparation ofmagnesio.

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THIS NUMBER.

EDITORIAL-

The Uniform Age ...

Side Lights on First Aid

The Art of Observation

Skinnin g rove Iron Co. Ltd.

S.J.A.B. Headquarters and District Reports

Make Your Holiday Safe

Railway Ambulance News

Mumps

Letters to the Editor

Don't Pull Children's Arms

QUERIES AND ANSWERS TO CORRESPONDENTS :-

LECTURERS & A.R.P. CLASSES.

comprising Anatomy, Physiology, Haemorrhage, Dislocations and Fractures. Mounted on linen with roller 27/6 net; postage 7d.

WRIGHT

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An Advanced Ambulance Handbook. Edited by NORMAN HAMMER,M.R.C.S •• Major,lateR.A.M.C.,T.A. FIRST AID JOURNAL.-" One of the most concise works on the subject published at a popular price .

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EDITORIAL.

NOTICE TO READERS,

Sole Manufacturers I

Ph ill ips· Dental Magnesi!

AUGUST, 1946.

No. 626 .-VOL. LUI.

Poisoning and Multiple Injuries

Examination Howler

Sympathetic Nervous System

Area Cadet Officer

Fracture of Humerus

Treatment of Compound Fracture

Medals

Complicated Fractures of Ribs

Humour in First Aid Dislocation of Joint Two-Handed Seat

22 22 22

1_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ ' _ _ _ __

Age.

not mean an age of uniformity, for never were nations and peoples wider apart or more given to dissension than at the present time. What we refer to is the calling or rank which is distinguished by some outward form of gar~. We have not yet unfortunately, among our workIng population, adopted the blouse wh ich is such a feature of the French working classes, and our workmen still carryon their various callings clad in the cast off tweeds obtained at second-hand from the classes above them. Duri~g the past six or seven years the country has ?een ~nundated by costumes and uniforms of varyIng kinds, and even the women have not disdained to en ter the khaki-clad ranks. We are led to these reflections by the letter, signed E. C. J. B. which we publish in another column. H'e is of the opinion that the present is an opportune moment for the style of uniform for non-commissioned officers and pri vates of the St. John Am bulance Brigade to be brought up w date. With his suggestion as to what form the uniform should take we have no concern, beyond saying that it has the desirable end of leaving the wearer free and unencumbered in his movements. This is most needful, and a tight" choker" collar, especially in hot weather, is most objectionable. There is always somewhat of undesirability in a change of uniform, and an ambulance brigade offers no exception. As a bird is known by its plumage, so is a man by his costume, and it is always wise before such a step as a change of uniform is taken to consider all the pros and cons. An ambulance service is really a ser'v£ce, and it has nothing of show or pomp about it. Its sole aim is to render first aid, and to this all must be subordinated . It may be early days yet to discuss the matter, however, for the larger quantities of material, which our correspondent forecasts, are yet somewhat in the clouds, and the needs of Army and Navy will of course rank first. When these are satisfied, the requirements of ambulance brigades and other bodies will doubtless be considered; but when such consideration takes place the St. John Ambulance Brigacie will have to fall into line with other bodies.

FIRST

FIRST AID 14____________________________________________ ___________________

Side Lights on First Aid. By SIR HENRY L. MARTYN, K.C. V.O., F. R.C.S.

THE circulation of the blood is a subject which students generally find difficult. It can only be mast~red by sitting down to it patiently, provided, if necessary, with a supply of black coffee and of wet towels to apply to the fevered brow. \Vork out first of all the general account of the circulation as a whole, including the anatomy of the heart, then, by means of diagrams, learn the names and course of the main arteries of the body. Do not be content only to work by pictures, if you can persuade a friend to act as a living model. Trac.e out ~ith a skin pencil on his body, the course of the artenes, notlOg carefully the points at which they can definitely be identified by their pulsation, for instance, at the wrist, in front of the elbow, in the neck, groin, etc. Once you have really grasped these anatomical points you will find that the whole subject of haemorrhage, the different kinds and their treatment, becomes a matter of common sense and requires no meaningless learning by heart. For instance, you will have learned that the blood in the veins is returning to the heart carrying waste products for excretion through the lungs. If you are asked what are the characteristics of venous haemorrhage, the answer is only cummon sense, the blood is dark in colour since it is impure and contains no oxygen, the haemorrhage comes from the cut end of the vessel furthest from the heart since it is flowing towards it, and, since it has passed through the mesh of fine capillaries, the arterial pulsations will have been, as it were, smoothed out and the flow will be a continuous one. As a matter of actual fact, there are very few wounds 0 f any size from which haemorrhage of one sort only will be found to be coming. The simple cut finger will probably only show the tiny stream of red ooze due to capillary bleeding but the really big wound will show all varieties, the capillary trickle from skin and muscles, the multiple small spurting arteries with perhaps one or more bigger ones deep among the tissues, and the general ooze of darker blood from the many injured veins. The whole wound fills rapidly with a pond of blood in which it is often quite impossible to determine at first, exactly where it is coming from. Do not be surprised therefore, when you see your first big wound, to find it quite impossible to identify the various kinds of bleeding, the main and most important practical ' consideration is to stop it and for that identification is by no means essential. While we are on the subject of haemorrhage as a whole, I should like to say a word upon what is meant by severe haemorrhage. Some people seem to havethe impression thatif an artery, such as that at the wrist, be severed, death will inevitably ensue, unless the haemorrhage is controlled, within a very few minutes. Such is very far from being the case and although I have no real knowledge as to how long it would take to kill a man by dividing his radial artery only, I am sure that it would take a very considerable time, if indeed, it could be done at all. What actually would happen is that after bleeding briskly for some minutes the patient would begin to feel faint, his blood pressure would fall and he would become unconscious. The haemorrhage would become less and less as his pressure fell. After a few minutes the patient wo uld rally, the bleed-

in<Y recur but to a less forcible extent than formerly, and th~ whole'sequence would be repeated again and again. The position is quite different where one of the large arteries such as the carotid, subclavian or femoral is concerned. When one of these is injured the haemorrhage is terrific and unless controlled within a couple of minutes at the outside, death would certainly ensue. Do not imagine from this that any haemorrage can be ignored, even the continuous ooze from a fair size wou~d adds greatly to the patient's shock. Try to keep th.e case ~n its proper proportion, don't lose your head even With a big haemorrhage, and above all avoid that state of hysterical energy which so many competition teams consider it necessary to display when dealing with a case of arterial bleeding. There are one or two points about wounds which are worth making a note of. Do not be deceived by the appearance of a scalp wound which has been produced by a ~lo~ with a blunt instrument such as a truncheon. The SklO IS apt to split under such a blow and a wound res~lts.close!y resembling an incised wound. Only careful examlOatIOn Will reveal the contused tissues round the edges. Remember that although a bullet may produce a tiny punctured wound of entry, the exit wound is fr~quently very large indeed, especially if bone has been commInuted by the missile and the multiple fragments forced onwards through the tissues by the emerging projectile. It is easy to think that this so called explosive exit is the only wound and to miss the tiny entrance wound altogether. It is in the directions for the treatment of wounds and haemorrhage that the new Supplement to the First Aid Text Book has effected the most radical and much needed changes. Some seventeen pages of the old Text Book ha ve been reduced to seven of clearly arranged modernised instructions. Let us consider the changes which have been made. The first which will strike the reader is the introduction of a paragraph upon mixed haemorrhages which I hav~ al~eady discussed as being the type most commonly met WIth In all large wounds. The next point is the great simplification that has been made in the directions for treatment of haemorrhage of various sorts. It has been appreciated by the authors that in its essentials the treatment of wounds accompanied by venous, arterial or mixed haemorrhage is the same and that the one thing upon which all other instructions centre is pressure directly upon the bleeding point. This pressure may be made with the thumb or even by grasping and compressing the entire wound. Thumb pressure can be replaced with that of a pad and bandages, if necessary reinforced with further pads and bandages on top of the first, and finally, if all else fails, by a rubber bandage applied immediately above the wound, subsequently loosened at intervals. At long last the very word tourniquet has been entirely eliminated from the Text Book. That horrible instrument the St. John tourniquet has disappeared, one may hope, for ever, and the pages devoted to unimportant pressure points have been done a way with excepting only those for the carotid, femoral and subclavian arteries. Gone are the instructions to wash as much dirt as possible from a wound by pouring sterilised water over it, as are also the rules to apply an antiseptic to the wound and surrounding skin. It is made clear that if a properly applied pad is

used, pressure can be made effectively over the wou~d itself, even if a fracture is present or the presence of a foreign body suspected. I regret only that, evidently by ov~rsight, the instructions not to apply sticking plaster or OIntment to a wound have been omicted-please continue to do neither. Only the rules for tr~atI?ent of capillary h8;emorrhage are retained separately, which IS tantamount to ~aylng that the simple household cut needs only a clean dreSSing and a firm bandage. What a revolution is all this and what a flood of questions will arise. I can imagine them flowing in by the dozen from those who have, up to now, regarded the Text Book as the laws of the Medes and Persians. Before you start however, to question, set yourselves to think. Try to work out the reasons for this and that, either from your common sense or from the experiences many of you have had in the war. Believe me, every word of the chapter on wounds and haemorrhages is ~ound surgery, it has been brilliantly written in accordance with modern theory and practice and, in itself, constitutes the greatest proof that could be adduced, for the urgent need f~r frequent revision of any text book, no matter what the subject.

The Art of Observation. By H. G. OSBORNE. IN first aid work there is a great difference between merely seeing and accurately observing. Observation may be regarded as a process of deduction .in which small a.nd even insignificant signs may lead to all· Important conclUSIOns and accurate diagnosis. The points to be aimed at in the cultiv.ltion of observation are Speed and Accuracy. Such things as profuse hcemorrhage, cessation of breathing, obvious deformities, are, of course, readily discernible, and the 6rst aider will deal with these immediately. Yet what a field for careful yet rapid observation there is in the surroundings alone! Such obvious dangers as moving machinery, falling bricks, a concealed bend in a road, a building in imminent danger of collapse ; a~~ less immediate sources of trouble such as an empty aSpIrin or poison bottle lying half-concealed in lo?g grass ; ma~ks indicative of a struggle, such as torn or disordered clothlOg or broken-down bushes; a weapon such as a razor thrown some distance away; there are a hundred and one things such as these which may either confirm the first aider in his diagnosis or go far to hel p hi~ make it. . Observation, of course, IS of the utmost Importance when the first aider commences his routine examination of a patient, particularly where there are no very clearly defined clues such as those mentioned above. The colour of the face, the condition of the pupils of the eyes, the presence or absence of fluid escaping from ears or nos~, a spasm of pain flitting momentarily across the face as a Itmb or other part of the body is being handled; a great deal could be written on the observation of the face alone in connection with ambulance work. Careful observation is very important in such cases as suspected fracture where deformity is not clearly marked; in these cases comparison with the sound side should be both rapid and accurate, always, of cours~, with. the understanding that in cases of doubt the first alder wtll treat for the more serious injury. Swelling, bruising, discolouration! peculia.ritie~ in speech or gait, the determined suppressIOn of palO, signs of mental excitement or of langour or drowsiness, sweat on the forehead, pallor or flushing, twinges of pain; all these

AID things should be observed and observed and given their due meed of attention promptly and efficiently. There is no doubt that the power of observation is much stronger in some people than in others. I heard of a case in which a doctor diagnosed a case of serious throat trouble merely because he noticed that his patient occasionally took a deep, sighing breath. The fact, however, that some have this gift in greater measure than others should not deter those in whom it is not naturally well-developed. A great deal can be done to improve it where this is necessary. Experience, of course, will do much, and the first aider who wishes to improve this faculty should lose no opportunity of gaining all the practical experience he can. If he is physically normal himself. it is not a bad idea for him to go into the privacy of his bed or bathroom, if he has a large mirror, and look at himselt with the closest attention for half-an-hour; in this way he will at least familiarise himself with the human body in its normal condition, and may also have the salutary effect of increasing his self-respect, or of shaming him into taking a course of physical culture! Let him examine the general appearance of the body in health; the colour of the skin, the movement of the limbs, the positions of the main muscular groups and bones, etc. He should also practise observing people with whom he comes into contact during the day; their facial expressions, manner of walking, sitting, etc., difference in speech, differences in physique due to age, and, in fact, anything he can think of which will aid him in this most desirable acquisition of observation. Indeed, it is more than desirable; it is absolutely essential to the efficient first aider, and no time spent in its cultivation should be considered as lost. Of all the senses, we learn most through the eye, and in our efforts to bring ease and well-being to our fellow-men and women, we must be able to see them clearly, if we wish to see them whole.

Skinningrove Iron Co. Ltd. FIRST AID COMPETITION. The Skinningrove Iron Co. held their first annual competition for the" Debenham " Cup recently. This Cup has been presented by the Company for annual competition by ambulance teams representing the various departments in the Works. Dr. W. Stevenson of Skelton was the judge. Five teams competed, the Engineering Department being placed first with 80 marks out of a po?~ible 100. On the Monday following the competItIOn, a pleasant e.vening was spent in the Club Hall, by the Work.s ambulance staff and friends. A number of the Works offiCials were also present. Light refreshments were provided by the Company. Durin<Y the evening Mr. H. G. W. Debenham, the Works Ge~eral Manager, presented the" Debenham ". ~up to the ,vinners of the competition, each member also receIVing a medal. Mr. V. Pendred, Director and Sales Manager, presented awards gained by employees during the winter session. . Squads under the direction of Mr. J. H. Jackson, chlef ambulance man at the Works, gave demonstrations in the use of Thomas Splint, Eve Riley Rocking Stretcher, Sparklet C. O 2 Administration Apparatus, and B.L. B. Oxygen Administration Apparatus. Mr. O. H. Armitage, Chairman of the ~mbulance Committee, ably filled the chair for the occasIOn and thanked everyone who had in any way contributed to the success of the evening's programme.

FIRST

St. John Ambulance Brigade DISTRICT REPORTS. No. I (prince of Wales's) District GRAYS.-The Grays Division Social Section journeyed by coa ch to Clacton-on-Sea on Sunday July 28th, and spent a most enjoyable day by the sea.

A- number of cadets were rec<:!ntly enrolled in the newly formed C. N. 99 (Rainham) Division with C/Office~ Mrs. Hussey in charge. Amongst those present were theIr own Vice President Mrs. Evans, and Supt. Mrs. Harvey, and members of the Grays Nursing Division,

County of Berkshire. County Officer Miss D. K. Gibbins, representing No.6 Region marched with the St. John detachment in the London Victory' Parade. She was very much impressed by everything she saw, particularly by the efficiency of the merr:bers on duty in dealing with such a large number of casualtles. ASCOT.-The first aid arrangements at Ascot Races, were the joint responsibility of the Bracknell S.J. A. B. and ~he Ascot detachment of the B. R. C. S. The services were divided into two parts; the stand side being staffed by the B. R. C. S. and the public side entirel y by St. John. The County Mobile First Aid Post was sent out from Reading for the four days and was served by an ambulance sent daily from Reading. All duties were covered by members of Bracknel1 Ambulance and Nursing Divisions, Ascot Nursing Division and Reading Corps. The whole of the arrangements worked splendidly and 208 cases received attention, including- two deaths, an acute appendicitis, a fractured metacarpel and a fractured nose. Div. Supl. V.,T. A. Green of Bracknell Ambulance Division received a letter of congratulation from the County Commissioner on the excellent work put in by the Brigade. READI:-lG CORPs.-Reading East Nursing Division recently celebrated their third anniversary by a dinner party held at the Lodden Bridge Cafe. Mrs. Eaton, who formed th e Division in 1943, was presented with a silver serviette ring and an illuminated address by Ambulance Officer Miss Palm er. Mrs. Eaton is leaving the Division to take up her appointment as Corps Storekeeper (N).

County of Lancashire. LIVERPOOL.-Ex Sergeant Albert Rider of the Royal Engineers has been informed that he has been awarded the British Empire Medal, for outstanding work during his five years service in Bomb Disposal (London Gazette, June 13, 1946). Prior to joining the Army in 1940, he was for seven years a mem ber of the S. J. A. B., and is at present a Corporal in the Gainsbro' Division of Liverpool" A" Corps. Be resides at 18, Alfred Street, Liverpool, and is employed by the Liverpool Corporation Passenger Department. TODl\lORDEN.-On the evening of Wednesday, August 7 th, the District Officer Mrs. Pitter Bayley, chairman of the medical comforts department of the St. John Ambulance Nursi 'lg Division, accepted a mechanically propelled chair

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AID for the use of invalids of Todmorden. The chair was presented by Mr. W. Bailey on behalf of the Todmorden exprisoners of war as a memorial to their comrades who died in Japanese prison cam ps. The Mayor of Todmorden (Coun. F. Sunderland, J. P.) presided over the meeting, and expressed the thanks of the town to 1\1rs. Colclough and the ex-prisoners of war for their efforts which had made the gift possible. They all owed a debt of gratitude to the men and women who had served this country. It was difficult, he said, to imagine the sufferings of men condemned to captivity. In the recent war, as in the 1914 struggle, voluntary workers had not been lacking to perform the numerous jobs which needed doing when a country was at war. It was a good idea, the Mayor concluded, to present a chair as a memorial gift, and it would be appreciated by the people who would need it. A service of dedication was conducted by the Vicar of Todmorden, Rev. W. P. Black. B.A., assisted by the Rev. Joseph Scott, B. D., Mayor's chaplain. \Vhen making the presentation, Mr. W. Bailey said that the prisoners of war in Japan did not know of the efforts which were being made on their behalf in Todmorden, because they were cut off from the outside world and had to rely on rumour. Mrs. Pitter Bayley, when receiving- the gift, said it would be a valuable asset to the comforts department, which is doing splendid work. Members of the Ambulance Brigade were called upon to do strenuous work in connection with the lending of medical comforts, of which they had a varied assortment. In moving a vote of thanks, Dr. J. C. Pitter Bayley, hon. surgeon, said he would like to tell the boys who had come back from the armed Forces how much they wished them love and prosperity, and how sorry they were for those who had been left behind. He concluded by appealing to those who borrowed medical comforts not to be slow in returning them wten they had finished with them. He attributed this laxity in returning articles to thoughtlessness. Coun. Dr. S. H. Brown, hon. surgeon to the Nursing Division, seconded the vote of thanks to the people who had taken part in the ceremony and to those who had efficiently carried out the arrangements. After the ceremony, Mrs. Pitter Bayley conducted the Mayoress, Mrs. Sunderland, on a tour of the medical comforts department. Dr. Bayley apologised for the absence of the president, Mr. J. O. Sager, who expressed his regret at not being able to be present. The arrangements for the ceremony were made by l'vlr. Tom Taylor, secretary to the e~ecutive.

County of Oxford. BANBURy.-In 1945 a Band was formed by the Banbury Ambulance Division. There are 34 members, most of whom had previously been in other bands. It has been a great asset to the Division, as it has brought in quite a lot of new members. The Band's first public engagement was at the annual church parade in July 1945. Since that date a number of public engagements have been fulfilled and the Band has recently been engaged by the Banbury Borough Council to give a series of six concerts in the Park on Tuesdays. There are many bookings for future performances and it has not been possible to meet all requests. At the Brass Band Contest held in Oxford in June, Banbury was placed fourth out of twelve competitors. This reflects great credit on the Bandmaster, Mr. Smith, who has held that position with various bands for over 20 years, and has worked hard to make the band a succ{'ss. OXFORD CITY.-N (Cadet Sergeant Betty Boulton joineq

the Oxford City Nursing Cadet Division in January 1940, at the age of 11. She was promoted Corporal in 194-+ and Sergeant in 1945. She has gained 13 Proficiency Certificates qualifying for her Grand Prior's Badge in November 1943. She holds a sixth year Service Star. Sergeant Boulton was one of the first cadets to win a War Service Badge (300 hours of war service; hospital duties, toy making for war time nurseries, knitting for the Navy, etc.), in August 1942, and is the only cadet to be awarded a fourth War Service Badge in December 1945.

County of Surrey. GUlLDFoRD.-The annual inspection of the No.1 Nursing Division, Borough of Guildford Corps, was held in the Ambulance Hall, Leas Road, on Thursday, July 4th. The Inspecting Officer was County Superintendent 1\1rs. Lionel Heald accompanied by County Officer Mrs. E. J. Henry. . A demonstration of First Aid and Home Nursing was gIven; Mrs. Heald congratulated , the Division on the high standard of efficiency and expressed her appreciation of the work carried out during the war years.

County of Worcester. LVE.-A very interesting vi~it was made on Saturday, July 13th, by members and fnends of the Central (Lye) Nursing Division, to the Houses of Parliament. The party was met by Mr. Moyle, M. P. for the Stourbridge Division, who very kindly undertook to conduct the visitors round the House. They were shown the House of Lords, and Mr. l\loyle explained in a very lucid manner the traditions and customs of the House. The old Parliament, built by William the Conqueror, was next visited, and the beautiful carvings were greatly admired by the members of the party. The visitors were then taken to the House of Commons and all the interesting features were pointed out to them: Lastly, the Hall of Westminster was visited, but the beauty of this historic building was somewhat marred by bomb damage, and the repairs in progress. The rest of the day was spent in sight seeing. . DUDLEy.-Through the kindness of Dr. Temple, in loan109 the Grammar School Ground, a cricl{et match was played between Dudley and etherton Cadet Ambulance Divisions, at Dudley on Wednesday, July 10th. Netherton won the toss and put Dudley in to bat. Cadet Supts. R. H. Hines and A. J. Willetts acted as scorers in what proved to be a very exciting match, with a victory for the Dudley boys, who proved to be the better team, by S2 runs to 41 runs. For Dudley, vVare, Walling and Davies scored 38 runs between them whilst Whorton took 5 wickets. For Netherton, R. Smith scored 2-+ runs whilst Locke took 3 wickets in one over.

-------.--.------Make Your Holiday Safe. "TAKE yo.ur commonsense with you on holiday" says the Royal SOCIety for the Prevention of Accidents in an appea for care. Holiday makers can prevent trouble for themselves and others by observing these hints. Obey all warning signs. They are put there for your safety and not to bt!autify the landscape. Watch for ammunition dumps and leave all suspicious objects alone. Competent people can collect these carefully and safely. It is not a job for amateurs. Don't bathe in places marked" dangerous." Warning notices are put there by people whose experience is greater than yours. Don't leave broken glass lying around. Somebody else may pay for your untidiness. Don't eat strange berries. They may be poisonous.

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Railway Ambulance News. L.N.E.R. ENGLAND \ '. SCOTLAKD AilIBULANCE CO:\IPETITION For the first time since 1939 the L.N.E.R. Engl~n~ \" Scotland contest for the Company's Ambulance Challen(y~ Shield took place at York on August 2nd. h Cr~mp,eting teams were two from London, Bishops~ate and h . mg s Cross (Loco.), and to represent the Scottish Area were Coatbridge (Kipps vVorks) and Glasgow Queen Stred. ""' B~shopsgate :ver~ the winners with 335t marks out of a possl~le 400i Kmg s Cross second with 324, Coatbridge third With 31° 2 , and Queen Street fourth with 26f.A.. The Coa~bri?~e team were highly commended for their ;"ork in the Indlvldal contest which took place simultaneously with the team competition (they obtained 18H out of 200 possible). ~ Mr. C. l\1. Jenkin Jones, Divisional General lanager Torth Eastern Area, presented the Shield to the winners ' This is the 14th annual contest in the series, whicl~ is open to all L..N. E. R. teams on the system, and a very high ~egree of skIll and efficiency is neccesary to rea ch the final. The judges were Dr. A. C. White-Knox (London) and Dr. J. K. Sutherland (Glasgow). The team test set by Dr. White-Knox was highly topical. A bread queue entering a baker's shop (9, B. U. Wheatley) ","as startled by a loud explosion in the bakery and the "wife" of the baker told them the cras had ex~ ploded and injured her husband. The team rhen cleared the shop, .escorted ~he wife outside and, protecting themselves agamst escapmg gas, dashed into the back premises and rescued the baker (who was most realistically made up to represent him as receiving multiple injuries). He was unconscious and not breathing, but recovered after artificial respiration had been applied. Ascertainiocr the nature of his injuries, which included a fractured fe~ur, appropriate treatments were given and the patient was removed in an " ambulance" which had been summoned by telephone. The team work was very good indeed , and although Dr. vVhite-Knox characterised some of it as not accordi~ (T to the manual, a great deal of common sense was used by each team to get the patient round and made comfortable. In making the presentation of the Shield, !\Ir. C. 1\1. Jenkin Jones-an Officer of the Order of St. John-said that all present would regard the day with great satisfaction because they all enjoyed these competitions and knew how very useful the movement was. He was afraid it was not quite as popular as it used to be, particularly in the early days of the war, but he was glad to see signs of revival, which he hoped would continue. That day's contest was the first after a six years' pause. and he hoped that never again would there be such a pause, Mr. Jenkin Jones paid a well-deserved tribute to !\Ir. Bramsworth (Assistant Works Manager, Carriage & \Vagon Dept.) for the very realistic presentation of a baker's shop his people had prepared, and commented on the topicality of the subject. He hoped that next year the Shield might come to the North Eastern Area, and congratulated ea ch member of the four competing teams on the excellent standard of efficiency which they had attained. Supporting Mr. Jenkin Jones " 'ere the followin g officers of the Company :-l\lessrs. T. F. Cameron (Divisional General l\lanager, Scottish Area, Edinburgh), ]. E. M. Roberts (Assistant Divisional General l\1anag-er, N. E. Area, York), E. 1. Rutter (Superintentendent, York), R.

FIRST H. Smeddle (Mechanical Engineer, Darlington), E. D. Trask (Locomotive Running Superintendent, Edinburgh), C. M. Stedman (Locomotive Running Superintendent, York), and L. E. Marr (Passenger Manager, Edinburgh).

In his annual report for the year ended June 30, 1946, the Secretary of the North Eastern Centre, St. John Ambulance Association, states that 110 classes were conducted in the Area during the 1945/46 session. They were as follows: Darlington District 19, Hull 10, Leeds 11, Middlesbrough 17, Newcastle 37, York 16. The number of students successful in passing examinations during the period were Certificates 106, Vouchers 94, Medallions 80, Labels 1,476, Total 1,756. This shows a decrease of only 78 against 459 on the 1944/4 5 session. HONOURS. His Majesty the King bestowed the dignity of Officer Brother from Serving Brother upon Mr. J. Burrows of Tyne Dock, also that of Serving Brother upon Mr. S. P. Thompson of Darlington. Dr. R. Murray, Great Ayton and Dr. C. E. Stainthorpe, "\,valkerville, were granted the distinction of Honorary Life Members of the St. John Ambuhmce Association in recognition of their services to the S. J. A. A. over a long period of years. COl\lPETITIONS. Owing to the international situation the Inter-Railway Competition was again discontinued but will be resumed in 1947. It was agreed that the District Competitions, North Eastern Area Final, Group and England v. Scotland Competitions be held under pre-war conditions. Competitions took place in all six districts as follows : Darlington District 6 teams, Hull 7, Leeds 6, Middlesbro ugh 4, Newcastle 3, York 7, which were well attended and proved very instructive. The Final Competition was held at Leeds on May 25th, before a large audience and at the close, Mr. C. M. Jenkin J ones, the Divisional General Manager, York, presented the substitute shield to the winning team (Hull Dock Engineers) and the Hornsby Challenge Cup to the runners-up (Tyne Dock). The adjudicator was Dr. K. H. Beverley, Worsbro' Dale, Barnsley. The Group Competition took place at Marylebone Station, London, on June 14th. GOLD MEDALS AND BARS. During the year 95 medals, 3020 years' bars, 23 25 years' bars, 2 30 years' bars, 3 35 years' bars and 3 40 years' bars, were approved. Unfortunately, however, owing to the restrictions imposed by the Limitation of Supplies Act, it was for the time being not possible to obtain the medals and bars, and a suitable certificate was issued to those concerned which will be exchanged for the relative gold token as ~oon as circumstances permit. CONCESSIONS. Further concessions were being considered to stimulate interest in the Ambulance Movement and full details will be sent to the District Secretaries as soon as approval is received.

SOUTHERN District Committees throughout the line have held meetings to complete their arrangements for successful class session during 1946/47. Enthusiasm to establish first aid work as a hobby is evidenced. Competitors are

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AID keen to test their knowledge against their colleagues from other sections of the system.

DISTRICT No.3 (Gravesend, Maidstone, Tonbridge and stations to Dover) have arranged for a First Aid Quiz to be held at the Workingmen's Club, Ashford, Kent, on Saturday, October 5th, 1946, which will be followed by a social. It is anticipated that approximately 600 persons will take part in the get-together event of first aiders and their families. LONDON DISTRICT.-Arrangements have been made for socials to he held at the Victory House, Leicester Square. W. C.2, on Thursday, September 26th, Tuesday, October 29th, Tuesday, November 26th, and a New Year Party on Saturday, January 11th, 194-7. Events held last year were a great success. First aiders and their friends are advised to obtain their tickets early to prevent any disappointment. Each event will commence at 7 p. m. Tickets 2/- each, obtainable from the Centre Secretary.

may spread to the other side as well. There may be a great deal of pain, and the worst points of tenderness are about the ear and under the jaw. Complications.-Mumps is not a dangerous disease but there are complicatinns which are serious. In men ~ condition known as orchitis, or inflammation of the testicle, may develop, and this condition requires immediate medical attention. In women the ovaries may become inflamed. Nephritis may also arise after mumps, but is uncommon. Pancreatitis is the worst complication which may develop from a case of mumps. This is a serious inflammation of the pancreas, and cases of diabetes following inOammation of the pancreas are known, but rare. First Aid Treatment.-The first aid attendant must remember that this is another case where good first aid means-to get the patient to a doctor as soon as possible. Do not tell the patient that he must see a doctor because you know he has the mumps-the first aid attendant should advise the patient to see a doctor. There is absolutely no need for the first aid attendant to tell the patient it is mumps; it is both risky and certainly not needed.

L.P.T.B. 223 EXAM. SUCCESSES. -Results of examinations in Metropolitan Lines Centre held so far this season are to hand. First Aid: 4 vouchers, 7 medallions, 170 labels. Home Nursing: to certificates, 32 pendants. The examinations were taken by 224 members, only one failed.

Letters to the Editor. We are in no way responsible for the opinions expressed, or the statements made, by Correspondents.-EDIToR.

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Th e Life 0/ JeaJt llen ri DUllallt

The Epic of the RED CROSS or

The Knight Errant of Chivalry

by FERNA 1\ TD GIG01\ f \'7ith a Foreword by the Han. Sir Arthur Stanley, G.C.\-. O., C.B.C., C.B. B£1'm£ngham Post: "Mr. Fernand Gigon has rendered an excellent ~en- ice in producing this study of a most ~uman and great humanitarian." Mancheste1' Evening ~Yews: "There is some fine ~epo~ti~g as well as fascinatin g biographical detail JI1 thiS Important book" 12/6

JARROLDS Publishers (London) Ltd. First aid lectures start at Chbwick Works on September 16th, at Baker Street on September 18th.

Several busmen serve their fellows in the 87th (Shoreditch) Division of the Brigade, and one of their number. the superintendent, Driver G. E. Pawley, Hackney Garage, has been admitted to the Venerable Order of St. Jobn. In the late war Driver Pawley lectured on first aid in the East End, he served as Batt. Medical Sergeant in the 41st Batt. of the Home Guard. All this was outside his driver's duties, which required him to drive an ambulance in the air raids.

------.---.-----MUMPS. MUMPS is a very contagious disease. It is one of the commonest of the acute infectious diseases, writes Bernadette in First Aid Attendant. Mumps is more common in children than amongst adults, but not common in infants. It appears to be more severe in grown-up people and certainly causes more distress. The danger of infection is not over for about three weeks. The infection is present in the secretions of the mouth, and is direct. The incubation period varies from fifteen to twenty-one days, so no household or camp that has had a case of mumps is really safe from it until about six weeks have elapsed. Symptoms.-Fever symptoms are present. The temperature rises to 100 degs. or higher. Swelling of the glands of the neck, under the ear and perhaps under the chin, is one of the most characteristic of the signs. These glands are the parotid and submaxillary glands. The swelling usually begins on one side, but after a few days

IMPROVISED BLANKET SPLINT FOR FRACTURES OF THE TIBIA AND FIBULA. DEAR SIR,T~e Yardley Division of the Birmingham A Corps of t~e Bng-ad: have ~rought to my notice the following modificatIOn of the ImprovIsed blanket splint for fractures of the tibia and fibula. Having worked the blanket under the patient's legs and rolled the two ends tightly to the outside of the limbs as described in " Side Lights on First Aid" in your July number, proceed as follows : . Take the r?ll lyi?g against the left leg over the two 11l?bs and place It outSIde the right leg, having first unrolled slIghtly the roll lying against that limb. Now take this second roll over the first roll and the two limbs placino- it outside the left leg, then bandage as usual. ' b This suggestion has been forwarded by 1'11'. L. A. Black the Div. Supt. and would appear to be an extremely sound one. Th: fractured limb in the final result will be completely wrapped 10 the blanket, not merely in a gutter, with the tracture as before controlled both by the uninjured limb and by the two tightly rolled ends of blanket. Moreover, neither speed or ease of application are in any way impaired. The method as originally described, was extensively ~sed in the ~litzes over the West of England and proved Itself very ~~tt.sfactory, the modification suggested by the Yardley DIVISIOn should make it even more sO.-Yours faithfully, HENRY L. MARTYN, F . R.C.S. Dittisham, Devon. July 30th, 1946. ALTERATION TO UNIFORM. DEAR SIR,As the production of clothing materials returns to normal and larger quantities are released for the home market p.ractically every Division in the country will need a con~ siderable number of new uniforms for replacements long

-+7 Princes Ga te, London, S.W/·7

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His energy and spirits are amazing. Simply bubbling over with life. Keeps you " on the go." But you would rather ha\'e him that way than peevish, cross and poorly! Mother certainly knows best when she gives an ailing child , California Syrup of Figs.' \Vhen he is bilious, sick or constipated, this natural laxative quickly corrects upsets of the system, and the little one is soon "as right as ninepence."

"Califo Syr pof

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overdue and to clothe new members recruited during the war yea~s. Tours of public duty and a parade during the recent spell of " tropical" weather have persuaded m~ that this is surely an opportune moment for the style of .umform for N. C. O.'s and privates of St. John Ambulance Brigade to be brought up to date. I suggest that a tunic with lapels, worn over a white shirt with" polo" collar and black tie would be smarter and much more comfortable than the present" choker" collar. As you well know, this style is now allowed in the R. A. F. and the Army.-Yours faithfully,

E. C. J. B.

Gillingham, July 27th, 1946. REVISION OF BRIGADE REGULATIONS. DEAR SIR,Now that Victory Day has been celebrated, I think that consideration should be given by the" powers that be" for the revision of Regulations governing thE: "Brigade at Home" and the " Brigade Overseas." With a multiplicity of amendments to the original issue of Regulations (Brigade at Home has approximately 790 amendments, whilst Brigade Overseas has approximately 190 amendments), one has to be a very alert person indeed, if one is not to make a mistake in the administration of the Regulations and their respective amendments.-Yours faithfully, WM. LESLIE. Belmore, N.S.W., Australia, June 15th, 1946.

Don't Pull Children's Arms. WHEREVER we go, be it for a stroll down the street or out in the country. we find parents as well as youngsters leading little children, four or five years old, by the hand. That is quite natural. But the part which is not natural is when the parent or the playmate pulls a child by the arm. The child may stumble and is pulled, by a quick jerk, back on its feet again. Many a child of four or five has had its elbow injured by this thoughtless practice. This injury is called a " pulled elbow." 'What happens is this: The sudden forcible traction of the radius causes a downward displacement of the head of this bone. The head of the radius is pulled out from the annular ligament. The victim, suspended by one arm, sometimes has not only a displaced bone but both the capsular and annular ligaments slightly torn. The injury may also be caused by swinging the child by the hands and one hand is accidentally released so the weight of the body is suddenly borne by one extremity. Considerable pain and discomfort is suffered immediately by the child. The signs and symptoms are: The child resents any interference with the limb, the forearm is usually semi-flexed, the forearm may be held mid way between su pination and pronation, the child holds on to his forearm, nursing it and often walks around in a circle. The parent sometimes causes reduction by trying to find out what is wrong and so moves the elbow joint and extends the forearm. Other cases are spontaneously reduced. In either case, both the injured child and the erring parent, or playmate, forget the incident. Instead of forgetting what has taken place, first aid should be given. Whether or not the dislocation has been reduced, the child should be taken to a doctor. If the erring party has caused a reduction, by manipUlating the limb (not knowing what is going on), the limb should be supported by a large ar.TIsling. This sling should be worn for at least four days to give possible torn tissues a chance to heal. Proof of reduction is the restoration of power to fully supinate the forearm again. When playing with youngsters, don't jerk or pull their arms. Be careful, don't scold your child by pulling the child's arms. Act safe. Play safe. Be safe.-G. HOLMBERGH in Fz'rst Az'd Attendant.

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Queries and Answers to Correspondents. Queries will be dealt with under the following rules : 1. -Letters containing Queries must be marked on the top left-hand corner of the envelope" Query," and addressed to FIRST AID, 46, Cannon-street, London, E. C. 4. 2. -All Queries must be written on one side of paper only. 3.-All Queries must be accompanied by a " Query Coupon" cut from the current issue of the Journal, or, in case of Queries from abroad, from a recent issue.

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lie sin

YOUR han d s

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

Poisoning and Multiple Injuries. W. K. (Shotton).-At recent Police First Aid Competition the competitors were asked to deal with a patient suffering from prussic acid poisoning, burst varicose vein, wound at back of head with arterial bleeding and a fractured patella. Would you kindly tell me the correct treatment for same, in anticipation of which I tender my best thanks? With this combination of poisoning and multiple injuries . the condition which calJs for immediate attention is, of course, the prussic acid poisoning because the drug is so quickly absorbed into the system. Further, the possibility is that, by the time the team reaches the scene of the emergency, the patient will be in a state of collapse, in which condition there is not likely to be severe haemorrhage either from the wound on head or the burst varicose vein. The first stage in treatment, therefore, is clearly for one Bearer (having tied feet and ankles together to minimise any risk of aggravation of the fractured patella) to commence at the earliest opportunity artificial respiration by Schafer's method which, if and when patient is able to swallow, may be interrupted while another Bearer administers one of the stimulants named in Rule 2 on p. 176 of Textbook. As soon as water is available, it should be dashed on head and spine (Rule 3, p. 176) while the first Bearer continues with arti ficial respiration. Then, as opportunity allows, the fractured patella should be immobilised by the application of splint and bandages as laid down on pp. 88 and 90 of the Textbook, except that the raising of feet and head and shoulders should be deferred if patient is still unconscious. It is noteworthy that, when in prussic acid poisoning a fatal dose is taken, the patient is nearly always insensible in two minutes and also that the drug is so rapidly eliminated that, if life can be maintained for half an hour, the recovery of the patient is probable. - N. CORBET FLETCHER.

Examination Howler. E. M. (Highgate).-In a recent examination, a candidate was asked to state the treatment of complicated fracture of ribs involvin g the lungs. She made a good start but stumbled when, quoting Rule 3 on p. 80 of Textbook, she said :-" Loosen clothz'ng, give z'ce to suck and appZJI cold compress to seat r;J.pa.tient ! " Good!

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Sympathetic Nervous System. E. K (Hanwell). -At a recent Divisional Practice, during which a discussion was taking place, we were unable to agree on the following question : " Does the sympathetic nervouS system come under the control of the brain? " Your opinion on this point. will be appreciated. In reply to your query, I cannot do better than quote from Tlte Mode1n Physician which was compiled by the late Dr. Andrew Wilson, and reproduce here the appropriate section : " A sharp distinction may be drawn between the brain system of nerves and the sympathetic system whi~h ~1as been termed the involuntary nervous system . The pnnciple here represented is that of the division of labour. It is obvious that the savina of the work of the superior nervous system (devoted to th: control of the body) through the action of the sympathetic system must constitute a very important feature of personal life. In other words, the brain system is the prominent and responsible one; and it is left free to devote its attention to the pressing questions of the day and hour. The purely mechanIcal work of life, on the other hand, is carried out by the sympathetic system of nerves." From this you will see that the brain is in supreme control ; and it is known that, following injuries to the higher centres of the brain, the sym pathetic system will after a short period cease to function.-N.C.F.

Area Cadet Officer. W. E. (Dorset).-Please inform me what is the status of an Area Cadet Officer in the Bri gade and what are his markings. We are informed that the status of an Area Cadet Officer is normally that of a Corps Superintendent, and that his badges of rank are white piping on epaulettes with a silver crown.-EDlToR.

Fracture of Humerus. A. M. (Leicester).-At a recent re-examination I was asked to treat a fracture of humerus close to shoulder. I applied a small arms!ing first and then two broad bandages round upper limb and body. My Superintendent told me that I should have put on the armsling after I had applied the bandages round limb and body. Please tell me if this is correct. The golden rule in the treatment of fractures is "first control the fracture, then the splints, and finally the limb." This is emphasised by the instructions on p. 82 of the Textbook where you are told in Rule 1 to apply a broad bandage and in Rule 2 to apply a small arm-sling. In short, the criticism of your Superintendent was good and sound.N.C.F.

Treatment of Compound Fracture. G.E. (Bettws-y-Coed).-Please tell me if, in the treatment of a compound fracture, splints should be used when the fragments protrude. I awai.t your reply with interest. It is obvious that with a compound fracture (bone protruding) there is a wound which calls for treatment, and that such treatment may necessitate some modification of the position and number of splints. With this injury I am of the opinion that splints are necessary, although these must be so arranged that there is no pressure on the fracture itself. In this connection you will find that such discrimination is taught on p. 18 of the Textbook where it deals with "The Essentials of First Aid." - N. C. F.

AID

FIRST

Medals. J.S. (Stanley).-Can you kindly tell me to what medals I am entitled, if any, and to whom I should apply for them? Particulars of Service :-S.J.A.B., 1931 to present date; M.H.H.R., 1932 to Sept. 1939, then" called up "; R.A.M.C., 1939 to Feb. 1945. I am still serving in theS.J.A.B.; and during the period in the M. H. H. R., and Brigade I com plied with all requirements as regards" efficiency." On completion of 15 years efficient service in the Brigade you are entitled to the Service Medal of The Order, for which application will be made by your Superintendent. There is no medal for service in the Military Home Hospital Reserve. Lastly, for medals awarded for service in H. M. Forces, you can apply to the OI C of your Depot if he has not already communicated with yoU.-EDITOR.

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COOKERY & CATERING MANUAL

Complicated Fractures of Ribs. M. U. (Phlistow).-In treatment of complicated fractures of ribs the Textbook tells us in Rule 2 on p. 80, to incline patient towards injured side. Please tell me why this is done and what, in your opinion, is the correct inclination of such a patient. Your kind reply is eagerly awaited.

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"Vhen the ribs on one side are broken, pain will cause a diminished range of movement. For the proper supply of air, therefore, the patient is dependent on an increased activity of the sound side which must not be handicapped in its movements. By inclining patient towards the injured side we accomplish both objects; and to me the correct inclination is effected by means of a blanket folded three (or at most four) times and placed as a pillow length wise along the patient's back.-N. C. F.

by BEATRICE AGAR.

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Humour in First Aid. M. W. (West Hampstead) -Recently a neighbour asked me if I could do anything to ease the pain and discomfort in his mouth. So I asked him what was the matter; and he replied-" lVEy doctor says that I have dia1'l'lwea of the teeth! II With difficulty I managed to conceal my amusement at this explanation but I made up my mind to send the joke to FIRST AID forthwith. Good!

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

Dislocation of Joint. W.S. (Oxford).-Recently I had to treat a man who had dislocated his shoulder. He was complaining of numbness in the joint and of pins and needles below the joint. I looked up the Textbook for an explanation of these symptoms but could not find same. So in my difficulty I turn once again to you to help. 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-needles) sensations below the joint. -N.C.F.

PRICE, 'Post free: 5s. 6d. per dozen. Remittances

Two-Handed Seat. R.T. (Moulton).-One of the most difficult forms of transport by two Bearers is the two-handed seat. I find it beyond my ability (1 po get a secure grip which can be

MUST

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DALE, REYNOLDS & CO., LTD., 46, Cannon Street, London, E.C.4.

It's a real comfort to know that' l\Iilk of M'agnesia '* is always to be found in its proper place-the Medicine Cabinet. Then everyone in the fan1ily can find it promptly when digestive upsets call for relief.

'Milk of Magn~'~'"t~ A PROVEN PRODUCT OF THE CHAS. H. PHILLIPS CHE~l1CAL co., LTD.

FIRST

DI.E IG -FIRST -AID "It doesn't hurt in the least "-Iglodine can be applied to an open wound without pain. This safe, but powerful antiseptic cleanses and heals cuts, wounds bruises, scalds and burns.

Th~ PAINLE.SS Antiseptic

Used by Factories, Hospitals, and Ambulance Authorities throughout Great Britain. PROFESSIONAL SAMPLE SENT ON REQUEST

From Boots' and all other Chem/sts-

If-, IflOt, 2/11. The Iglodine Co. Ltd., Newcastle upon Tyne.

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ADAM, ROUILLY &

co.,

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AID maintained for a reasonable journey, and (2) to rise with a patient who is near my own .weight. . The following method whtch I have worked out wIll enable the operation to be successfully carried out : Fold a triangular bandage narrow and tie it with a reef knot so as to form a ring of about 10 in. circumference as in diagram Fig. 1, each loose end being in turn wound round and the ends being secured by a half hitch as shown in Figs. 2 and 3. This forms a semiriaid ring which can be held by one Bearer who passes it 5 well up under the patient's thighs where it can be grasped by the opposite bearer, both being down on one knee. The free arms are passed under the shoulders and the patient raised to a sitting position, the bearers then come to a stooping position and lift. It can also be used 1n the same circumstances as the three-handed ~eat by holding the ring in the inner hand and each Bearer supporting the injured limb; one holding the thigh and the other the calf. Further, it can be improvised by a len g th of string being coiled and the strands bound by string or handkerchief, &c., forming what is nautically known as a selvagee strop. My recollection of the" human stretcher" is of the same difficulty, and had this simple assistance been employed, it is possible its use would not have lapsed. There is much to be said in favour of your suggestion, which meets a difficulty experienced by all first aiders, and, in my opinion, is worthy of adoption in the forthcomin g revision of the Textbook. Incidentally, there is no need to introduce further diagrams (which lack of space prevents reproduction here) because your ring pad made from a trian g ular bandage is merel y a development of the ring pad described on p. 117 of the Textbook and illustrated in Fig. 64. To me, this ring pad is more satisfactory than that made from string, because th e latter, given a heavy patient, may cut into the hands of the Bearers.-N. C. F.

Aug., 1946.

(.6.rticulated & Disarticulated)

HALF-SKELETONS,

EMERGENCY TREATMENT

OF SKIN INJURIES Be prepared for an emergency and keep Cuticura Brand Ointment in your First Aid Kit. It brings instant soothing relief to cuts, burn~ , skin lacerations - prevents spread of infection. quickly heals. Obtainable at all Chemists and Stores.

SON, Ltd .

CLIN ICAL

THERMOMETERS.

Completl:l 10 CaGer

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Bailey's" Premier" Splint Set, comprising 3 Finger, 16 Fore Arm, 16 Upper Arm, I Set (3 sizes) Angular Arm Splints, 6 Assorted Leg and Thigh ranging from 24"'-54"', (44 Splints in all) - - - PRICE 21/-. (Post and Packing 2/- .)

Tunstall Bandage Winder each 6/6 Splinter Forceps, pair 3/6 St. John's Pattern Tourniquet 1/9 each Solid Steel Scalpels 4f6 each N.P. Scissors from 7/6 pair Artery Forceps, N.P. 6f- pair Fitted Pouches and Haversacks always in stock. Let us quote for your First Aid requirements. 46, OXFORD STREET, LONDON, W.1. 'Gramll "Bayleaf, London." ' Phone : Gerrard 31B5 &. 2313

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Seven th Edition. 1 •• 3d . post ~d. Flrlt-Ald Simplified and Tabulated, with Aldl to Memory. Col. Sir lames Can tlie contributes an mtroduction and we en dorse his g ood opinion 01 t lu book." -LAN CET ,

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Third E dition . Price 18. ~d . , post free. Hom•• Nanln, Simplified Iln d Tabulated, with Ald. to Memory. This book w01tded'ully simplifies a complex sulnect and should be read b." stude1tts." -L. & N.W . R v . G AZRTTR.

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Fourth Edit ion . Price 18. 3d. post 2!d. Problemlln Stad" Treatment and Examination lolved lor Senior StadenU. " Without doubt the book w i ll be Of g-reat service in tlu t rai1ting of those f or wkom it is desig ned.' - BRITISH MEDICAL JOIJ R NAL.

Classified Advertisements. Adv ertis e ments with remittance should be sent to ,First Aid, 46, Cannon Street, London , E.CA. Rat e 3d. per word, minimum 45. 6d. Trade advts . 4d. per word, minim u m 65. Box numb ers Is. extra .

7/ 6. Posters, Hats, Memos, Rubber Stamps . 25 0Tickets " A" 11, Oaklands Grove, London, W.12. AID Competition and Practice Tests. No.2 series. FIRST 6 Team, 6 Individual, 6 Oral. Price 2/- postage 1d. TICES,

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From: Robinson, BCM/ Superb, London, W.C.1. Colliery Ambulance Division. Annual ComH ARDWICK petition for the (( Graham" Cup will be held in the . Holmewood Miners Welfare on Saturday, September 14th, 1946. Apply for entry forms to the Secretary, J. Cocking, Haslemere, North Wingfield, Chesterfield. SALE B.R.C.S. Uniform, G'Coat, Cap, etc., hardly FORworn, will accept reasonable offer. View evening. Phone Edgware 4586. DIVISION. The 4th Annual Open SADDLEWORTH Ambulance Competition to be held in the Mechanics Inst., U ppermill, on Saturday, Sept. 21st, 1946, at 2 p. m. Sec. Superintendent W. H. Wood, 12, Court Street, Uppermill, Oldham.

COMMON

ERRORS

FIRST-AID.

Third E dition. 1•• 3d. post ~d. Errorl In Flnt.Ald Detailed and Explained. This book gives a clearer insig ht into the methods an d ditJiculties 0/ emergC1tcJl treatment by laymen than the otJicial Textbook i tself. "-LANcRT.

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Stretcher, Individual and Question-S ix F olders). Price 6 for 35. post 3d .. Ea~~ Folder contains special ar ticle on C ompe tit ions :- No . I, T raining of Competition. Teams; ~~ . 2 , Conduct of T eam in C o mpetition Room; NO.3, CommoD Errors In Compet ition ; ~o. 4, Further Errors in Treatment ; NO. 5, History o f Competition Tests; No. 6, P reparation of Tests .

WHY

AND

WHEREFORE

FIRST-AID.

Fifth Edition. 18. 3d. pos t 2d. DlfHcultl.. la Study and Treatment lolved by QueatloD aDd ADlwer. "We commend this book to Lecturers a1td S tudents who will /i1td it oll>re~ ( .rervice."-FIRST AID.

HINTS

FOR

A HINT TO HELP

S( N TROU LE HEAL QUICKLV What a gratifying experience it is to find that the skin no longer irritates, and has become clear and healthy again. Germolene has helped many a skin sufferer to get rid of his, or her, complaint ... and it is interesting to know why t h is should be so,

PROTECTIVE

ANTISEPTIC

First, let it be said that Germolene has proved to be a protection against deliberate or accidental irritation. Without the soothing, cooling touch of G ermolene some skin troubles provoke scratching which, of course, delays healing.

Th e purifying effec t of Germolene penetrates down into the sweat pores, hair follicles and sebaceous glands, counteracts the activity of skin germs, reduces inflammation. If you are suffering from skin trouble get a tin of Germolene today ! 1/4 & 3/3 including Purchase T ax.

NEVER

Use Germole1'le for ECZEMA, PIMPLES, IRRITATING RASHES, CUTS, SPOTS, BURNS, SCALDS, ABRASI ONS, Etc.

WI T HOUT

HOSPITAL ORDI!RLI1!8.

Price 9d . po.tale 2d. Orderl, Dutlel Simplified Qnd Tabulated, with Ald. to Memory. A most comjJact brochure . . cont ains m uch useful information. "- PRRSCRIBI!. R.

To be obtained from DALE, REYNOLDS & CO., LTD. 46, Cannon Street. London, E.C.4.

OINTMENT

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"PORTLAND" AMBULANCE

C(!Dbe ~nbepenbtnt 30urnal for rl)¢ Ambulance nub :3}lul'sing J¢t'\l~

CEAR

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 two stretchers in position.

Shows the top stretcher lowered ready for loading.

C. Illustrates the same Gear with the top stretcher frame king-cd down for use when only one stretcher case is carried.

, Where Ambulances are required to carry four beds two Gears are fitted, one on EITHER SIDE, and the same advantages apply as described above.

By KATE STEVENS

FilII cotalogue of Ambulance Equipment No.7 A wiil be sent on request. I

--------~

~-------------------

KAIH'ALI "l, VlfSDO, LONDON

K. F. Armstrong, S. R. N.

~~~O.q;

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MANUFACTURERS. IS4-I64, TOOLEY STREET,

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JORDAN

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~~~

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THE TYPIST'S TREASURY

D. Shows the same position as in .. C" only with cushions and back rest fitted for convalescent cases.

Handbook of First Aid and Bandaging.

SEPTEM BER, 1946.

No. 627, Vol. LIII.]

"Phone:

"Gram.:

Hop 1.476 (4 UncI)

.. Hobeon, Boroh, London."!

One or other or. all of the three races of germs, Streptococci, Staphylococci and B. pyocyaneus are found in every skin infection common to this country, and ANTIPEOL OINTMENT contains the antibodies (antivirus) of these germs. Healing is expedited by the proved ingredients of the ointment, and septic development is stopped or prevented by its antivirus sterile vaccine filtrates. ANTIPEOL OINTMENT is unsurpassed for BURNS and SCALDS, for it is microbicide and non-adhesive, and dressings do not require to be changed every day. WOUNDS, BURNS, etc., WILL NOT TURN SEPTIC if treated with ANTIPEOL OINTMENT.

OPHTHAlMO-ANTI PEOl is a semi-fluid ointment, more convenient than the ordinary Andpeol ointment for ocular infections and lesions. Eyes affected by smoke and dust are soothed almost immediately by the application of Ophthalmo-Antipeol, and the antivirus prevents germs from developing.

RHINO-ANTIPEOl ~ords rapid relief of COMMON COLDS, IN~LUENZA, 4ND CATARRH. Containing. the antibo~ie~ of the ge~s common ~o mfections of the nose and pharynx (StaphIylocoCCI, StreptOCOCCI, B. pyocyaneus, pneumOCOCCI, pneumobacilli, enterOCOCCI, M: catarrhalis, . B. Pfeiffer), Rhino-Antipeol is not just a palliative, but is a remover of the cause of the infection. During epidemics It is the ideal preventive of microbe development • Clinical Sample. 00 requelt from MEDICO-BIOLOGICAL LABORATORIES LTD., Car.r•• o Road South Norwood, London, S.E.15

Printed and Published by DALE, REYNOLDS & Co, LTD., 46, Cannon~street, London, E.C.4, to whom all communications should be addressd Teleg1'ams-" Twenty-four, London." Telephone-City 77 IO. To be had of all Newsagents, Booksellers and Bookstalls in the United Kingdom and at all Railway Bookstalls of Messrs. W. H. Smith & Sons .

FIRST AID

"SANOID" INTERLOCKING EXTENSION SPLINTS (Patent Number 53165 of 2817139.) INCURVED EDGE OF SOCKET /

TRANSVERSE GROOVE OF . S!LlNT

~~ ~S!P~L~IN~T~~~~~~~S~0~9EK!E:2T===~ €¥$§ S PL I~~ Sound t ee th are amo n g t he most valuable possessions yo u can ensure for your child. Here is a wa y to make certain h e keeps th em cl ean and healthy: see that he brushes them with Ph illi ps' D ental Mag nes ia twice a day. R egul a r u se of Philli ps' D ental Mag nesia, which is the one toothpaste con ta inin g • Milk of Magnesi a',* neutralizes harmf ul mouth acid s a nd h elps to keep tee th white and free from decay . Make sure yo ur child's futur e in clud es that sparkli ng Magnesia s mile!

Sold everywhere I/Id. and I/ IOt d .

S.1343 .. SANOID" INTERLOCKING EXTENSION SPLINTS With Metal sockets for jointing. 2 pieces : 2 5/Bths. In. x 3/ 16ths. In. x 15 In . 2 pieces : 2 5/8ths . In . x 3/ 16ths. In. x 13t in. I piece: 2 5/8ths. in. x 3/ 16ths. In. x 7t In . I piece: 2 5/8ths. In. x 3/ 16ths. In. x 6 In. 2 Webbing Straps with metal buckles: 18 In . x I In . 2 Webbing Straps with metal buckles: 27 In . x It In. 3 sockets.

NOTICE

* ' M ilk o f Magnes ia ' is th e trade mark of Phillips' preparation of magnesia. ADAM, ROUILLY & CO.,

By this Invention Splints made In any convenient lengths make rigid connections by means of incurved opposite edges of the metal 50ckets or sleeves firmly engaging with transverse grooves In the 5urfaces ofthe Splints when pressed home Into the 50cket. Unlike the ordinary socketted Splint, this type Is rigidly coupled together and held against relative displacement but can be disengaged by pulling apart with sufficient force. N.B.-To ensure perfect locking It Is Imperative t hat the Splint should be correctly Inserted In the socket, I.e., BY MAKING CERTAIN THAT THE INCURVED EDGE OF METAL SOCKET ENGAGES WITH THE TRANSVERSE GROOVE OF THE SPLINT.

* ** First

Aid Specialists

MADE UNDER THE SUPERVISION OF PROFESSOR C. F. V. SMOUT, BIRMINGHAM UNIVERSITY.

FIRST

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336 pages.

"FI RST AI D" 3/6

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Treatment of Poisoning Examination H owler Compound Fracture of Patell a Negative Press ure ... D efen ce Medal Promotion within Brigade .. . Bleeding fr om T ooth Sock et Humour in Firs t Aid R ate of H ear t Bea t Loa din g Stretch er .. . Atta chments of Patella

E " t,,,,d a t ] [ Statio",,,s' H all

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Phillips' Dental Magnesia!

SEPTEMBER, 1946.

No. 627.-VOL. LUI.

INCURVED EDGE OF SOCKET

32 32 32 34 34

34 3.f 3.f 3.f 3.f 3.f

THE tern porary set-back in the numerical strength of First Aid, Ambulance and allied organisations is another proof of the ev ils for whic h warfare is responsible. There was a dro p in the membership of all societies, but recovery h a~ been rapid, and there is every indication o.f res.uscitated. substantial progress. Never at any t Im e In the hIstory of these organisations was a keener interest awakened in the public mind. \Ve a re n o t concerned with the actual figures at the mome ;lt, and this passing reference must suffice as som e indication of the way in the wind is blowing. Du r ing the war, countless thousands who had never h and led a tool or worked at a bench joined the giant army of workers. Accidents were comparatively few, but enough to instil into the minds of the w o rkers the value of first aid. It was recognised t hat, as a preliminary to medical treatment and n urs ing ca re, first aid, intelligently applied, was invalua bl e. Of importance, too, was recognition of th e fact that it was the first twenty minutes which m ad e, in many cases) all the difference between recovery and final collapse. It is scarcely necessary to say th e objects of firstaid are two-the alleviation o f suffering and the prevention of the aggravation of the injury or illness by injudicious handling. Rashly to raise the injured person may seriously agg ravate the injury, and a person with a knowled ge of first aid will apply the neces5ary treatme nt befo re moving the patient. As has been said, "many instances can be given in which life has been u nn ecessarily sacrified while untrained onlookers h a ve all owed the vital momen ts to pass." The first du ty of the first-aider is to get the patient to the h osp ital or under the care of a doctor. It is safe to say that in every industrial country the casualti es atte ndant on civil life, resulting in death or mo re or less serious injury, are approx imate to the losses e ntai led by a considerable war. Compet iti o n is th e soul of progress, and we welcome the retu rn of contests between first aid teams from the Lo ndon Passenger Transport Board, the railway serv ices and others . Vve signify here that we g ive thes e co n tests our co-operation in the way of publicity and keen inte res t .

Progress in First Aid?

FIR S T

AID

Side Lights on First Aid. By SIR HENRY L. MARTYN, K.C.V.O., F.R.C.S.

THE bleeding nose and the cut tongue, how easy it sounds in the textbook to deal with either, and yet how extremely difficult it is in practice and how very common these emergencies are. The former may occur from injury, in which case the hcemorrhage may come from anywhere in the nasal chamber, but it is most commonly due to the spontaneous rupture of a tiny vein which exists on one side or other of the septum, or division of the nose into two parts, barely half an inch inside the opening. You will probably find the patient doing everything he ought not to do. Either lying down surrounded by anxious relatives or leaning with head well down over the sink. violently blowing or sniffing away the blood and bathing his face meanwhile with a large towel dripping with volumes of cold water. Put a clean dry towel round his neck and sit him up for a start, with his head leaning slightly forward, thereby facilitating the venous retu;n and inducing the blood to run out of his nose rather than down the back of his throat. Stop all the excitement and tell him to cease attempting to clear his nose by blowing or sniffing, wipe the lips when necessary and allow him occasionally to rinse out his mouth. Reassure him and put a small towel or a swab of wool well wrung out in cold water on the bridge of the nose. Note that I said well wrung out, if the water is allowed to flow down over the lips, some will find its way into the nasal openings and tend to wash away the clot we are so anxious to form. Try all this for five minutes by the clock, if at the end of that time the flow is as brisk as ever, take the end of the patient's nose between finger and thumb and compress both sides. firmly, making him breathe meanwhile entirely through hiS mouth. By so doing you will be compressing the actual bleeding spot. Keep up the pressure for three whole minutes by the clock-which you will discover is much longer than you thin~~-and then relax gently. It is ten to one you will succeed by this method in stopping almost all spontaneous hcemorrhages from the nose .in. young adults, but-having successfully stopped one-1I1slst that the victim report to his doctor or the nearest hospital, where the tiny enlarged vein which has caused all the trouble can be permanently and painlessly destrore~, that is unless you want the whole party all over agam 10 a week or ten days' time. As to ~ea~in~ with hcemorrhage from a cut tongue or ch~ek,. agalO It IS a. matter of knowing what to do and domg It ?rmly. ~Ither ~onditio,: is the common injury to the. child who trIpS while runn10g and bites tongue or ch.eek 10 the fall. A tongue can be literally half severed in thiS way, and appalling injury to cheeks, tongue and palate may result to the unfortunate infant whose parent has been fool enough to allow him to run about with a tin trumpet in his mouth. . You will find the infant yelling his little heart out the while h~ coughs, splutters and reaches, covered from head to foot 10 blood and froth. First catch a suitable assistant pr~ferably not the mother. Get a large towel and wrap th~ cht1~ carefully i~ it, enrolling arms and legs firmly, and gett10g your asslstan~ to hold the wriggling cocoon erect between her knees With the head against her chest. Slip

a fold of towel between your own index finger and thumb in such a way that not only will tongue or cheek not slip from your grasp. but your fingers are protected from the sharp teeth of your. probably terrified, patient. If it be a tongue that is injured, get the finger beneath the cut and the thumb on top; if it be a cheek, let the thumb go inside the cheek and the fingers outside, or vice versa, according to the side involved. In either case compress firmly and hang on until a doctor can be called to deal with the matter with a stitch. The child may make frightened efforts to bite, and it may be necessary to obtain a second assistant to steady the head and to defeat the efforts at cannibalism by firmly pressing the child's cheek inwards between the back teeth. All this sounds very alarming, but provided the child is held really firmly by your assistants the process is neither difficult nor painful, but you must know exactly what you intend to do and be prepared to do it. Half measurp,s do more harm than good, and merely terrify the child and increase the hcemorrhage. Many people find it difficult to comprehend how internal hcemorrhage can prove fatal; that a patient may die from loss of blood without visibly losing a drop is to them an enigma. Let us be quite clear therefore that a man's blood is only of use to him when it is within his own circulatory system; it might as well be on the floor if it has escaped into his stomach, bowel, or the cavity of his abdomen. Upon the first aider's ability to diagnose that a patient is suffering from internal hcemorrhage his life may literally depend. Remember that it is a condition which may be met with not only as a result of injury, but as a complication of disease such as gastric or duodenal ulcer, and you are as likely to meet with it in your own or your neighbour'S house as you are at the scene of an accident. Once diagnosed, there is only one answer-a doctor and transport to hospital, and in the meantime treat the shock. The diagnosis sounds sim pIe and the signs and sym ptoms obvious, but just think of them for a moment as they would very possibly occur. Picture a patient, run down by a car, lying in the road groaning and complaining of agonising pain in the left Oank. He shows all the signs of severe primary shock, pallor, cold sweat, a small fast pulse and perhaps vomiting. Now what signs and symptoms would lead you to think that the patient was also suffering from internal hcemorrhage? Not so easy, my friends, if you think of it like that. He is already pale, faint and giddy, with a fast pulse, but, since he is bleeding internally from a ruptured spleen, he bas progressively less and less blood available to carry the vital oxygen to his tissues. His breathing therefore becomes more and more laboured and gasping in an efiort to get all the oxygen he can into his lungs for the little blood he still has available to carry it. Instead of lying listless and disinterested in his surroundings, he becomes restless, throws his arms about and tends to take gasps of air like a fish out of water, he shows, in fact, every sign of the so-called and quite characteristic air hunger.

FIRST Remember, therefore, if you do find a shocked patient who is even beginning to exhibit air hunger and restlessness instead of shallow breathing and listlessness, think at once of the possibility of internal hcemorrhage, and-get busy, or it will be too late! At this point I think' the weary, and probably bored, student deserves one spot of cheer. No longer is he required to learn all about the treatment of wounds caused by venomous snakes or rabid animals. The supplement to the standard textbook states that these subjects will not in future be included in the syllabus of examinations in the United Kingdom. The respiratory system and artificial respiration are subjects which students generally enjoy. Even the anatomy is not difficult, and, for some unknown reason, most people seem to like doing artificial respiration. There are only one or two points to which the attention of students need to be directed. In your haste to get to work at artificial respiration itself, do not omit first of all to ensure that the patient's air way is not obstructed, for instance, by artificial teeth, weeds or vomited food, and do not forget that if an unconscious patient falls upon his back, as, for instance, in a case of concussion, he can quite easily suffocate himself by reason of his tongue falling back and obstructing his larynx. Do not waste time in removing the patient's wet clothes, wrapping the body in warm blankets, drying and rubbing the limbs, etc., make the bystanders do these things, leaving you free to get on with the urgently needed artificial respiration. Get someone to check over the body for evidence of other injuries. I have seen a case recovered from the water on which artificial respiration had been carried on energetically for more than an hour betore it was appreciated that the whole of the top of the victim's head had been smashed in on the rocks. One last word! What does A do if he finds his patient with smashed ribs or collar bones? The answer is, of course, that he uses the rocking stretcher, or Eve's, method of artificial respiration. This is a most valuable alternative method now described in the appendix to the new supplement. The student will now be expected to know all about it, and-as an adjuvant to artificial respiration-let him not forget the use of carbondioxide.

Nostell Colliery First Aid Society. A MOST pleasing featUle of the meeting of the junior section of Nostell Colliery First Aid Society was the presentation of preliminary first aid certificates to those members who had been successful in a recent examination. The assembly was graced by the presence of the Society President, Mr. W. L. Whittle, Hon. Serving Brother of the Order of St. John, and Mr. H. Hartley, manager of N ostell Colliery, who made the presentations. Mr. Whittle said that he had been particularly pleased with the result of the boys' endeavours and that of their instructors. Mr. Hartley. continued Mr. Whittle. had previously expressed his pleasure in a practical way by offering a prize of £1 to the most proficient boy undertaking the examination. First aid was a most important work in our national life, and he hoped the boys would continue with their studies. Mr. Hartley, making the presentations, said the certificates represented the fruits of some excellent work by the members and their instructors, Messrs. E. H. Fenn, D. Makinson and J. Abbott, all of whom were doino- a useful job. First aid was most useful knowledge for ~y boy to possess. .Preliminary certificates were handed to Bernard Selby, Regmald Webster, William Daley, Roy Pease. Louis Martin, Harold Booth, David Conway, Mark Abbott and Arthur Askey.

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St. John Ambulance Brigade DISTRICT REPORTS. Brigade Headquarters The Surgeon-in-Chief regrets to inform all ranks of Surgeons of the Brigade that the Surgeons' Week-End Conference, which he had hoped to hold at the end of September, will not take place owing to the insuperable difficulties of accomodation and catering'.

County of Kent. FOLKEsToNE.-The annual inspection of the Folkestone Corps, the first to be held since 1939, took place at the Corps headquarters, on Sunday, August 18th. The inspection was made by the Kent County Commissioner, J. H. Day, Esq., M.B.E., J.P. who was accompanied by County Officer C. C. Elam, O. St.]., Assistant County Supt. Miss H. May, S.S.St.J., County Officer the Hon. Mrs. C. Neame, County Cadet Officer l\liss Curzon Smith, S.S.St.J., and Area <;adet Officer Miss G. Higham. They were received by A/ Corps Supt. W. Smith. S. B. St.]., Corps Officer L. B. Easton, S. B. St.]., Corps Officer R. Moat, S.B.St.J., and A/ Corps Officer 1\1iss M. Davis. The Divisions were formed up under the charge of the following Officers, Supt. J. Huntley. S.B.St.J. (Ambulance), A/Supt. Mrs. P. Hadaway (Folkestone Nursing), Supt. Mrs. A. Jay (West Folkestone and Sandgate Nursing), Supt. Miss D. Simpson (Cheriton Nursing), Cadet Supt. G. Huntley, S. B. St.]. (Boy Cadets), Cadet Officer Miss E. Rigden (Folkestone Girl Cadets), Cadet Officer Miss C. Breed (Cheriton Girl Cadets). After the inspection, which included a display of first aid and nursing, the Commissioner addressed the Divisions, complimenting them on their smartness and their enthusiasm in the work they were doing. He thanked them on behalf of the Chief Commissioner for the great service they had rendered throughout the period of the war which had been a very trying period for everyone, especially in this corner of Kent. He was sure that they would continue to serve the community in the best way, and so uphold the traditions of the Order of St. ] ohn.

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County of Leicester.

DONISTHORPE COLLIERY.-One of the largest and most successful ambulance competitions ever staged in the l\1idlands was seen on Saturday, August 31st, in the Donisthorpe Church Hall, when the annual competition was revived after a lapse of seven years, due to the war j 29 teams from all parts of the Midlands competed for the challenge cups. The Judges were Dr. Robertson (Div. Surgeon), Dr. Camac (Church Gresley) and Dr. Bewick (resident Surgeon, Burton Infirmary). The practical test was: an elderly man had fallen down when crossing the street, and the teams had to diagnose and treat the case, which was a fracture at the neck of the right femur and a fracture involving the right elbow. The winners were as follows ;-1, Bestwood Colliery A, 185 points; 2, Pinxton Colliery, 181 ; 3, Bestwood Colliery B. 166. ViTinners in the Cadet Section were; 1, Donisthorpe Colliery A, 112tpoints j 2, Gresley Colliery B, 10+ j 3, Shepshed Division, 92. Other teams competing were; Bentinck. Babbingtun, Blidworth, Cinderhill, Thoresby, Donisthorpe, Gr~sley Collieries, Rolls Royce Motors. Coventry Morris Engmes, Chesterfield Steel Tube Works, Burton, Sapcote Lutterworth, South Wigston Ambulance Divisions.

FIRST At the close, Lady Turner, J. P ., congratulated all the teams and presented the prizes to the winners. Refreshments were served by the Divisional ladies committee. After the competition a very successful dance was held in the Hall, when music was supplied by Len Nash and his band.

County of Worcester. OLD BURY.-This Nursing Division recently held a party to ce lebrate its 21st birtbday. The event was held at the Titford Road Girls School and in addition to existing members all old members were invited. Mrs. A. Bird, who is at present Acting Div. Supt. of the Division, presented to Miss Dysor" her badge of office as Divisional President, and 1rs. Gould became the first VicePresident. Miss D yso n, in thanking them for the honour conferred upon her, gave a brief resume of the history of the Division, and among other things pointed out that the Division was the oldest Nursing Di vision in the North Worcestershire Corps. After tea, games were enjoyed. LYE.-An inspection of Lye Nursing Division, by the Corps Officers, was held during August. The inspecting Officers were Corps Supt. 1\1iss Ashton and Corps Officers 1rs. Northwood and Miss ·Wakefield. In parade were Div. Supt. 1\1rs. Price, Cadet Supt. Miss Green, Cadet Officer Mrs. Griffin and 17 Ambulance Sisters. After demonstrations of first aid, home nursing, company drill and hand seat drill, refreshments were served. The inspecting Officers expressed their satisfaction with the books, records and work of the Division. A successful camp for Nursing Cadets of the S.]. A. B. in (he County of Worcester, was held at Astley Burf Camp, Stourport (by kind permission of the Dudley Education Committee) from July 27th to August 3rd. Seven cadets from Birmingham County were also in camp. Officers present were '\1rs. Hugh Robinson, County Cadet Officer and Mrs. W. Lamb, Area Cadet Officer and Camp Commandant, assisted by Miss Margaret Newton (daughter of Dr. F. L. Newton, County Commissioner for Worcestershire. The County Commissioner accompanied by Mrs. and Miss Newton inspected the camp and expressed his approval of the arrangements. The cadets, who came from various Divisions in the county enjoyed visits to Stourport, Stratford-on-Avon, Evesham and other places including a river trip on the Severn. The Officers were p.ntertained on the last night in camp by the cadets and a very enjoyable time was had by all. It is hoped to hold another camp next year.

A special service for Nursing Cadets of the S.J.A.B . was held in the Bethel Church, Langley, on Sunday, August 25th. The ~ervice! ~~ich had been arranged by the Old bury Cadet NurslOg DIvIsIOn was conducted by the Rev. J. D. Crossland. Solos were given by Margaret Turton and Robert Murphy. A very inspiring and interesting address on the Order of St. John was given by Corps Supt. F. G. Price, M.B.E. ADong those present were Area Cadet Officer Mrs. Lamb, Corps Treasurer H. S. Bennett, Cadet Supts. Mrs. Edmunds, Miss Tomlinson, Miss Bidmead, Miss Green, Mrs. Brettle, A/Div. Supt Mrs. Bird, and Cadet Officer Mrs. G~il?~' Members of Oldbury and Rowl ey Regis Nursing DIvISions, and Quinton, Halesowen and Oldbury Cadet Nursing Divisions were present. The collection was for Church Funds.

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Railway Ambulance News. LONDON, MIDLAND & SCOTTISH L.M . S. INTERNATIONAL AMBULANCE COMPETITION. The L. M. S. International Ambulance Competition between the leading teams in Eng-land and \Vales and Scotland, which was inaugurated in 1929, and held in abeyance during the war period, was revived at Derby on Wednesday, the 14th August, when the following teams took part : England and Wales.-Uttoxeter, Bolton, Crewe Machine Shop" B." Scotland.-Dundee 'West, Edinburgh, Glasgow(Eglington Street). The Competition was divided into three parts, team test, individual injuries and questions. The result was as follows : Team Marks InTeam dividual QuesTest Injuries tions Total 1, Crewe Machine Shop 226 183 164-b573t 2, U ttoxeter 222 163 175 560 3, Glasgow (Eglington St.) 210 165 175 550 4, Edinburgh 228 161 t 157 546t 5, Dundee 205 181 159 545 6, Bolton 211 156 150 517 Tho Judges were Doctors W. Duncan, M. B., Ch B. . Liverpool; J. R. Sutherland, 1\1. B., Ch. B , Glasgow; R. A. Dench, 1\1.C., B.A., M.B., B.Ch., B.A.O., York. The presentation of prizes was made by Mr. H. J. Comber, Chief Officer for Labour and Establishmem, and the proceedings were presided over by Mr. C. Phizackerley, Div. Supt. of Operation, Derby. The undermentioned members of the L. M.S. Staff and Dr. Wilson, lecturer to the Sheffield Ambulance Classes have recently been admitted to the Order of St. John in the grade of Serving Brother in recogniti.on of their services to the L.M . S. Ambulance Centre:J. Ash, Porter-Manchester, London Road; E. Bramwell, Permanent Way Dept.-Doveholes ; H. La cy, Motive Power Dept.-Normanton; A. Pargiter, Motive Power Dept. -Monument Lane, Birmingham j J. Foxcroft, Operating Dept.-Morecambe Prom.

L.N.E.R. NORTH EASTERN SECTION. It has again been possible to hold competitions in all the six districts, which have been witnessed by large audiences of interested spectators. The staging of the team tests was particularly outstanding and thanks were extended to the Works Managers for their efforts in this direction. Details of competitions held, are as follows : Date of Com- No. of District petition Teams Winning Team Newcastle 16th March 3 Tyne Dock Darlington 27th March 6 Darlington District Engineers Hull 3rd April 7 Hull Dock Engineers Leeds 13th April 6 Starbeck "A" Middlesbrough 1st May 4 Middlesbrough "A" York 15th May 7 York C. & W. No.2 Sincere thanks were extended to Doctors C. D. Wilson and W. A. Hog-g, Darlington j H. Fallows, Redcar and J. c. Lamont, Leeds; ]. M. Hermon, Hessle and G. Thompson, South Cave j S. T. Pybus and E. H . Lodge, Wetherby; L. L. Westrope, Gateshead and G . P. Harlan, Newcastle j

G. McDougall and 1. N . Dunn, Hull, who g a ve valuable assistance in judging the competitions. LONG SERVICE GOLD AWARDS. Long Service Gold Awards for the period ended July 31st, 1946, were made as follows : 1\ledals, 60. Bars, 20 years 19 j 25 years 17 j 30 years 2 j 35 years 2 j 40 years 2 j making a grand total of 142 award:>.

SOUTHERN NEW WELFARE O FFICER.-In consequence of the death of Mr. E. Uzzell, Welfare Officer of the Southern Railway, the work formerly carried out by him has been transferred to the Chief Officer for Labour and Establishment, who will control all Welfare arrangements throughout the system. For this purpose 1\1r. J. H. Chitty of the Traffic Department has been appointed to the Staff of the Chief Officer for Labour and Establishment as Welfare Officer to deal with the following matters : 1. Social and Recreational. 2. Staff accommodation and amenities (including contacts with Ministry of Labour Regional Welfare Offi cers). 3. Ambulance and First Aid. The womens' Welfare organisation continues under the control of the Chief Officer for Labour and Establishment. The Welfare Supervisor (\Vomen) is Mrs. Hargrave. The Southern Railway staff now numbers 67,000. FIRST AIDER HONO URED.-A pleasing function took place at Barnstaple recentl y, when lr. W. H. Stevens, Foreman, Motive Power Depot, Barnstaple, received from Sir Eustace Missenden, President of the Southern Railway Ambulance Centre, a Meritorious Certificate for services rendered to the first aid cause. The General Manager in presenting the award, congratulated him and thanked him for performing such excellent work. "BOMB ALLEY" Cup.-To mark an age just past when for close on six years of war the staff demonstrated a very high standard of discipline under trying and varying circumstances, and to pay tribute to first aiders who performed such excellent service to those in need, when they were on duty as members of the staff and with Civil Defence in their spare time-the District Ambulance Committee of No.3 District have decided to present a trophy to be known as " Bomb Alley)) Cup, which will be competed for annually in the area between Gravesend, l\laidstone, Tonbridge, and Dover, by ambulance teams of four members. The first competition will take the form of a First Aid Qui z, which is being held at the Working 'Men's Club, Station Road, Ashford, on Saturday, October 5th, heginning at 3.0 p.m. Tea will be provided and a Social will follow the presentation of cu p and prizes at 7.0 p. m. NEW ApPOINTMENT.-Mr. G. Pointer of Ramsgate, who has for a number of years been the popular Class Secretary of the Ramsgate Class, has accepted the post of Honorary District Ambulance Secretary for District 3B. Mr. Pointer's appointment will be welcomed by first aiders, who know of his enthusiasm for the work; under his guidance there are great prospects for the area in an increase of membership and interest. Mr. Pointer is an Ambulance Officer in the St. John Ambulance Brig-ade. Members of all Brigade Units <'It Ramsgate and the Police, will be pleased to hear of his new post. SOUTHAMPTON DOCKS. A course on "First Aid" will start at 5.15 p. m., 1\lon-

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day, September 30th, 19-+6, at the Staff Canteen, Boundry Road, Southampton Docks. The presentation of awards for 19-+6 will be held on Thursday! October 10th. The programme will include tea and a vanety concert.

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lr. W . L. Ayers, Divisional Superintendent's Office Newport, has been appointed Divisional Ambulance Secretar~ to the G. \rV. R. Newport" A" Division in succession to 1\lr. Howard Jones, who is leaving the Company's service. l\lr. E. J. Hamblin, Traffic Department, Readino- has been appointed Divisional Ambulance Secretary t~' the G. ·W. R. London "B" Di vis ion in succession to :\1r. E. D. Keefe, who has retired from the Company's service.

L.P.T.B. (Met. Line). The annual distribution of examination and other awards took place on Saturday, August 31st, in the Dining Club of the offices at Baker Street Station. A good company assembled to welcome the new President of the Centre Me A. B. B. Valentin e, Operating Manager (Rys.), wh~ has succeeded lr. Evan Evans, lately retired from the Board. 1\1r. A. ]. Webb, Chairman of the Centre introduced Mr. Valentine in a pleasing speech, and it ~as felt that the new President was well planted. An address was given by 1\1r. E. C. Claxton, the Hon. Organiser of the Casualties Union. He spoke of the casualties in the make up and the careful treatment of patients, and impressed his hearers throughout. Dr. A. C. \VhiteKnox followed and congratulated the speaker on his address and the work that he is organising. Thc Centre Sectetary, in his report, gave the number of examination awards gained this year as 228 and no First Aid Lectures have been held. Ie was felt that to re\'ert back to pre-war methods of lectures during the winter months was more practical, so lectures were due to commence at Chiswick Works on September 16th, and at Baker Street on September 18th. All awards fo r those members who had taken the 19-+6 Label were increased by 19-+2 4S Labels and Pendants. 744 awards in all were issued. Dr. A. Ehrmann, after searching through 1,790 reports of first aid rendered, selected three of special notice and certificates "'ere av:arded to :-!\Ir. H. V. Burrows, Car Examiner, East Ham Depot j 1\lr. R. Weekes, Station Inspector, Farringdon Station j Miss E. Gooden, Ticket Collector, North~'ood Hills. A special certificate of merit was awarded to 1\1r. H. Walford, recognising his efforts to further the work of the Centre amongst the staff at Chiswick Works. Long Service Awards were gained for 15 years by lessrs. R. Proctor, S. Harden and Richard \\ eekes ; fur 20 years, Messrs. H. Steele and Stanley \\ eekes j for 25 years, Mr. A. Brudenell, and for 30 years, Messrs. F. Hercock and E. Dunn. Reference was made to the good attention gi\'en to the Centre by 1\1r. Evan Evans, and good wishes were expreesed to him on his retirement. Mr. Valentine thanked all present for the reception granted him and expressed his willingness to learn of and to lead the Centre in the spirit of the Order. Among those present were-1\l r. R. C. Hider, 1\1. B. E., District Traffic Sup. L. P. T. B. j District Olncers (S.]. A. B.) Mrs . Lapply, !\Irs. Matthews and 1\1r. Dunford; Doctors White-Knox A. Ehrmann and O. S. l\lay j Capt. T. Claridge, M~. Ernest Evans, Mr. H. Alder, County Officer (Buckingham, S. J. A. B.). After a brief pause for remembrance of absent friends, refreshments were served.

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FIFTY YEARS AGO. THE following is taken from an issue dated September 1896, and is the first of a series of extracts that will appear from time to time, to give readers an idea of first aid activities during the last century :AVOIDABLE DEATHS. The number of deaths that may be avoidable, and are the result of negligence, carelessness, or so-called' 'accidents," is somewhat remarkable, and will well rcpay a fe\\! minutes' attention and thought. When we corne to consider that some 18, 000 persons in England in the course of a year suffer a violent death from the above causes, the idea is furced upon one that most of them are a voidable, and therefore ought not to take place. Let us take a few instances and see how the deaths are caused. In coal mines we constantly hear of dreadful accidents occurring by which scores and sometimes hundreds of men are entombed or killed by choke-damp; yet more men lose their lives by the fall of coal or stone, &c. We may take it for granted that the existence of choke-darn p cannot al ways be ascertained and that therefore some of these deaths are not preventable, but surely those caused by the fall of coal, &c., are due to somebody's gross carelessness, and can be classed as avoidable. Our railways are answerable for a good many deaths, and a large proportion are the result of a mistake on the part of a signalman or engine driver, or are caused by the carelessness of the victims themselves, and can be put down as avoidable. Many more deaths are caused by vehicles than by railways, and may be classed as street accidents. Carelessness eithar on the part of the drivers or of the persons injured is answerable for a large share of them, and these also ca~ be put down as avoidable. Most of the deaths from burns and scalds can hardly be termod anything else but avoidable, for carelessness and negligence-to wit, cheap lamps-are the chief cause. Many of the deaths from drowning are avoidable, either from the person immersed being unable to swim, or on account of no one being at hand able to perform artificial respiration . Deaths from suffocation, being mostly infants that are overlaid, make one's heart ache to think of, and cannot be possibly called by any other name than avoidable, unless it be manslaughter. We cannot leave this part of the subject without mentioning cycling. So far this pastime has not been guilty of many deaths, according to statistics recently published, but as all the world seems to have gone a-cycling this year, we are afraid that the fatalities attributable to it will be largely increased. The deaths and injuries resulting from this form of exercise must be placed in the avoidable list, for so long as cyclists are rash and careless, and tear along roads at a " scorching" pace, and are allowed to ride in crowded thoroughfares, so long will these kinds of "accidents" happen. But avoidable deaths do not occur only as the result of Thousands of children perish annually from violence. diseases which are preventable, but which we are afraid will continue to exist as long as our poor live under their present conditions. We allude to the zymotic diseases. Measles, scarlet fever, diphtheria, and other allied complaints are killing children daily in our midst, and although sanitary authorities maintain that they ought to be stamped out yet they continuc their rava g es, apparently defying all our efforts to check them. Notification Acts are passed, hygiene is preached, isolation hospitals are provided, and disinfection is largely carried out at the public expense, but what is the result? We cannot congratulate ourselves that the death ra,te from these diseases is appreciably less.

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Looking at the matter from a first-aider's point of view, we cannot see that in the future there will be any diminution in the necessity for Ambulance work Accidents will happen notwithstanding all possible precautions, for human nature is not so constituted that everybody will do the right thing at the right moment. Let every first-aider remember that he will be doing his duty if he can by any means in his power prevent an accident; he should cultivate his powers of observation in order that he may be able by friendly advice to check any act of carelessness, negligence or oversight that he may be a witness of, and thus, perhaps, stop some fatality, and the consciousness of this kindly action will no doubt compensate him for the loss of the" good case" he otherwise might have ·had.

Foreign Bodies in Eyes. FIRST, obtain the history of the injury. If you find that the foreign body has penetrated or if the foreign body is not visible, but you have reason to believe that it has penetrated, refer the patient to a doctor immediately. In examining eyes, always follow a definite routineexamine the eyeball and eyelids carefully with magnifying lenses, preferably in front of a strong light. Evert the lower lid, instructing the patient to look up, to right, and to the left. Examine the eyeball, again having the patient look up, down, to the right and to the left. Evert the upper lid and examine. When a foreign body is located, note its location, character and size. Decide whether the foreign body is loose ·or em bedded. Also look carefully to see if there are any abrasions on the eyeball. If you find one forei g n body, do not stop your examination as there may be more. If your examination is negative, examine the upper and lower eyelashes to make sure a hair has not curled inwardly and is irritating the surface of the eyeball. If the foreign body is loose, remove with a sterile cottontipped applicator dampened with sterile boracic solution, sterile normal saline solution (one level teaspoon to a pint of water), or distilled water. Do not use large, fluffy cotton applicators. The cotton fibres are apt to remain on the eyeball and set up an inflammation. Instead, use tightly wound cotton on an applicator moistened as above before using. Just dab applicator over foreign body. Do not try to swab eyeball. After the foreign body has been removed, irrigate the eye with sterile boracic solution. There usually will be some pain or discomfort. Instruct the patient, that if this persists for any length of time, to immediately report back to you. It will then be advisable for you to refer the patient to an eye specialist-do not be afraid to refer every doubtful case to a specialist. If the foreign body is adhering to the surface of the eye, so that it cannot be removed with an applicator, use a sterile eye loop. If it does not come off easily with the loop, instil a few drops of sterile castor oil, place a pad and bandage over the eye, and refer to an eye specialist. Indicate on the patient's medical card, the exact location of a foreign body. For example: "loose particle of steel removed, at 8 o'clock, on the cornea of the right eye," or "foreign body, embedded, 4 o'clock, left eye. Castor oil instilled and pad applied. Sent to doctor . . . " If no foreign body is found, state your findings, "examined right eye for foreign body-negative." Briefly record negative as well as positive findings. Any eyes which are markedly inflamed should be referred to an eye specialist at once- the patient may have a serious eye condition and only quick action may prevent the loss of the eye. - TIle First A id A tLendant.

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Letters to the Editor. We are in no way responsible for the opinions expressed, or the statements made, by Correspondents.-EDIToR. UNIFORMS. DEAR SIR,I have read, with interest, your editorial and letter from E. C. J. B., of the August issue. I resent your statement" that our workmen still carry on their callings in cast off tweeds second-hand from the classes above them." I may have agreed to this 30 years ago, but to-day one will find that "our workmen" have considerably elevated their status in the community, and on the contrary, many are clad in raiment above the" classes above them." Uniforms, unfortunately, have been inflicted on us voluntary organisations for the purpose of distinguishing ranks, discipline and general prestige of the organisation concerned. Nevertheless, surely this is a very minor detail. To the gennine voluntary worker, especially concerning first aid, I feel that all uniform together with its ironmongeryand encumberances, constitutes to a large extent, an impediment to the humantarian work which has become a religion to them. How often have I heard it remarked, "I wish we could go out on duty with just a badge in our buttonhole and a well equipped attache case." Again, if we must have uniform, I agree let us be comfortable, and apart from tunics, etc., let us not forget to consider modifications for pouches, haversacks, water bottles, etc. This subject and matters that are closely allied open up, or could do, a vast scope for revolutionaay changes for the better. I cannot help but think that we have become "antiquated" in many respects, but despite this, the good work still goes on.-Yours faithfully, \V.A.W. Middx .

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" STRIPES." DEAR SIR,Returning to our local S.J.A.B. Division (and many others I am told) are many members who have been Service N.C.O.'s. These members have to pass the Brigade examinations for N.C.O.'s and on passing same will then be Bri g ade N.C.O.'s supernumary to establishment, I understand. Is not this sort of promotion likely to make the Bri g ade "Stripe Top Heavy"? i. e., on parade recently, order was given" Fall out the N. C. O.'s," more fell out than stayed in the ranks. Also I noticed" Stripes" very prominent at the Victory Parade. Again, what about members of the Brigade who, during the late war, have taken charge of First Aid Post's, Stretcher Parties, Rescue Squads, etc., in fact in many places have done far more to earn stripes in the S.J.A.B., than, say, a Sergeant in the A. C.C. or R.A.P.C. ? Also, with so many stripes about, what chance has the Private got who wants to further himself ? The Brigade Regulation affecting this, is sadly at fault and needs revision, as we are a civilian organisation, and Service stripes and decorations for the most part, should come after the Brigade ditto. Incidentally, so many of our fellow members coming back with stripes is, I think, quite a pointer to the qualities of confidence and leadership among them, and a tribute to the training of the Brigadp.-Yours faithfully, REGULAR REAnER. Ley ton. Sept. 2nd, 1946.

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FIRST

Priory for Wales. THE NATIONAL EISTEDDFOD OF WALES-AMBULANCE COMPETITION SECTION.

AID

FIRST

Notice to Ambulance Secretaries. Will Ambulance Secretaries please forward reports of local activities as soon alte1' the actual event as possible. 'We regret that owing to the shortage of paper we are not able to include all reports submitted. Preference is given to those of general interest.

Queries and Answers to Corresponden tS. Queries will be dealt with under the following rules : -

The National Eisteddfod is regarded as the chief and principal function of the Welsh Nation. The 1946 Eisteddfod was the first post-war Festival and was held in the mining district of the Cynon Valley from which the Cynon Valley Ambulance Corps takes its name. The Ambulance Competitions (which were spread over four days) were held at the Mountain R. C. E;hurch School, . Church Hall, and the Miskin County Primary School, all the premises being kindly loaned for the occasion. On the first day the males competed for the" Trevethin Shield" and 23 teams entered, with 5 Nursing teams entering for the" Silurian Shield." The winners of the males were Pochin Colliery Tredgar 1st, Ferndale 2nd and Pontypool3rd. The winners of the Nursing section being Treh~rris 1st and Tredegar 2nd. The massive trophies were presented to the winners by Mr. G. S. Morgan, M.E., agent for the Messrs. Powell Duffryn Colliery Group. On the second day the boy Cadet teams competed for the " Isca Shield" and 16 teams had entered. The girl Cadets competed for the "Gwent Shield" with 6 entries. For the all Welsh boy Cadet team competition, 2 teams entered. The winning teams in the boys competition being Tredegar 1 st, Ferndale 2nd, and Trelewis 3rd. With the girls Tredegar B were 1st, Tredegar A 2nd and Dafen Llanelly 3rd. In the boys all Welsh, Onllwyn was declared 1st. The Hon. John H. Bruce, Principal Secretary and Commissioner for Wales, presented the respective shields to the winners. On the third day the males competed for the" Lady Lewis Cup" with 29 teams entering. There were 6 entries for the "Lady Bute Cup," the female competition. The winning teams being Crewe L. M. &S. (England) 1st, Pochin Colliery Tredegar 2nd, Bargoed 3rd and Ffaldau 4th. In the Nursing competition, Treharris was 1st and Tredegar 2nd. The trophies were presented by Lord Aberdare, a special ovation beir.g given to the Crewe team who were the first English team to go to Wales and win the premier Welsh trophy. On the fourth day the First Aid in Mines Competition was held, also local Ambulance Competitions for the Cynon Valley Corps. Thirty entries were received for the First Aid in Mines Competition which was won by David J. John of Evans and Bevan Colliery Group, with Ewart J ones of Tredegar 2nd, and William H. Lloyd of Evans and Bevan Colliery Group 3rd. The" Doctor Milne Bowl" was won by Aberdare, and the "Doctor Ogilvie Cup" by Duffryn Aman Division. The competition for the Corps Officers Cup, individual championship of the Aberdare Valley-Cynon Valley Corps-was won by W. J. Jones of Cwmaman Division. The Ambulance Committee were very grateful to the medical men and matrons for their valuable voluntary cooperation in making the competitions such a success. During the Eisteddfod Week, 232 cases were treated.

AID

1. -Letters containing Queries must be marked on the top left-hand corner of the envelope" Query," and addressed to FIRST AID, 46, Cannon-street, London, E. C. 4. 2. -All Queries must be written on one side of paper only. 3.-All Queries must be accompanied by a " Query Coupon" cut from the current issue of the Journal, or, in case of Queries from abroad, from a recent issue.

Ot;

lie sin YOUR han d s

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

The Art of Healinq Treatment of Poisoning. P.S. (Cardiff).-Please tell me how you would act if, on being called to a case, you had reason to suspect poisoning by mouth but could not definitely decide whether the poison taken was a corrosive, an irritant or a narcotic. The classification and treatment of poisoning by mouth in the Textbook is based on the condition of the patient's mouth. If, therefore, you are called to a case such as you describe you should at once examine the mouth for signs of burns. If these are present you should at once treat as for Corrosive Poisoning whereas if these are absent you should treat for Non-Corrosive Poisoning. This point being decided, you should continue treatment in accordance with the General Rules on pp. 170-176 of the Textbook and obtain medical assistance at the earliest possible moment.-N. CORBET FLETCHER.

Examination Howler. K.L (Mundesley).-Recently, I was examining the members of a Cadet Nursing Division and asked one candidate what she would do if called to a man who was bleeding profusely from a wound of the forearm. She replied-" I would send jor Police-Sergeant John !ones I" When I asked why she would act thus, she answered promptly-" To stop the haemorrhage, oj course I" Good!

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

Compound Fracture of Patella. N. P. (Stourbridge).-If we had to treat a patient for compound fracture of patella, should we end our treatment by applying a cold compress over the fracture to lessen swelling of the joint as instructed in Rule 7 on p. 91 of the Textbook? We await your kind advice on this point and thank you for the same. Emphatically no! A compound fracture being a fracture and a wound, you should first treat the wound and then the fracture. The Textbook in Rule 7 on p. 109 tells you to wash the wound if it is obviously dirty and if medical aid cannot be procured; but this is a very different proposition from the application of a cold compress. Incidentally, you forget that in this case, since the fractured patella is complicated by a wound there would in all prohability be no swelling of the joint.-N.C.F.

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:34

FIRST

Negative Pressure. RC. (Milford Haven).-I regret that in my letter which, under the above title, was published in the F~bruary issue of FIRST AID I did not make my query plato. You stated in 'your reply on the subject in the February issue of FIRST Aro-" There is ~ir between the two layers of the lining membranes whIch enclose the lungs." I wish to know if this statement is correct. Yes.-N.C. F.

Defence Medal. P. M. (Bilton).-Could you please tell me why men:bers of Ambulance Divisions are allowed to wear the nbbon of the Defence Medal on Brigade uniform while members of Nursing Divisions in the same Area are not allowed to do so? The Defence Medal is a King's Medal; and the ribbon can be worn on the clothing or uniform by all individuals to whom this Medal has been awarded. In these circumstances it would appear that there must be some misunderstanding if you have been told that you cannot wear the ribbon on Brigade uniform.-EDITOR.

Promotion within Brigade. P. R. (Wrexham).-I am deeply interested as to how a Private in the Brigade can gain promotion. Does one obtain it by his ability and efficiency as a first aider, by servicf' or by influence? Are special examinations held or are there standard rules laid down for promoting N.C.O.'s? Meanwhile I thank your for your kind answer.' In Clause 130 of Brigade Gene1'al Regulations it is laid down that nominees for promotion shall pass the regular driil examination and satisfy the Officer deputed to conduct the examination that they are qualified to give instructions and suitable in all other respects. Further, in Clause 330, it is laid down that the Divisional Superintendent, while being personally responsible for nominating qualified persons only, will naturally ascertain the opinion of the Divisional Committee as to the acceptability of the candidate. Incidentally, Clause 323 states that the Divisional Committee should consist of the Officers, the Sergeants, Secretary, Treasurer and two co-opted members. The last-named are usually drawn from and can present the views of the rank and file. It would seem, therefore, that if you desire promotion, you should convey your wishes to members of the Committee. -EDITOR.

Bleeding from Tooth Socket. S. T. (Clevedon).-Please tell me if the presence of a blood clot in the socket of a tooth is an exception to the rule with regard to not disturbing- a clot when present in a wound. The instruction to plug the socket would appear to suggest these. Your kind ruling will be much appreciated. A blood clot is the evidence of Nature's efforts to seal a wound and so to stop the escape of bloo:i and also the entrance of germs. Plugging a tooth socket is only indicated while bleeding is present. Consequently it is not an exception to the general rule of not disturbing blood clots.-N.C. F.-

Humour in First Aid. \1. W. (West Hampstead).-Recently I was asked to see a girl who complained of suffering from pains all over the

AID

FIRST

body. I was much amused when, in response to my enquiries as to possible causes, she replied-" Olz! I had a hot bath last nz'ght! !" Good!

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

Rate of Heart Beat. P.Y. (Scarborough).-The Textbook on p. 99 tells us that the heart contracts in adults at the average rate of 72 times per minute; and that its rate increases as the position is changed from the sitting and still more to the standing position. We are puzzled to know for which of these three positions the rate of 72 times per minute holds good ; and so we ask you once again to come to our help. For each of us adults there is an average rate of heart beat. The rate of 72 times a minute is assumed " on the law of averages" to be normal when we are resting quietly -that is without mental or physical exertion-in the sitting position. The rate usually drops a little when we lie down (68 per minute) and rises when we assume the erect position (78 per minute).-N.C. F.

Loading Stretcher. J. M. (Montreal, Canada).-I am a member of Brigade Overseas and also an interested reader of FIRST AID. In the case of complicated fractures of the ribs, the Textbook tells us to incline the patient to the injured side. In the removal of such a patient, however, I think that the four-man lift with Bearer No.1 in the centre is extremely difficul t, as Bearer No. 4 has a big job on his hands and also that in an actual case the patient would suffer severe pain which it is our object to prevent. If there is an extra helper I wonder if it would not be a good idea for Bearer No. 1 to join hands with Bearer No.4 and then to support the patient's shoulders and body below the injury while the helper supports the patient's head. By this ' method the fractured ribs are well protected and the padding to keep the patient inclined to the injured side is kept in place. We tried this method with the C. P. C. (A. R. P.) ; and our patients told us that there was less movement. Meanwhile I should appreciate your expert advice on this matter. It is realised that Bearer No.4 has a difficult job while the patient is being lifted preparatory to being loaded on the stretcher. Hence the instruction in par. 1 on p. 205 of Textbook that this Bearer should be taller and stronger than the other members of the stretcher squad. Further, in the footnote on p. 207 you are told that the position of the Bearers " will be modified at the discretion of Bearer No. 1 who will be governed by the nature of the particular injury." Incidentally I fail to see why the lifting should be more difficult with the patient on his side, as you still have the same weight to lift.-N.C.F·.

Where movement is concerned, no bone is directly attached to another bone, althoug-h the bones are coupled together by ligaments. The patella is peculiar in that at its lower end the ligament which attaches it to the tibia is longer than those present in joints while its upper end receives directly fibres of the thigh muscles.-N.C.F.

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Attachments of Patella. J. M. (Montreal, Canada).-Also am I right in saying that the patella is the only bone in the body that is not joined directly to another bone?

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Classified Advertisements. Advertisements with remittance sh?u)d be sent to First Aid, 46, Cannon Street. London. E.C.4. Rate 3d. per word. minimum 45. 6d. Trade advts. 4d. per word. minimum 6.. Box numbers 15. extra.

7/6. Posters, Hats, Memos, Rubber Stamps. 250Tickets " A " TreES, 11, Oaklands Grove, London, W.12. Teddy Bears and Dolls Already to Make. Send L OVELY for Catalogue: G. Russell Inman, 1-3-5, Roundhay Terrace, Leeds, 7. Clo~h,

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QUERIES and ANSWERS COUPON To be cut out and enclosed '1mth all Quen:es.

Sept., 1946.

FIRST-AID.

Seventh Edition. 18. 3d. post 2d. Flrlt.Ald Simplified and Tabulated, with Ald. to Memory. Col Sir fames Cantlie contributes an zntroduction and we endorse his good opinion 01 tlu book. " -LANCET.

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FIFTY YEARS AGO

RE~3WS

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THE relaxation of the restric-

Our Future tions governing the supply of Programme. paper gives us the opportunity for which we have long been to enlarge. FIRST AID and to carry out Impro vements In the contents and makeup of th e J ournal which we have for some cons iderable t ime had in contemplation. For example, the p:-esent, the Octob~r, issue contains four pages ad d itIO nal to those which have preceded it, and the cove r is printed in red and black. The increase in size will permit of our giving ill ustrated articl es dealing with all aspects of the wide field covered by FIRST AID and these will be published as regular features, while new appliances and aids will be commented upon as they appear on the ma rket. FIRST AID was first published in 1894 a nd has appeared monthly since without cessation, and it is a notable fact that Dr. N. Corbet Fletcher O. B. E., has been its Hon. Medical Corresponden~ for no fewer than 31 years. A series of improvemen ts such as this must add considerably to the value of the Journal, and the series has arrived at an oppo rt une time, when first aid is more than ever in req uest and the onerous duties imposed upon first aide rs are added to almost daily by the alarming series of "accidents" which on sea, on land a nd in the air, are occuring with startling freq ueney. In the ea rl y nineties a few motor-cars crawled throu gh Lo ndon, preceded by red-flag bearers, and it was not till 1896 that this restriction was removed, since when motor traffic has been a prime feature in more or less tragic occurrences. The air has now claimed its victims, and has by no means arrived at the peak of its activities, and we feel s u re that the study of our pages, and especially those wh ich feature Dr. Fletcher's replies to correspon dents, will go far towards supplying the defici ency which the s tress of post-war conditions has c reated. I t is not too much to say that everyo ne shoul d take a course in first aid, and we note with satisfaction that many branches of the St. John A m bu lance Brigade have risen to the occasion and are ind ul ging in more or less wholesale circularisati on in their immed iate district, setting forth the adva ntage attendant upon a knowledge of first aid.

s e ek i~ g

FIRST

AID

Side Lights on First Aid. :J

••

By SIR HENRY L. MARTYN, K.C.V.O., F.R.C.S.

- -THE subject of insensibility is one worthy of the most careful study on the part of the student. Unfortunately it is one which does not lend itself to practical work, and, since the student is unlikely to see actual cases, the whole subject becomes a purely theoretical one, most of which has to be learned by heart. Fortunately, Chapter XIII is one of the best arranged in the textbook, and the student may find it helpful to think of it on the following lines. Let him picture himself entering a room upon the floor of which, to his complete surprise, lies an unconscious man. He realises that no information as to either history or symptoms can be got from the patient, and that it is up to him and him alone both to treat him and to endeavour to make at least a provisional dia~nosis. It is along this line of thought that Chapter XIII has been written, and the first paragraphs have been designed to answer the first aider's im mediate agonised gasp" What on on earth do I do now?" Let the student learn by heart these general rules for treatment of insensibility, let him learn them so thoroughly that word for word they spring to his mind no matter how worried he is. With them to cling to, he has at once a settled and definite program me to follow, and at least he will be doing the right thing while his brain is trying to supply the answer to the next question "What is the cause of the unconsciousness ?" In order to do this, the first question that he must ask himself is-whether or not the patient is breathing. If he is not, then it is clear that he is either dead or suffering from asphyxia, and it should be fairly easy both to find the cause and to treat it. Incidentally, do not forget to ex, amine the throat for foreign bodies obstructing the airway, including, be it noted, the patient's own tongue, which, if he be lying on his back, may have dropped backwards, obstructing the opening of the larynx. If the patient is breathing, matters are not so easy, and the next question to be answered is whether or not convulsions are going on. If there are, then the case is probably E~ilepsy, Hysteria, or poisoning due to cer~tain drugs or pOisons. If there are no convulsions, then It is probably concussion, compression, shock, fainting, apoplexy, or sunstroke, and it is up to you, my unfortunate friend, to have a shot at deciding which is which. Thus far I have nothing but commendation for the texthoo k in its efforts to simplify a very difficult subject, but, unfortunately, it does not go far enough, and, to my regret, even the Supplement does nothing to elucidate some of the problems left untouched, . Let us briefly consider one or two points. Epilepsy is included under the heading as a cause of insensibility when breathing is present and there are convu~sion.s. But remember that the convulsive stage in an epI.leptlc ~ttack may be very sl10rt indeed, and you may qUite eaSily find a man deeply unconscious and with no sign of convulsions whatever. Don't be had; have a look at his mouth to see whether or not he has bitten his tongue, and at his trousers to see if he has been incontinent ~f ur~ne. If he has both of these signs, the odds upon It betng a case of epilepsy are fairly high. Don't be too trusting, by the way, in approaching and handling a man in the post epileptic state. Some cases are apt to

--. - - - be violent and even dangerous as consciousness is returning. I have never understood why alcohol is not included among the causes of unconsciousness without convulsions, possibly because it is given as a cause of coma in the chapter on poisons. It is not common nowadays to find cases of complete unconsciouness due to alcohol, but it certainly can produce it easily enough, and I can recall vividly the bodies of three German prisoners who, having escapeu their guards in 1915, settled themselves in a barge laden with cases of rum. Some 20 degrees of frost encouraged their potations but not their recovery, and death ensued quickly enough upon their alcoholic coma. The star trap, always made so clear to the police, is that of the unconscious man found in the road at night reeking of alcohol. The temptation to put him into a cell to sleep it off must be considerable, but there is always the possibility that he may be found there next morning very dead indeed, his unconsciousness having in reality been due not to alcohol but perhaps to the apoplectic fit which the indulgence in alcohol induced, or to concussion caused in a drunken fall. Never be content with a diagnosis of drunkenness as a cause of coma until a doctor has made absolutely sure that no other cause exists. It is regretted that diabetes as a cause of unconsciousness is not included in the textbook, Some of my readers may remember an article of mine in the July, 1945, number of this Journal entitled "Within the Scope of First Aid." They may find it worth reading again, both in view of the remarks upon insulin poisoning as a cause of unconsciousness and also in view of the newly published Supplement with its gallant and much needed effort to modernise training in First Aid. . The paragraphs devoted to ~oncussion and CompressIOn are the one blot upon the entire chapter, since they are both inaccurate and misleading. The signs of concussion as given depict a patient in a state of .stupor which may last for a short time only or may deepen mto coma. In actual fact, as those with any experience of blit z casualties wilt confirm, the signs and symptoms of concussion may vary in the extreme. The excitable talkative individual endeavouring to help in a da zed and muddled way may equally well be suffering from concussion as the individual in a state of coma. Moreover, delayed concussion symptoms coming on even several hours after the event are often classical, headache, nausea, vertigo and loss of memory are typical of such. The description of compre~sion conveys no hint tl1at the condition is in fact one of urgent surgical emergency. There is no sug~estion that the .life of th.e patient may hang upon the capacity of the first alder to diagnose it, for the one and only treatment lies in operation at the earliest possible moment. Let us try to see whether it is possible to get a vivid mental picture of a typical case in which concussion is followed by compression. Picture a cricket match with a hard hilting man at the wicket. He gets a ball to his liking and drives it straight and hard back to the bowler, who t~kes it on the side of his head over his temple and drops like a shot rabbit.

FIRST He is found to be partially unconscious, his pupils equal and active, pulse quick and face pale and cold. He is pick~d up on a stretcher and carried to the pavilion, and by the time he has reached it, is beginning to come round and demand to know where he is and what has happened. He complains of severe headache, is probably sick, but his colour is improving and his pulse is stronger. Within half a.n hour he is in bed looking almost himself, b~t the ~eadache.ls rather worse, the vom iting persists, and hiS face IS becoming mor~ flushed than usual. It is noticed, too, that he appears to be becoming drowsy, and that his pulse has slowed from 100 to 90. His respirations are becoming slower, and within an hour he can no Ion O'er be roused and has sunk into deep coma. By this ti~e his pulse has dropped to 40 or SO, and his breathing is stertorous and becoming slower and slower and-unless the compression is relieved by urgent operation-he dies without recovering consciousness.

AID

Such !S the picture of a patient dying from compression of the brain. .The blow with the cricket ball caused first of all conCUSSIOn, but at the same time cracked the thin bo?e o.ver the temple and tore an artery running at that pOint 111 a groove in the bone. The artery bled and the blood accumulated between brain and bone. The clot, b,ecame larger and larger, compressin g the soft ~raln tissue beneath it until either death occurred or operatIOn was undertaken, the bleeding vessel tied, and the clot removed. Get that pi.cture clearly into your minds, convert the man on the cncket field into a man hit with a piece of bomb or. the bumper of a car, it does not matter in the least which, but watch f~r t~at de.epening coma, slowing pulse and .stert?rous respiratIOn, With pupils becoming unequal and l~actlve, and, even if yo u have learned nothin g else, yo~ wIll have learned one thing which one day may save a life.

AMBULANCE NEWS FROM ALL QUARTERS. S.J .A. B. No. I (Prince of Wales's) District 98 .( W AND~\vORTH AND SOUTHFIELDS). - An SOCial .even 109 was provided by mem bers of th is Dlvlslon at St. Michael 's Hal1, Southfields on Wednesday September 25th. A good number of me~bers and friend~ were entertained by an exhibition of first aid, District Surgeon Selby took the chair in the regretable absence of the Asst. Com missioner, Dr. Rangham. The programme opened with the Finals of the Divisional competitions. Div. Supt. A. C. Brown of the 149th Cuddin gto n ,Division, kic:dly. set the tests, and these were very capably Judged by Dlstnct Officer Stratton. The winners were 1st, Pte. S. Bowker, 2nd, Pte. H. Leach, 3rd, Pte. C. Penny and 4th, Pte. H. Luckin. The" Diagnosis" Cup was won by Pte. H. Leach. District Officer Stratton commenting on the competi~ions, said how pleased he was to be called upon to act as Judge, as he was a great believer in this kind of training. Then. fol1o~e.d. a b~d-making demonstration by the 88th N ~rs1l1g DIVISIOn With a commentary by Divisional Supt. MISS Tucker, also roller bandaging- by Nursing Sister 1\1 rs. St~ vens of the 88th and Pte. H. Leach of the 98th. After tillS refreshments were served. . Anolhcr interesting item was a first aid quiz staged by Dlv. Supt. A. C. Brown; the winners of the quiz ,,,ere a tie between Sergt. Mrs. Penfold and Private C. Penny and 2nd, Mrs. Peach of the Roehampton and Putney Division. Th.en came the presentation of the Cups by Dr. Selby, ~ho said he had actually come on a holiday visit, but it gave him much pleasure to present the cups and pri zes, also he tbanked the people who worked in the dark behind the scenes preparing for such a successful evening. The Div. Supt., F. T. Brown of the 98th, wished to tha?k all the members and friends who had worked in prepanng the Hall and supplying the refreshments' he also thanl~ed Dr. Selby, District Officer Miss West and District Officer Stratton for their support. .

No:

10 ~e:e.stlOg

County of Lancashire. ULVERSTON.-The above Division have lost a stalwart

in the death of Mr. Albert Laycock at Bardsea near Ulverston ~t th~ c:~e ef .73 years. The deceased was well known f?r hiS c:ctlVltl~S With the Ambulance and Nursing AssociatIon, belOg actively engaged in the movement in Barrowford from 1896 to 1922, when he was Ambulance Officer tb under Dr. Pim. He then left to go to Bardsea and c~:~ menc~d ambulance duties there at once, rising to the rank of Supenntendent of the Ulverston Division. He was made an Honor~ry Serving Brother of the Order of St. John of Jerusalem 111 1923. The remains were interred at Bardsea.

County of Surrey. BOROUGH OF GU1LDFORD.-Between 40 and 50 members (including five. medical officers) of the Borough of Guildford Corps. served 10 t?e ~or~es during the war. One, Pte, L. M~~rtdKP, lost hiS ltfe 10 Japan. One was a"warded the MIlItary Medal and two were men'tioned in despatches. Recentl y, a large number of them were \\ elcomed back at a reunion held at the Corps Headquarters, Woodbrido-e Road.. Advan~age was taken of the occasion to make a p~_ sentatlOn to Dlv. Supt. J. Cheshire, who has served for ,r o years in the Brigade al!d who, excepting for a fortnight'S illness, spent every night of the war at the headquart ers. The returning members were welcomed by District Officer C. E. Chaplin and by Mrs. W. J. Henry, Lady County Officer. Foll,owin~ the presentation of ribbon and stars denoting 30 years serVice, by the Mayor, Councillor A. W. Graham Brown, 1\1r. Cheshire said it was up to the young men whether they were going- to carryon the work and were going to do it better than they had done. They should shoulder the responsibility. Speaking of the magnificent service the BriO'ade had r.endered .during a critical period the Mayor said thtCorporat10n conSidered them one of the municipal activities in the sense that they relied on the voluntary services of the members to act as a casualty service in the halcyon days of peace, as. well as to be prepared for any contingency that might anse as a result of war. He hoped they t;\'o uld retain that spirit of comradeship which they had experienced over many years. Entertainment was provided by Arthur's Concert Party.

FIRST County of Worcester. NORTH WORCESTERSHIRE CORPs.-This Corps held their eliminating round of the Lechmere Cup competition on Saturday, October 5th, in Trinity Schools, Old Hill. The Lechmere Cup is competed fo r annually by teams composed of 4 members and is open for Ambulance and Nursing Divisions. Officer-in-Charge was Corps Supt. F. G. Price, M. B. E. Judges were: team test, Div. Surgeon M. MacCormac ; individual tests, Dr. A. W. Weston. The card for the team test was as follows :-" You and your team (without any equipment) are passing a bungalow when a woman inside the house screams to you to come inside and help her." The action of the test was that the woman and her husband had been quarrelling and that the latter had attempted to commit suicide. The patient, on examination, was found to be suffering from cerebral haemorrhage. Corps Supt. F. G. Price announced the results as follows :-Rowley Regis, 138 marks; Halesowen, 134 ; T. W. Lench, 129; Langley, 117 ; Cradle)" 114. Dr. MacCormac in his criticism of the work done in the team test said that on the whole the examination of the patient was well done especially by the winners. The test was a very simple one but it had its" catches." In a case of this nature it was essential to report the case to a policeman. It was also essential for the teams to move the bed from the position in which they found it, i.e., against the wall. Dr. MacCormac concluded by congratulating the winners. Dr. Weston said he was very pleased with the individual work of the teams. He had enjoyed taking this part of the competition. Corps Supt. Price said that he wished to very heartily thank the doctors for setting and judging the tests. SOUTHERN AREA.-The above Area held their eliminating round of the competition for the Newton Cup at the Christopher Whitehead Schools, Worcester, on ~aturday, October 5th. The Newton Cup, which was given by County Commissioner Dr. F. L. Newton, is competed for annually by teams of Am bulance and Nursing Cadets. Three teams competed. The judges were: Team Test, Div. Surgeon Elliott, Malvern j Individual Tests, Div. Surgeon Miles, Kidderminster. After a very interesti'ng competition, Redditch Cadet Ambulance beat Kidderminster Cadet Nursing by one mark with Malvern Cadet Nursing a good third. Redditch Cadet Ambulance will now represent the South of the County in the Final against Halesowen Cadet Nursing, the winners of the Northern Area competition. The Final will be held on November 9th, at the Boy's County School, Stourbridge Road, Halesowen. NORTHERN AREA.-The Northern Area eliminating round for the Newton Cu p for Cadets, was held on Saturday, September 28th, in the canteen of Messrs. T. W. Lench Ltd., Blackheath. Seven teams entered. Officer-in-Charge was Area Cadet Officer Mrs. Lamb. Judges were: Team Test, County Surgeon L. Bold j Individual Tests, Div. Surgeon A. Hill. Many Brigade Officers were among the large crowd present. The card for the team test was as follows :-' ( You are at practice, just finishing and packing up, at your headquarters, when a boy comes in to say that his brother has had an accident at a house across the road." On examining the patient the teams would find him to be suffering from insensibility, a fractured left leg and brui~ing of the left fore-arm. The results which were announced by Area Cadet Officer

FIRST

AID Mrs. Lamb were as follows :-Halesowen Nursing, 300'2 marks j Brierley Hill Nursing, 292 '7 ; Dudley Ambulance, 276 '5 i Netherton Ambulance, 252 i Lye Nursing, 252 i Dudley Nursing, 215'5 i Oldbury Nursing, 186 '2 Amidst applause County Su pt. Dr. Mrs. Porter presented the Fisher Cup to the winning team. County Surgeon Bold said that he was glad to have been given the opportunity of judging his first Cadet competition. He wished to congratulate all the teams upon their work. Div. Surgeon Hill said that the Individual work of the teams was good. Area Cadet Officer Mrs. Lamb said that she wished to congratulate the winners upon their success and wished them the best of luck in the Final. She also wished to thank the judges for giving of their valuable time in setting and judging the tests.

East Riding of Yorkshire. HUMBERSIDE CORPs.-The annual inspection of the Humberside Corps was held in the grounds of Brantinghamthorpe, Brough, kindly loaned by Mr. and Mrs. Arnold Reckitt. The Inspecting Officer was The lIon. Mrs. Copland Griffiths, Lady Supt. in Chief of the S.J .A. B. Overseas. Every Division in the Humoerside Corps was represented, together with two newly reg istered Cadet Di visions at North Ferriby and Gilberdyke and two probationary Divisions from Newbald and Brough. The ambulances and equipment of the Corps were also inspected. The parade was drawn up under the charge of Corps Sergt. Major A. H. Ransome and during the inspection and for the march past, the band of the 2nd Battalion East Yorkshire Regiment provided suitable music. Before addressing the parade, Mrs. Copland Griffiths presented warrants of appointment, also certificates in first aid and borne nursing to Cadets. After the inspection a garden fete was held at which a sale of garden produce, given by local residents, conducted by Mr. Gilbert Baitson, and side shOWS, were the main attractions. In the evening a dance was held in the Brough Village Hall at which the music was provided by the dance band of the East Yorkshire Regiment and attended by a large number of Brigade supporters, including The Hon. Mrs. Copland Griffiths.

West Riding of Yorkshire. SADDLEWORTH.-Members of the Saddleworth S.J.A.B. held their fourth annual ambulance competition and dance on Saturday, September 21st. Twel\1e teams entered. The Judges were Dr. P. B. Wood (team test), Drs. Holgate, P. Stonehouse (individual), Dr. N. Wood (open individual test). The Dr. P. B. Wood Cup for the team test was won by Crossfields ("Warrington) with 1831 marks. Agecroft L. M.S. with 179t were 2nd, and Batley B 168, were third. Forty-four persons entered the open individual test. It was won by G. W. Glave, Agecroft L.M.S . with 44 points. H. Hesson, Wath Main, with 43 points was second, and A. Dunning, Batley, third with 41 points. Three ladies from North Manchester entered the individual and the winner was Miss Garner with 33 points. The local cup was won by Sgt. A. Townrow. The Assistant Com missioner Mr. H. Harrison of Huddersfield was Chairman. Whist and dancing followed, and an enjoyable evening was spent by all.

Notice to Ambulance Secretaries. Will Ambulance Secretaries please forward reports of local activities as soon after the actual event as possible. We regret that owing to the shortage of paper we are not able to include all reports submitted. Preference is given to those of general interest.

RAILWAYS. Southern. Mr. F. A. Trott has been appointed Ambulance Centre Secretary and is responsible for all Ambulance and First Aid activities throughout the system, including competitions . WIMBLEDON.-The annual presentation of awards took place in St. Georges Hall, Wimbledon, on Wednesday, October 2nd, at 7.0 p.m. The gathering was presided over by Mr. A. Barrow, 2a District Secretary and supported by various officials of the Welfare and Traffic Depts., and attended by a large number of railway men, their wives and friends. The awards were .as follows :-Two 3 year medallions, twenty label awards, SIX 7 year medals, and a 21 years gold medal awarded to Mr. G. Levett, Stationmaster Tooting J unction Station. A concert followed the presentation. W?~KS FIRST AID COMPETITloN. ----:-The "March" Cup competltlOn between teams from Bnghton and Lancing C. M. E. Works, was held in the Brighton Works Staff Canteen recently, and witnessed by a number of interested spectators. Lancing No. 2 team were winners with 203 points out of a possible 300. Mr. M. S. Hatchell, Assistant to Chief Mechanical En~ineer, presented the trophy and congratulated the winners on their fine display. Mr. F. B. Illston, who presicfed, expressed the hope that more teams would compete next year.

H'JNouRs. -O rder of St. John Honours were awarded to Dr. J. D. Gray, lectu rer, Ashford class i Dr. T. J. Cobbe, lecturer, Dover class j Mr. F. Hodge, signalman, Shoreham, Kent j Mr. H. Simmons, clerk, M. P. Depot, Waterloo.' Mr. C. E. Harrison, motorman, Elect. D ept., London Bndge, Mr, G. T. Olstead, foreman, Bricklayers Arms Goods, Mr. J. B. Bodkin, lengthman, Paddock Wood. NEW CLASSEs. -F urther Ambulance Classes were formed at Aldershot-Class Secretaay, Mr. W. H. Jarvis; Clapham Junction-Class Secretary, Mr. Anderson i Rotherhithe Road-Class Secretary, Mr. S. Leno. GUiLDFORD.-A most enjoyable evening was spent at the Orphanage Hall, Guildford, recently, the occasion of the Class annual presentation of awards and social, when Mrs. J. H. Chitty presented the prizes. Mr..f. H. Chitty, Welfare Officer, congratulated Mr. H. Bickn ell and his Committee on the efficiency of their arrangements, and spoke of the future plans for the improvement of the Southern Railway Ambulance movement. FELTlIAM.-Preceding the Feltham Class annual concert which was of a very hi g h standard, 1\1rs. E. G. Moore presented the Ambulance awards to class members and a Meritorious Certificate for services rendered to the First Aid cause to Mr. W. Leming. Mr. A. Barrow, District Secretary, pres ided. Mr. Moore spoke of the value of the work, and made reference to the many ambulance honours that had been won for th: Company by staff of the Western Division, and asked first alders for such awards to be again received. WATERLOO. - The annual distribution of a wards took place at the Brunswick House, Vauxhall, on Tuesday, Septern ber 24th, on the occasion of a special concert.

AID

Mr. R. M. T. Richards, Traffic Manager, presented the awarcl:- and congra~ulated each recipient, and on handing a founta1l1 pen, the gl:t of the Class to the lecturer Dr. M. M. Scott, he thanked him for his interest and help in the affa' of the Class. In his pleasing speech, he extended a welco~! back to the Class those members who have been serving with H. M. Forc~s, and expressed the hope that Waterloo Class members Will be doubled durin g the coming session. Mr. DePury, London West Div. Supt., paid tribute to the old stalwarts of the movement and promised his contin ual support for the furtheranc e of fi rst aid. Arrangeme~.ts were made by Mr. H. Sims, Class Secretary,. ~nd Mrs. SI! verston, who are to be congratulated for provldlOg enterta1l1ment and refreshments ·to the likin g of all present.

Great Western. HONOORS.-As a result of a recommendation made by the central ambulance committee. the Company's Chief Medical Officer, Dr. H. H. Cavendish Fuller, has been admitted to the Order of St. John of Jerusalem in the Grade of Serving Brother. Mr. R. F. Borrough, divisional ambulance secretary London "A" Division, and Mr. P. Thomas, inspector' Docks Department, Plymouth, have been promoted in th~ Order to the Grade of Offi cer (Brother). . The following mp.mbers of the staff have also been admitted to the Order in the Grade of Serving Brother for exceptional services which they have rendered to the first aid movement on the Great Western Railway over a long period of years : Mr. E. E. Speare, signalman, Traffic Department, Bugle j Mr. A. J. Webb, clerk, Goods Department, Stroud j Mr. R. H. Pryce, chief clerk, divisional superintendent's office, Chester i Mr. R. N. Patton fitter Chief Mechanical , ' , · E ng1l1eer s Department, Swindon j Mr. G. Payne, ched{er, Goods Department, Yeovil. MI.L~B.AY.-The annual inspection of the l\lillbay Railway DlvlslOn, S l.A. B., Plymo uth , was held in the Cadet headquarters. The J nspecting Officer was the County Commissioner, Mr. C. C. Prance, M.B . , B.S., D.L.O. i also p~es~nt were the Div. President, Mr. J. S. P. Pearson, dlstnct traffic manager, G. W. R. j thp. Vice-President, Mr. R. C. Hunter Russell, and Div. Surgeon Dr. R. Howarth, M. D., F. R. C. S. Suspected fractures, wounds, etc., and means of transport were carried out to the satisfaction of the inspecting officer.

London, Midland and Scottish. Preparations for the winter session are being made by the L. M. S. Ambulance Organisation in Scotland. Altogether there are 70 centres in Scotland, and classes an~ again being- organised at Edinburgh, Glasgow, Paisley, Wlshaw, Larbert, and many other centres throughout Scotland, at which tuition in the theory and practice of first aid will be given. Proficiency competitions are held annually, and during the past session Edinburgh (Princes Street) Station team obtained first place in the district competition, the Scottish final, and inter-railway competition. The Edinburgh unit, which has performed invaluable service at football matches and various other functions, has iust celebrated its jubilee, which was deferred from 1944. A CLARIFICATION. - On page 32, September issue, we stated that Crewe L. M. S. were the first English team to go to \Vales and win the premier Welsh trophy. This, of course, referred to male teams. The ladies-Birkenhead Central ~ursing Division, we are reminded, went to Denbigh Eisteddfod in 1939 and won the Lady Bute Cup in the same competition series.

FIRST

AID

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

HOWEVER little one is attracted to nursing, few of us can go through life without experiencing the necessity for some knowledge that will enable us to ease the burden of sickness for a member of our own household , or for a friend. And when the sufferer is one who belongs to us, or is important in our lives, the desire for that knowledge and for skill in its practical application becomes in tensified. One cannot, and would not, wish to send all sick people to hospital, even if there were suffi~ieI?t accommodation and sufficient staff, so that It IS important that everyone should know something about nursin g in the home. All the equipment that is found in a hospital is not available in a ho me , and a good deal of im pro '{ isation is necessa ry ; but nevertheless it is surprising how comfortable and well nursed a patient can be, even with the most meagre of equipment, if he is looked after by a cheerful, intelligent and resourceful person. CHOICE OF A ROO M. The first question that arises when a mem ber of the famil y is taken ill is " Which room shall he have? Shall we move him or leave him where he is 7" To a nswer the second question first-that depends upon the suita bility ·and the general convenience of the room he is already occupying, for there is no point in moving him unnecessarily, especially as he will feel ml' ch less strange in his own room with his accustomed surroundings and belongings than he will in another. So perhaps we had better consider the ideal room and then compare it with those available. Inevitably, we shall have to forego some desirable characteristics in order to obtain others, so that the choice will demand an appreciation of the relative importance of th e various points. A consideration that must influence the decision is the type and probable duration of the illness. For example, if a child develops an in fectious condition, such as measles, his room is already infected, so that unless it is very unsuitable for nursing he had better remain where he is, and any other child who was sharing his room should be moved. The ideal sickroom should be in a quiet part of the house , not over a kitchen for example, when the clatter of utensils and the smell of cooki ng could be disturbing. A south or south-west aspect will ensure the maximum degree of sunli g ht, and the ro o m should have a pl easant outlook, over-

looking a garden and with a verandah where some of the convalescent hours could be spent. The room should be near a bathroom and lavatory , but not so near that the sound of runnin g water could be disturbing. The furnishings should be. as simple as possible and the bed should be. of a ktn.d that is convenient for nursing. A hospital bed IS 3 feet wide, 6 ~ feet long and the wire mattress is 2 feet from the floor. Most" home " beds are lower than this, but a low bed is conducive to a good deal of backache for the nurse who has a num ber of patients and beds to care for. It s hould not be in a corner, for this would involve movin g it for bedmaking and for any examination that the doctor wishes to make, when it is usuall y convenient for the nurse to take up a po siti o n o n the other side of the bed. The mattress should be firm but not hard, and if the patient is not allow ed up for toilet procedures it should be protected by a machintosh sheet exte ndin g from ben ea th the shoulders to the back of the knees and cove red by a "drawsheet" which can be pull ed throu g h to give the patient a fresh, cool spot to lie upon. The number of pillows requirecl, de pends upon the position in which the patient is to be nursed. I t is necessary to have a small ta ble or cu pboard by the bedsid e , on which to sta nd trays , a vase of flowers, books or an y other articl es which the patient or nurse requires to have a ccess ible . VENTILATION AND HEATING. In modern times it is not necessa ry to stress the fact that a sickroom should be we ll ventilated, for every intelligent person realises the vallie of fresh air, especially in sickness; but it is equally important that the bed should not be in a drau g ht. A coal fire in an open grate is an excellent ventilator, for as so much stale air is g oing up the chimneyall the ti me, fresh air must come in to th e room, via the open window, to take its pl a ce. Then a fire gives a more cheerful and comforting atmosphere to a sickroom than any o th er form of heating and it provides a means of destroy in g small infected articles, such as swabs and small d ressings. Its disadvantages are that it involves a good deal of labour, it needs fairly fr equent repl en is hing and it adds to the dust in the room. The fa ct that it utilises oxygen and produces carbon dioxide has no ill effect upon the purity of the air, for the carbon dio x ide goes up the chimney . Makin g up a

FIRST fire noisily often causes acute discomfort to a sick person. An old glove should be kept handy so that the lumps of coal can be put on quietly, and if the fire is to be kept in all night the coal should be wrapped in paper or put into paper bags before it is brought into the sickroom. The best temperature for a sickroom is from 60 degs. to 65 degs. F. A thermometer should hang near the bed, but not in a position where it can be heated by the fire or chilled by a draught. If a gas fire must be used, a . shallow dish of water should be placed in front of it, so that the s low evaporation of the water can somewhat counterbalance the drying effect of the burning gas upon the air. LIGHTIN G. During the daytime no stron g sunlight should fall directly upon the patient's face, and when artificial light is necessary it should come from behind or from the side of the bed. If someone must stay with the patient all night, a well-shaded table lamp is desirable so that the nurse can carry ou t the required attentions or sit quietly reading or working without disturbing the patient. Electricity, both for lighting and heating is ideal in that it involves no labour, it takes no oxygen from the air a nd it adds no impurity to it. GENERAL MANAGEMENT OF THE SICKROOM. As scrupulous cleanliness is essential, it is well to remove any unnecessary furniture, especially any articles that can be dust-traps. The grate should be cleaned, the ashes removed, the fire made up and the coal box replenished before sweeping starts each morning. The bed should be pulled away from the wall and rugs should be taken out of the room to be shaken in the open air. If the floor is carpeted a vacuum cleaner is by far the best means of removing dust from it. Alternatively, a carpet s weeper can be used or dam p tea leaves can be sprinkled over the floor before sweeping with an ordinary carpet broom. This prevents dust from rising. Another method is to use a wet newspaper, sweeping into it all the time. Polished boards or linoleum surrounds can receive attention with an O-cedar mop or can be dusted and polished by hand. In dealing with an infectious case, carpets and rugs are undesirable and all collected dust should be burnt. D USTING. A dampened duster should be used, followed by a rub with a dry duster. For polished furniture, a little oil or polish on the first duster is more suitable than water; but dry dusting just scatters the dust, it does not collect it. Everything in the room should be dusted, including the bed and all ledges and chair legs.

AID

FLOWERS. These give a very cheering note to a sickroom and serve to remind the patient of the concern of his friends. They should be removed at ni g ht , however, and the water should be chan g ed each morning. ( N f'x t month 's artz'cle w£11 deal w dh B ed making.)

First Aid Quiz. Questions. (1) What is toxremia ? (2) How man y bo nes a re there in the vertebral colu mn? (3) Crepitus is (a ) An infectious disease, (b) Old ag-e, (c) A creak in g at the s ite of a fracture, (d ) A disease of t he heart. (4 ) What causes asp hyxia in electri c shock cases? (5 ) What is a Potts fr act u re?

(6) Name th e t hree va r ieties of hce m orrh age and desc ribe how y OU would distinq ui!>h t he m . (A nswe rs on page 52. )

Plastic Skin. By S. A. LEAD E R , F.R ,C. S. , L. R. C.P. , L. D .S., R. C.S . A VA LUAB LE First Ai d m edicame n t, first k nown as Vela " Portex, " was e vol ved d urin g the war to meet t he urgent demand for an adh esive, germ icid al dress ing needed in Blood Transfusions, a nd imm ed ia tely rece ived the approval of no less an auth ority tha n D amp. J anet Va ughan herself. Appli ed to th e ski n before a nd afte r ven u pun ct ure, it sterilised th e area and dri ed r ap idl y to form a n a d herent elastic film whi ch could sa fely be perforated by t he needle. After bl ood ha d been take n fro m t he do nor or a dmin istered to the patient , a furth e r a ppl ica ti on, hermeticall y sea led the wou nd and no ba nda g e or fu rth e r dr essing wa s needed. The adva ntage of this m et hod a p plied to t he a nt i-cubita l fossa can r eadil y be appreciated , a nd g reat economy of precious materia l and time w as effected . It w a s noted that pain ceased upon applica tion, bu t its impli cation was not appreciate d at first. Sh ortl y afte rw ar ds, h oweyer, one of the h ig h -r a nkin g a d visory s urgeons to the Directorate of l\l edi cal Su p plies requeste d a su pply for " private use," and s uggested t ha t it be ma d e avail able to the public through the m edium of the general ch em ists an d d ruggists. When p ressed for th e reas on , he stated t ha t it was inval uab le for th t rea tment of chil bla ins, fr om wh ich his wife suffered a nd th at she ha d found it ga\'e im m ed ia te relief. He a scr i bed this to its vaso-co nstrictive actio n, du e to its high ph e nyl sa lycil a t e con tent, whi ch a lso act ed as a powel ful ob tund ent. It is of in ter est to r ecord th at the manuff'lcturers h ad incorpora ted t hi s valuable medicament in [he ba sic " Portex" plast ic to prod uce elashcilJ', and \H're most hi g hl y g ratified to learn of its t herape u tic proper! its. Stimulated by thi s d is covery, a nd und er pr ope r Ill£dical guidance, research was in st itu te d to see what furt h er m edi cati on mi a- ht be a chi end , us ing th e Cl ri gi na l ~(\lut i ()n as an incipi e nt~ a nd in du e co urse E ugenol a nd Recorr ina l

FIRST

were added and the perfected product was submitted to the hospitals and medical profession. Letters of approval, criticisms and suggestions came pouring in from this highly conservative body. One pioneer stated in "The Lancet II that he used it instead of sterile towels as a surgical barrier membrane with great success in two hundred operations, and that he had noticed the complete absence of excoriating fistul re after operations in which they had been so common, e.g., cholecystotomy. A Medical Officer of Health in a large town used it on children for impetigo with gratifying results, another referred to the relief it afforded to burns, and this went on until sufficient data had been colIected to make the product available to the public. "Portex" is manufactured by Portland Plastics Ltd., 6, Victoria Street, London, S. W.1.

FIFTY YEARS AGO.

AID

FIRST

morally responsible for their continuing efficiency, and should take care that they are not allowed to forget what they hwe been ·taught. This can be done by drill, constant instruction and periodical examinations. We maintain that every wearer of a hadge who is available for duty, and therefore is placed in a responsible position, should undergo periodical instruction and examination, and that it is the duty of the directors and officials to see that this is properly carried out. We should be extremely sorry to know that any serious case suffered through any wrong- treatment carelessly carried out and produced by over-confidence. The possession of a badge should mean that the holder has periodical instruction and is always competent (so long as he wears it) to render first aid assistance. We trust that these few remarks will be met by railway companies and others with the same spirit in which they are made, that is, for the improvement and benefit of ambulance work generally.

------.---.-------

Reviews. From "FIRST AID," October, 1896:THE WORTH OF THE AMBULANCE BADGE. IT is difficult to oVGr-estimate the importance of having certificated in ambulance work, large numbers of men who are in the employ of companies concerned in the conveyance of the public, or who are in the course of their duty obliged to look after the safety of the public in our streets. Although ideas and opinions of (his kind have not yet penetrated the minds of our legislators , elected or hereditary, and taken shape in the form of cumpulsory legIslation, we have every reason to believe that they are taking root amongst the general public, and will in course of time grow and bear fruit in due season. We should like to see this little plant flourish with great vigour and rapidity, for we already perceive its branches spreading out in certain directions which augur well for its future existence. In one of these direr.tions, that of the railway companies, we are pleased to observe that great progress has been made this last year or two. One compa?y, south of the Thames, has lately had a large number of Its employees taug ht and rendered efficient in first aid, and the companies north of the Thames have increased their nun:bers so that we may expect in good time to see properly eqUlpped ambulance wagons on their lines. To these directors and officials who have taken so much interest in the work we feel very grateful, and sincerely hope that they will go on with beneficent labours. Another branch of the little ~mbula~ce plant has reached the London County Co~ncll, and ~s there blossoming and bringing forth fruit. It IS pleasant tor Londoners to know that some of the officials who watch over them when taking their pleasure are qualified to rend~r first aid, for accidents will happen in spite of all precautlOns . . . There is one important fact that ought not to be lost sIght. of by those who are responsible both for ambulance teachmg and for the men who have to render first aid assis.tance v.:hen required; and that is, the liability of those holdmg cerb~cates to.forget what they were originally taught. We dO.not WIsh to ~hnd ourselves to the fact, nay, we desire to remmd others of It, that first aiders may make mistakes in treatment, which on enquiry will be found to be due to forgetfulness or nervousness. Some instances are on record. The fact of a man having a certificate is no guarantee that he will.always have at command the amount of knowledge ?e receIved on a~quiring it, especially if it has not been called mto use for some years. Those directors who have had a certain number of men instructed in first aid principles in order to depend upon their services in cases of emergency are

Notes on Essential Factory First A id. By Sir Ernest Cowell, K.B.E., M.D., F.R.C.S. Couldrey & Co. (Croydon) Ltd., 8-10, George Street, Croydon. Pr£ce II- n et. This useful little pamphlet has been designed to serve as a guide for lecturers and also to impart a knowledge of essential first aid for workers in factories and workshops. It sets out a syllabus which covers the whole range of first aid and then stresses the main points with which the lecturer must deal in each of the seven lectures. Further, it is rCl,;oolLlended that the p? mphlet be read in conjunction with the textbooks of S.J.A.A. and B.R.C.S.

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3 U seCnl books * * * HANDBOOK OF ELEMENTARY AND PHYSIOLOGY

ANATOMY

By A. D. Belilios, M.B., D. K. Mulvany, F.R.C.S., & K. F. Armstrong, S.R.N. A complete outline of the human body, simply written and easily understood. ProPrice ~ides .a basic knowledge of ~he subject for students of Anatomy and Physiology, Including first-alders, prospect Iv e nurses, nursery nurses and school children in upper 4s. 6d. forms. Clear and helpful drawings supplement the very lucid text. Postage 8d.

HANDBOOK OF

EDITION

FIRST AID & BANDAGING

By A. D. Belilios, M.D .. D. K. Mulvany, F.R.C.S., & K. F. Armstrong, S.R.N. A Second Edition of this up-to-date book based on war experience and deSigned to Price provide a concise and complete training. It covers all the ground for training recommended by the British Red Cross Society, the St. John Ambulance Association, the Civil 4s. Nursing Reserve and the Genera l Nursing Council. Fully illustrated . Postage 6d.

BAILLIERE'S NURSES' MEDICAL DICTIONARY By Margaret M. Hitch, S.R.N. Every first aider and nurse must have a Medical Dictionary. Bail/iere's Nurses' Medical Price Dictionary contains 462 pages of essential information. giving explanation and pronuncia- 3 6 tion of thousands of words in common use, and a compendium of 21 sections of valuable S. d. information. Over 500 illustrations. Postage 3d.

COX,

DALE, REYNOLDS & Co., Ltd.,

7 & 8, Henrietta St., London, W.C.2

46, Cannon Street, London, E.C.4

BAILLIERE, TINDALL &

FIRST

AID always start your routine examination from head downwards unless there is obvious haemorrhage.

lie sin

YOUR

han d s

Intelligent men and women who are prepal"ed to study an hour or two each day can become expert practitioners in Swedish Massage. If First Aid is a subject in which you are interested, then you will readily understand the value of SWEDISH MASSAGE and how it can assist in healing the sufferer.

Nearly 30 years of teaching experience

The proof of the pudding is in the eating; and the fact that you obtained immediate relief by immersing your r.ands in luke warm water proved the correctness of your treatment. Incidentally I suggest that next time you corne across a bucket of liquid you exercise your" discrimination" before plunging your hands into it.-N. C. F.

has enabled the S.M.A.E. (Swedish Massage and Electrical) Institute to secure for its Graduates in all parts of the world an assured future in a profession of fascinating and absorbing interest.

entitled

"Manipulative Therapy as a Profession" tells you how many of the

World's leading Masseurs and Practitioners of Manipulative Therapy have been trained by the S.M ..A.E. Institute.

Write for FREE copy of Booklet to :Department SO. .

.THE·· SMAE INSTITUTE l ,E· A·:T HER H E AD, SUR REV.

Site of Knot of Armsling. N.E. (Melbourne, Australia).-Recently, discussion arose as to the right and wrong side on which the knots of the large and small armslings should be tied. As we could not agree we decided to submit our problem for your kind ruling. With both large and small armslings the instructions of the Textbook read: "Pass it (the end of the bandage) round the neck so that it appears on the injured side; then carry the second end up to the first and tie them." In other words, the knots of the large and small armsling are tied off on the injured side. When lecturing, I am wont to remind my classes of the need to keep all the troubles of the patient (injuries and knots of slings) on the same side, and to select a lady as model for the large and small armslings and a man for the St. John sling! !-N.C. F.

"PORTLAND"

AMBULANCE

A knock-out blow on the chin results in a violent sbal{eup of the brain and causes what is termed concussion of the brain. The essential difference between concussion and shock is that in the former condition there is either a history

GEAR

The Gear Illustrated (A. S.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 .

Shows t he top stretcherlowered 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 catalogue of Ambulance Eqult>ment No. 7A wlH be sent on request.

GREAT PORTLAND ST., LONDON, W.1 Te/elrraphlf: Address:-

. ' P~one.: Langham· 1049: . ' " . _

. ~~------------J KARVALID, WESDO, LONDON

ASTH MA, BRONCH ITIS CATARRH, HAY FEVER and ?ther R~spiratory Sufferers should communicate with British Medica Laboratories Ltd., f~r particulars of .. Sano/en "the most ef1!caclO us ~ome Remedy known to Medical SCience; Now being used with remarkable succ~ss everywhere; Endorsed by the Med Ical Profession.

•

BRITISH MEDICA LABORATORIES LTD. (Dept. Z.A.3) Heathcote Road B05f:ombe, Bournemouth. '

ADAM, ROUILL Y & CO., Human Osteology, Anatomy, etc., 18 FITZROY STREET, FITZROY SQUARE, LONDON, W.I TELEPHONE:

Concussion or Shock. W.S. (Slough).-Please tell me if a knock-out blow on the chin of a healthy boxer causes concussion or shock. Also please tell me what is the essential difference indicated by these two different terms. Finally, please accept my best thanks for your kind replies.

PATENT

Hydrochloric Acid Burns. H.C. (Warrington).-Sorne years ago I was working in a galvanising shop. At meal time I saw a workman dip his hands in some fluid and then run away as fast as he could. Why he ran, greatly puzzled me; but, assuming that the liquid would cleanse the hands, I dipped my hands in it. Immediately it felt as if I had dipped my hands in fire. So I ran as quickly as I could after the workman, for when I removed my hands they felt just as if they were still in the fire and burning terribly. When I reached him, my companion was just taking his hands out of a tub of luke warm water. So I put my hands into this liquid. The result was miraculous; and every bit of the terrible agony went immediately just as if it had never happened. Later I was told that we had put our hands into a solution of hydrochloric acid.

I would have thought that carrying out the treatme(jt for poisoning would have been more important than wasting time to tie the feet together. Many thanks for your kind help in the past. Tut I Tut! ! You have misread the query as it was presented in the August issue of FIRST AID ; and if you will reread it, you will find tbat you are raising a totally different problem. In short, in the original query all the injuries were known when the test began. Consequently no time was required to be spent in the examination of the patient.N.C.F.

AID

MUSEUM 2703.

THE HOUSE FOR

HUMAN SKELETONS (.~rticulated & Disarticulated)

Sound teeth are among the most valuable possessions you can ensure for your child. See that she brushes them with Phillips' Dental Magnesia twice a day. Regular use of Phillips' Dental Magnesia, which is the one toothpaste containing *'Milk of Magnesia " neutralizes harmful mouth acids and helps to keep teeth white and free from decay. Sold everywhere I/Id. and I/Ioid .

HALF-SKELETONS,

ETC., ETC.

Ph i II ips' Dental Magnesia Rel1d.

* . Milk of Magnesia' is the trade mark of Phillips' preparation of magnesia,

FIRST

w. H. BAILEY & SON, Ltd. BAILEY'S

GUARANTEED CLINICAL Complete In Ciue.

t Min.

"Diska" t Min. each 2/6

Bailey's" Premier" Splint Set,

comprising 3 Finger, 16 Fore Arm, 16 Upper Arm, I Set (3 sizes) Angular Arm Splints, 6 Assorted Leg and Thigh ranging from 24"-54", (44 Splints in all) - - - PRICE 21/-. (Post and Packing 2/- .)

Tunstall Bandage Winder each 6/6 Splinter Forceps, pair 3/6 St. John's Pattern Tourniquet 1/9 each Solid Steel Scalpels 4/6 each N.P. Scissors from 7/6 pair Artery Forceps, N.P. 6/- pair Fitted Pouches and Haversacks always in stock. Let us quote for your First Aid requirements. 46,

OXFORD

STREET,

LONDON, W.1. 'Phone: Gerrard 3185 & 2313.

'Gram. I "Baylelf, LondoD."

S.J.AIB. STOCK POSTERS Size-30 in. X 20 in. Printing Space-16 in. X 14 in. Suitable for Concerts, Meetings, Socials, or any other function. A local printer can fill in the blank space with any required matter.

PRICE, post free: 5s. 6d. per dozen. Remittances MUST accompany all orders. DALE, REYNOLDS & CO., LTD. 46, Cannon Stt'eet, London, E.C.4.

FIRST AID

MANUALS OF

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

FIRST-AID.

Seventh Edition. 1•• 3d. post ~d. F~r.C.Ald Simpl.lfled a,:,d Tabulated, wlt~ Ald. to Memory. Col. Str {ames Canthe contrtbutes an tntroduciton and we endorse his good opinion 0/ the book."-LANCET,

AIDS TO

HOME-NURSING.

Thitd Edition. Price 1•• ~d., post free. Home.Nanlal Simplified and Tabulated, with Ald. to Memory. This book wonderfully simplifies a complex sub1ect and should be read by studtnts."-L. & N.W. Rv. GAZBTTB.

BFFICIENCY

FIRST-AID.

Fourth Edition. Price 1•• 3d. post 2~d. Problemlla Study I Treatmeat and Examination lolved lor Senior Studenh. " Without doubt the book will be Of great service in the training 0/ those for WMm it is designed.' -BRITISH MEDICAL JOURNAL.

COMMON

ERRORS

FIRST-AID.

Third Edition. ~ •• 3d. post ~d. Errorl la Flnt·Ald Detailed and Explained. This book gives a clearer insight into the methods and ditficulties 01 emergency treatment by laymen than the ot/icial Textbook itself-"-LANCBT.

AMBULANCE COMPETITION

TESTS.

Stretcher, Individ~al and .Quest!on-Six Folde~s~. Price 6 for 3s. post 3d .. Ea~~ Folder contains speCial article on C?mpetltlon~ ;-No. I, Training of Com· petition. Teams; ~~. 2, Conduct of Team In COlll:petltlOn Room; NO.3, Common Errors In Competition; NO·4, Further Errors 10 Treatment· NO.5 History of Competition Tests; No.6, Preparation of Te~ts. '

WHY

AND

WHEREFORE

FIRST-AID.

Fifth Edition. 1•• 3d. post ~d. Dlfflcultle. 10 S~udy and Treatment lolnd by Qu ..tloa aad Anlwer. " We commend thu book to Lecturers and Students who will find it 01 Great serviCl. "-FIRST AID.

HINTS

FOR

FIRST

AID

or local evidence of some violence to the head which has caused a shake-up of the brain.-N.C.F.

THERMOMETERS.

"I~

Mag. each 2/6

AID

HOSPITAL ORDI!RLII!S.

Price 9d. Po.ta,e 2d. Orderly Dutf •• Simplified an~ Tabulated, with Ald. to Memory. A most compact brochu", . • contatns much. use./ul in./ormatioH."- PRBSCRIBBR.

To be obtained from DALE, REYNOLDS & CO., LTD. 46, Cannon Street, London, E.CA.

Baking Powder and Soda. N. M. (Finchley).-Please tell me what is the difference between baking powder and baking soda. Baking powder is usuaJly a mixture of tartaric acid, sodium bicarbonate, cream of tartar with g round rice or starch, whereas baking soda consists of sodium bicarbonate only.-N.C.F.

A HINT TO HELP

SI(IN

S.J.A,A. Medallion.

H. A. (Selby).-I hold the following awards of the St. John Ambulance Association - November 1940, First Aid Certificate (first examination) ; January 1946, Voucher (First Aid) ; May 1946, Home Nursing Certificate. Please tell me if I am entitled to my Medallion. No. We are informed that you are not entitled to the medallion until you have passed a further re-examination in First Aid which should not take place until after December 31st, 1946. In other words, the final examination must be in first aid and twelve clear months must lapse between this and your previous examination in first aid.-EDIToR.

Convenient) palatable) effective . .. 'Milk of Magnesia' * Tablets, by effectively correcting acidity, give prompt relief from indigestion. They are pleasantly mint-flavoured; convenient to take whenever the need arises.

FIRST AID" QUERIES and ANSWERS COUPON H

To be cut out and enclosed w~th all Queries. Oct., 1946. Answers to First Aid Quiz. (1) A mild form of blood poisoning arismg from the absorbtion into the blood stream of poisonous substances formed fnJrn the tissues which have been damaged. (2) 33. (3) (c). (4) Paralysis of the circulatory or respiratory centres. (5) The commonest injury in the region of the ankle. An oblique fracture of the fibula about in. above its lower end. (6) (a) A1ierial.-Bright red blood spurts from the end of the vessel nearest heart. (b) Venous.-Dark red blood, flows continuously from the end farthest away from the heart except in varicose veins (both ends of vessel). (c) Capillary.-Red blood, oozes steadily from all parts of the wound. BOOKS OF REFERENCE. -" Aids to First Aid." N. Corbet Fletcher. "Why and Wherefore in First Aid." N. Corbet Fletcher. "Handbook of First Aid and Bandaging." Belilos, Mulvany and Armstrong.

~ 'MILK OF MAGNES~~.~ ~ TABLETS * 'Milk of Magnesia' is the trade mark of Phi /lips' preparation of m(lgnesia

~-~~ ~~~. ~ f(.O FOR DIVISIONS

OF THE

Sf. John Ambulance Brigade can be OBTAINED from

HOBSON « SONS (LONDON) L TO.

Classified Advertisements. Advertisements with remittance should be sent to First Aid, 46, Cannon Street' London, E.CA. Rate 3d. per word, minimum 45. 6d. Trade advts. 4d. per word, minimum 6s. Box numbers Is. extra.

UNIFORM CLOTHING & EQUIPMENT

Tickets 7/6. Posters, Hats, Memos, Rubber Stamps. " A" TICES, 11, Oaklands Grove, London, W.12.

250 Teddy Bears and Dolls Already to Make. Send LOVELY for Catalogue: G. Russell Inman, 1-3-5, Roundhay Terrace, Lee?s, 7. OR SALE Complete Officer's Uniform and Raincoat. J. White, 10, Hall Road, Stratford, E.15.

F F

IRST AID Competition and Practice Tests. No.2 series. 6 T eam, 6 Individual, 6 Oral. Price 2/- postage 1d. Coming soon-revised No. 1 series and No. 3 series. Robinson, BCM/Superb, London, W.C.1.

MANUFACTURERS. IS4- I6 4, TOOLEY STREET,'

TROUBLE HEAL QUICKLV Wha ~ a g.ra tifying experIence It is to find ~h~t the skin no longer IrrItates, and has become clear and healthy again. Germolene has hel ped many a skin sufferer to get rid of his, or her, complaint ... and it is interesting to know why thi s should be so.

PROTECTIVE

ANTISEPTIC

The purifying effect of 9"ermolene penetrates down 1llto the sweat pores, hair follicles and sebaceous glands, counteracts the activity of skin germs, reduces inflammation. I f you are suffering from skin trouble get a tin of Germolene today 1 1/4 & 3/3 including Purchase Tax.

PENETRATING It is the penetrating power of Germolene which enables it to sink right in through the top skin into the true living skin below-and so t~ reach the tortured nerve endings-which brings such 'wonderful relief.

Use Germolene for ECZEMA, PIMPLES, IRRITATING RASHES, CUTS, SPOTS, BURNS, SCALDS, ABRASIONS, Etc.

BE WITHOUT

LONDON BRIDGE, S.E.I. "Phone:

"Gramt'

Hop •• ,6 (4 Unel)

•• Hob.on. Boroh. London.II!

OINTMENT

FIRST

AID

FIRS

"R ODUCI NG

CijE'~¢ :Jnbeptnh~nt Journal for fbe Ambulance nub J}lursing ~~ No. 629, Vol. LIII.]

NOVEM BER, 1946.

Entered at ] ( Stationers' Hall

PRICE

THREEPENCE

4•• Per Annum. Post Frel!

PI LCHERS AI'1BtJlANCE BUIl.DERS 314 KINGSTON ROAD

S W20

T E A BULANCE & MOBILE X-RAY UNIT SPECIALISTS contains sterile vaccine filtrates (antivirus) of all the common strains of STAPHYLOCOCCI, STREPTOCOCCI and B. PYOCYANEUS in a lanoline-zlnc.ichthyol base. SPECIFIC AGAINST the micro-organisms causing abscesses, boils, eczeml, dermatitis, erysipelas, h<emorrhoids , Impetigo, ulcers and all inflammatory cutaneous affections. ANTIPEOL LIQUID for infections of the ear, septic cavities and suppurating wounds .

shall be pleased to receIve enquIt1eS for deliveries in this country and in any part of the world.

PHTH LMO ~oo~8c~~~1. semi-fluid

INDICATIONS:

base,

the

sterile

vaccine

filtrates of STAPHYLOCOCCI,

314, Kingston Road, VVimbledon, S.W.20 & 47, High Path, London, S.W.19

B.PYOCYANEU5, PNEUMOCOCCI FRAENKEL and

Conjunctivitis, blepharitis, keratitis, dacriocystitis and all inflammatory conditions and letions of the eye.

RHI

PILCHERS • AMBULANCE BUILDERS

N IPE L STREPTOCOCCI ,

-A

A nasal immunlsing cream, contains Antipeol Liquid as well as the antivirus and autolysins of PNEUMOCOCCI, PNEUMO-BACILLI , ENTEROCOCCI , M.CATARRHALlS, B.PFEIFFER and calmative and decongestive ingredients. INDICATIONS: Coryza, rhinitis,:hay fever, catarrh, influenza, colds and other nasopharyngeal infections .

Telephone; LIBERTY 2350 & 7058

ENTER F GOS

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polyvalent bacteriophages specific against 156 strains of micro-organisms common to infections of the gastro-intestinal track, kidneys and bladder. RAPIDLY EFFECTIVE RESULTS in enteritis, dysentery, colitis, diarrhceas, B.co li infections, typhoid and para-typhoid fevers, and other intestinal and para-intestinal infections. Oral administra. tion. No reaction. No shock.

3507

DETEN

No contra-indications.

CLINICAL SAMPLES AND LITERATURE FROM Printed and Published by DALE, REYNOLDS & Co., LTD., 4 6, Cannon-street, London, E.C.4, to whom all communications should be addressd

Teleg1'ams-" Twenty-lour, London."

Telephone-City 77IO,

To be bad of all Newsagents, Booksdlers and Bookstalls in the United Kingdom and at all Railway Bookstalls of Messrs. W. H. Srruth & Sons.

MEDICO-BIOLOGICAL LABORATORIES, LTD., Cargreen Road, South Norwood, London, S.E.2S

FIRST

AID

FIRST

HOME TRIAL!

FREE

"PORTEX"

AID

MEDICATED

PLASTIC SKI N As supplied to Hospitals

"HEALTH RAY SUNLAMP" ULTRA-VIOLET or INFRA-RED

FOR

ULTRA VIOLET RAYS can the skin, form vitamins in th: .issues, cr~ate new blood cells, and so fortify the whole body . Persons dep~lved these rays .g~t s allow and anaem ic. INFRA·RED RAYS relieve Rheumatism , SClatlO, NeurltJ~ , Skin Troubles , etc. Made for Home Use. As safe and easy to use as elec~r1c li ght. A .C. or D .C . , 200 250 volts .

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Ple ase send deta ils of your Health Ray Sun Lamp

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Sprinkle a

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3 U seCnl books *

HANDBOOK OF ELEMENTARY AND PHYSIOLOGY

SEALS AS IT HEALS

Hospital Size - 23/4

PORTLAND PLASTICS LTD.

Abbey House, Westminst.e r, London , S.W.I

Telephone: MUSEUM 2703.

JUST ISSUED!

NEW!

By A. D. Belilios, M.B .. D. K. Mulvany, F.R .C.S., & K. F. Armstrong, S.R.N.

BAILLiERE'S NURSES' MEDICAL DICTIONARY By Margaret M. Hitch, S.R.N.

3/4

. 10/-

Human Osteology, Anatomy, Etc.,

A Second Edition of this up-to-date book based on war experience and deSigned to Pr ice provide a concise and complete training. It covers all the ground for training recom4 mended by the British Red Cross Society, the St. John Ambulance Association, the Civil S. Nursing Reserve and the General Nursing Council. Fully illustrated Postage 6d.

Sound

teeth

MADE UNDER THE SUPERVISION OF PROFESSOR C. F. V. SMOUT, BIRMINGHAM UNIVERSITY.

are

among the most valuable possessions you can ensure for your child.

Here is a way to make certain

he keeps them clean and healthy: see that he brushes them with Phillips' Dental Magnesia twice a day. Regular use of Phillips' Dental Magnesia, which is the one toothpaste containing • Milk of Magnesia', * neutrali zes harmful mouth acids and helps to keep teeth white and free from decay. Make sure your child's future includes that sparkling Magnesia smile!

Price

t ion of thousands of words in common use, and a compendium of 21 sections of valuable S. • information. Over 500 illustrations. I20stage 3d.

DALE, REYNOLDS &

Large

18, FITZROY STREET, FITZROY SQUARE, LONDON, W.I

HANDBOOK OF FIRST AID & BANDAGING

7 & 8, Henrietta St., London, W.C.2

Proprs.

ANATOMY

Every first aider and nurse must have a Medical Dictionary. Bailliere's Nurses ' Medical Dictionary contains 462 pages of essential information. giving explanation and pronuncia-

1/8

Medium -

ADAM, ROUILLY & CO.,

A complete outline of the human body, simply written and easily understood. ProPrice vides a basic knowledge of the subject for students of Anatomy and Physiology, 4 6d including first-aiders, prospective nurses, nursery nurses and school children in upper S. • forms. Clear and helpful drawings supplement the very lucid text. Postage 3d.

COX,

Small-

No FIRST AID Kit is complete without this. Available at all Leading Chemists

By A. D. Belilios, M.B., D. K. Mulvany, F.R.C.S., & K. F. Armstrong, S.R.N.

BAILLIERE, TINDALL &

Inc. tax

etc.

PENETROL

PRICES

CUTS BURNS ABRASIONS IMPETIGO INSECT BITES CHILBLAINS

Co., Ltd.,

46, Cannon Street, London, E.C.4

Sold everywhere I/Id. and I/Iotd.

Phillips' Dental Magnesi,2 * 'Milk of Magnesia' is the trade mark of Phillips' preparation of magnesia.

FIRST

FRACTURE

AID and

DISLOCATION

CHARTS,

COLOURED. FIRST AID FRACTURE CHART

Size 28' x 40'

Price 17/6d.

FIRST AID DISLOCATION CHART

Size 20'" xiS'

Price 7/6d.

P-ostage 1/- extra. Two charts, coloured, on cloth, With rol/ers,

FIRST

AID

FIRST AID

-* VALUABLE FIRST-AID BOOKS *ARTIFICIAL RES'PIRATION EXPLAINED By FR A NK C. E VE,

B.A., M. D.,

F R .C.p. (Lo n::l) .

Cro wn 8vo. 80 pag es with 26 ph otog r a phi c illustrations. 3s. net. ~

No . 629.-VOL. LII 1.

In this Bookl et- fur th e first ti me-all th e new and improved m eth od s of Artifi cia l Respiration ha ve been br oug ht up to d ate.

No matter how obscure the cause of a headache, palliative meas ures are an essential 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 in action and partic ularly well tolerated, their anodyne action is unattended by dep ression or nausea.

ANADI~oH .Tablets ANADIN LTD · CHENIES ST. . LONDON· W.C.l

ILLUSTRATIONS OF BANDAGING AND FIRST AID By LOIS OAKES , S. R.N ., D. N . Third Ed it ion. Ext ra Crown 8vo . 300 pages w ith over 300 photograph s of triang u lar and roller bandaging , 6s. net.

CASUALTY WORK FOR ADVANCED FIRST AID STUDENTS By A. W. MacQUARRIE , M. B., Ch •.B. Demy 16mo. 254 pages full y illustra ted. 45 . 6d. net.

NOTICE

A POCKET MEDICAl, DICTIONARY By LOIS OAKES , S. R. N. , D . N., and Prof. T. B. DAVIE , M.D .

N O VElVI B E R , 1946 TO

READE RS

FIRST AID is publish ed on the ::zoth of each month. Annual Su hscription is 45. post fr ee ; !'ingle copies 3d .

T he

Its aim and object being toe advancement of Ambulance Wor k In all its branches, the Editor invites Readers to send Arti cl es an d Repo rts on subjects pertaining to the ~11)vement and also welcomes suggest ions for Pra ctical Papers.

FIRST AID TO INJURED AND SICK

All Reports, &c. , shou ld be addr essed to I ht Ed itor at tb e address below, an d should reach him before the 8 t h of each month, 'and mnst be accom pan ied (n ot necessarily fOT publication) by the name a nd ad d ress of th e Correspondent.

Fort y- Fifth Ed it io n. 88 p'ges. 46 illustrations. 9d. n , t.

Subscriptions, Adve rtisements a nd othe r business Communications connected with F I RS T AI D shou ld be forwarded to the Publ ishers DA LE, REYN O L D S & Co., L TD., 46 , C A N N ON S TRItKT, LONDON,

PUBLISHED BY

-LIVINGSTONE of EDINBURGH-

E.C.4.

Telegraphic Address - " Twenty-j aur, London " Telephone-City 37 IO.

IN TH IS ISSUE.

"SANOID" INTERLOCKING EXTENSION SPLINTS

FIRST A ID MOVEMENT ...

(Potent Number 53165 of 28/7/39.)

Am. By Sir H e nryL. Ma rtyn , KC.V. O. , F.R.C.S.

SIDE LIGHTS ON FIRST INCURVED EDGE OF SOCKET /

TRANSVERSE GROOVE OF .SjLlNT

~~~S~P~LgIN~T~~~~~~~s~o~gEK~E~T::::::= ~ SPLJNT1?

INCURVED

S.1343 .. SANOID" INTERLOCKING EXTEN SION SPLINTS With Metal sockets for Jointing. 2 pieces : 2 5/8ths. In. x 3/ 16ths. In. x IS In . 2 pieces: 2 S/Bths. In. x 3/ 16ths. In. x 13, In. I piece : 2 5/8ths. in . x 3 / 16ths. In . x 7t In . I piece: 2 5/8ths . In . x ::I/ 16ths. In. x 6 In. 2 Webb ing Straps with metal buckles : 18 In. x I In. 2 Webbing Straps with metal buckles: 27 In . x It In. 3 sockets. By this Inve ntion Splints made In any convenient lengths make rigid connections by means of incurved opposite edges of the metal sockets or sleeves firmly engaging with transverse groove. In the surfaces ofthe Splints when pressed home Into the socket. Unlike the ordinary socketted Splint, this type Is rigidly coupled together and held against relative displacement but can be disengaged by pulling apart with sufficient force .

* * *

N.B .-To ensure perfect locking It Is Imperative that the Splint should be correctly Inserted In the socket. I.e., BY MAKING CER.TAIN THAT THE INCURVED EDGE OF METAL SOCKET ENGAGES WITH THE TRANSVERSE GROOVE OF THE SPLINT.

Prices on application.

Sole Manufacturers :

DOlSON, GERRARD & CO. LTD. First

Aid Specialists OlDBURY,

BIRMINGHAM

AMBULANCE NEWS FROM ALL QUARTERS . ..

FIFTY YEARS AGO

EDGE

SOCK ET

FIRST

AID QUIZ

PRACTICAL N URSI NG TN THE HOME.

By Ag nes E. Pavey, S. R . N . Moder n Surgic"ll practice favour s an undis tu rbed dressin g and for th is purpose ' Elastop last' is used extensively in hospitals. I t stays in place, p rotec ting the wou nd , while permitti ng uninterrupted healing. 'Ela<;toplast ' is elastic, adhesive, antis eptic. w it h confiden ce for all minor inj u ties.

THE

INSTI roTE OF CERTIFIED AMBULANCE

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Use it

Elastopl9.~t BANDAGES AND PLASTERS MarIe In Englan :l by T. J . Smith & N t' ph~w Ltd ., lJ ull

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EDITORIAL.

Seven t h Editi on . 464 pag es . 267 illu H ration s. 4s . net.

Rev ised an d Re wri t te n by HALLIDAY ~UTHE RL AND , M.D .

E,.t~1'ld a t ] [ Statiotc.1's' Hall

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First Aid M ove ment. OF an interesting nature an article on the " First Aid Movement" appeared in the October iss u e of the G . W. Ratlway klagaz£ne, and it goes fa r to prove our assertion that the movement of fi rst aid is in the upward direction "towards a bi gger membership, wider facil ities for stud y ing pract ice, and higher efficiency than ever before. " Me n , says the article "are retu rn i ng from the Forces with a new appreciation of the value of skilled first aid for injuries. Conditions in general are gradually becoming more settled. Leisure, w h ich during the war was encroached on by Home Gua rd or civil defence duty, is our own once more, to use as we will. Long hours of railway duty are fast contracting in the direction of the normal. The strict blackout is only a memory, and premises are being freed from protracted occupation. Evenings are drawing in, providing the ideal time for the combined study and sociability which the onset of wi nter, despite all its d isad van tages, happil y brings. Already the first aid competitions ha ve been held this year, on a modified basis, but the coming winter's preparations are the prelude to next year's retu rn to the sem i-final and final competi tions," all of which are extremely welcom e aspects of the movement. It is popularly assumed that virtue is its own reward, and as it is with virtue' s o it is with first aid, which seldom receives due compensation. There are few who recognise the amoun t of skill and patience which are necessary to attain to full competence. It is therefore highly satisfactory to note the valuable leave and travel concessions which qualified first aid exponents enjoy at the hands of the Company. These comprise an additional free ticket granted to each regu la rly employed member of the staff passing a first aid examination, for self, wife a~d dependent chi ld ren; one additional day's leave with pay, after passinO' 15 annual examinations, and in respect of t> . . eac h subsequent annual examInatIOn passed; two add itiona l days' leave, w ith pay, after passing 30 an nu a l exam inations, and in respect of each further an n ual exam i nation passed. In concI usion a list is O'iven of the divisional ambulance secretaries t> . ' . who will answer inqUIries.

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AID

Side Lights on First Aid. By SIR HENRY L. MARTYN, K.C.V.O., F.R.C.S.

------- .-- .------CC IF only they don't ask me anything about poisons I shall be all right." How many students have confided this to one another on the eve of examination, for certainly the subject is one of the most dreaded in the syllabus! Take comfort, for certainly neither your lecturer .nor your examiner will have much more knowledge of them than you have, and the experience of the average doctor in the treatment of cases of poisoning is almost nil. I al ways like the first of the general rules for treatment which instructs you, when sending for a doctor, to state the name of the poison if known. This, of course, suggests that it is for the purpose of allowing him to bring the appropriate antidote. Personally, I think it is much more likely to be for the purpose of giving him the chance to look up the subject with great speed in the nearest book he can lay his hands on ! Be that as it may, the chapter is a good one, with a clear cut easy classification which, once learned by heart, will always be a ready help-in the examination room. Remember, however, it must be learned intelligently. I have known students perfectly a ware that the irritants include the metalliC poisons, but when asked the symptoms of arsenic poisoning, stare at you as though the question was most unfair. Similarly, I have asked a student what symptoms he would be likely to exhibit if he took an entire bottle of 100 aspirin tablets. The fact that aspirin is harmless in ordinary doses and helps to relieve pain and induce sleep, but in doses of 500 grains would produce some at least of the symptoms of hypnotic poisoning never occurred to him. Learn the general rules for treatment word for word, one or two points upon their why and wherefore may help you to do so. Why do you not give an emetic if the lips and tongue are burned? Because no emetic could get rid of an acid or alkali already eating its way into the walls of gullet or stomach, and, because the violent contractions induced by the emetic in the act of vomiting, might easily cause rupture of the already ulcerated stomach. Therefore use antidotes, not emetics. Give castor oil after the emetic has acted in all other than corrosive poisons in order to get rid of such of the poison as has passed through the stomach into the intestines, thereby evading the action of the emetic. Curiously enough, no mention in the chapter is made of the necessity to treat the shock which invariably accompanies all cases of poisoning other than those such as the cyanides, in which death is almost instantaneous. One or two pegs may help to hang the memory of facts upon .. Car~olic acid and Lysol at one time were very faVOUrIte pOIsons used by suicides, especially love-sick ladies -why, Heaven only knows, since it would be difficult to chouse a more unpleasant and painful death, but they were both fl'!-irly easily obtained. Arsenic was the poison used by Armstrong in the murder ?f his wi e, and hyoscine, an hypnotic, by Crippin in disposmg. of Belle Elmore. Prussic acid was used by \Vhittaker Wnght as a means of suicide after his trial and sentence at t~e Old Bailey, and .several of the wanted men among the hIerarchy of the NaZIS are said to have followed his example. Strychnine has been used as a means of ml,lrder , the crystals

closely resem ble those of ordinary medicinal salts, and were taken by the victim under the impression that she was taking her usual little morning dose. Especially in opium poisoning, the giving of a dose of castor oil after the emetic has acted is of great importance, in view of the fact that the drug is absorbed rapidly from the upper bowel and is then excreted into the lower bowel, from whence it may be again absorbed unless it is cleared out by a powerful purgative. It is equally important to keep the patient awake and prevent him sinking into coma. I have vivid recollections of an occasion when, as a student in the casualty department of a London hospital, I spent the greater part of one night staggering up and down the out patient hall with an enormous man who had taken an overdose of opium, the while another weary student supported him upon the other side and administered an occasional flick with a v. et towel to add energy to the proceedings. I ncidentally, the victim recovered. Under the heading of miscellaneous injuries, many conditions of very real importance to fir~t aiders are included, the kind of accidents that one is apt to encounter in one's own home. The first part of the chapter is devoted (0 the treatment of burns, and this section has been entirely rewritten in the new supplement. . It may be of help to consider for a moment the reasons why these alterations have been made. There is probably no subject in surg-ery which has occasioned so much controversy in the last ten years as the best treatment for burns. From the very beginning of this war it became a matter of urgent and vital importance, owing to the number of cases which were occurring both among the civil population and in the Air Force. Each individual through whose hands the case passed bore almos t an equal share of responsibility, for a mistake, anywhere in the chain, could not only endanger the \'ictim's life but could delay his return to the fighting line or condemn him to lifelong deformity. Let us consider for a moment what are the causes of death from burns, and, from our knowledge of these causes, let us see how even the earliest first aid treatment can influence the final result, the life or death of the patient. The most common cause of death is shock, which is invariably early and of exceptional severity. It depends upon the extent of the area burnt rather than upon the depth of the burn. An individual who has suffered even a superficial burn involving more than a third of his body area will seldom survive. The rapid loss of fluid from the ra\\< surface, the intense pain and the fear occasioned by the fire all contribute to the severity of the shock. The next most common cause of death is sepsis, and the supplement points out tbat most burns and scalds are fundamentally sterile for a short period following their cause. Here, then, are two clear cut indications for the correct first aid treatment of burns. Do everything possible to treat shock and to limit its severity and to keep the wound sterile. With these points in view, tte supplement modifies the instructions for treatment given in the older editions.

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The student is advised not to remove clothing under any circumstances, since to do so must entail handling, exposure and increased pain, and so must perforce add to shock. He is further instructed, whether medical aid is readily available or not, to take immediate steps to combat shock with warmth and fluids, and to transport the case to hospital quickly -where transfusion can be started almost as soon as the patient is within the doors of the building. In other words, the question of shock is stressed to a much greater extent than in former editions of the textbook. Secondly, the importance of clean hands and sterile dressings from the very first is impressed upon the student. He is told not only to cover the \.vound with a dry dressing but with a sterile dry dressing, and, at last, the almost medireval advice to use dressings of warm strong tea is omitted. If there is to be any delay in transport to hospital, the use of warm alkaline solution to saturate wound and dressings is recommended. The tannic acid treatment of burns described in Appendix XII of the former edition of First Aid appears at present to have been allowed to stand. This is rather to be regretted, since the method has been largely bO'iven up owing to the tendency for the formation of dense scar tissue and contractures of joints subsequent to its use. Foreign bodies in the eye for some unknown reason appear to present great difficulties from a practical aspect to the first aider. I have been amazed at the number of times that I have found a fully certificated man jib at the idea of

everting an ~pper eyelid. It is not difficult, and there is no reason why it should cause the patient any pain whatever. . Always ~xamine an .eye for a fo~ei!?n body methodically, 10 a. good lIght and With a magOlfYlOg glass if possible. HavlOg made sure that there is nothinO' stuck to or embedded in .the cor?ea itself, pull down the lower eyelid gently and examIne the lOner surface, making the patient turn the eyeball first inwards and then outwards. If the search is still unsuccessful, take your courage in both hands and evert the upper lid. With regard to foreign bodies in the ear it would be wiser not to make any attempt whatever at removal even the installation of olive oil for the purpose of "floatinO' out" an insect can be followed by serious results. t'> Take the case to a doctor and let him deal with it. ForeiO'n bodies in both ears and nose can easily cause faral injuries if attempts are made to remove them. Small stones an~ be~ds ar~ the ~ommonest objects inserted by children in their httle fnE'nds ears, and, lying at the opening of either ear or nose, look .sim~licit.y itself to remove. In actuality, they are extraordmanly dIfficult and tend to slip deeper and deeper into the passage at each attempt to grasp them. I have seen the total destruction of the middle ear in a child upon whom such an attempt was made to remove a stone, and the death from meningitis of another infant whose mother refused until too late to believe his story that he had pushed a bead up his own nose. (To be concluded)

AMBULANCE NEWS FROM ALL QUARTERS. S.J.A.B. No. I (Prince of Wales's) District No. 147 (E. BARNET}.-This Division a year a<.To was one of the smallest in the country j it is now growing ~apidly an.d there are signs of great activity at headquarters, Church Hill Road. A "Campaign Committee" has been formed under Supt. Bowyer who reports good progress. A series of classes are being held, the chief instructor being Dr. ·Westlake. The team of four were the runners-up in the Area Competitions for the Massey-Mainwaring Trophyand the Osbourn Shield. Credit is due to the leader, 1\1r. Waller who trained the team in a very short time. The Social Committee announce that a dance will be held at H.Q. on December 14th.

County of Hampshire. ANDOYER.-The Andover "A" Nursing Division this year won the Twiss Rose Bowl on Saturday, 'September 21st. There were five entries, Andover" A " and" B," Farnborough, Southampton and Southsea. I n addition to winning the Twiss trophy, Andover" A " also secured the Tutte Rose Bowl for most marks gained in the home nursinO' secb tion of the Twiss Bowl competition. The Matron of the R?yal South Hants Hospital expressed great pleas~re at. the high standard shown in the nursing tests, lO whIch POlOtS were gained as follows, out of a possible 50-Andovel- " A " 44, Farnborough 43, Southsea 42, Southampton 41, Andover" B " 38.

County of Lancashire. WARRINGTON.-It is with deep regret that we learn of

the passing of l\1r. A. E. Spann who died suddenly on Sun., October 6th. . . ~1r. Spann had been a member of the Headquarters' DIVISIOn of the local Corps for 43 years, amonO' the posit ions he held being those of Divisional Secretary, C~rps Secretary, and Corps Officer of the Division. He was amonO' those on parade at the King's review of ambulance \\·orkers in London in 1912, and some years later received the insignia of a Sen'ing Brother of the Order of St. John. He held the S.J.A.B. Long Service ledal and two bars for 2S years continuous ~ervice. I n the first. worl.d war he served as a Staff-Sergeant lO the R.A. M.C., chIefly lO Salonika. IRLA~l AND CADISHEAD.-At the invitation of District Officer J. Sinclair Kerr, O. St.]', president of the Divisions, members of the Irlam and C"ldishead Ambulance and Nursing Divisions, the Lancashire Steel Corporation, Irlam 'W orks Division, and the Boy and Girl Cadet Divisions, were entertained to a "high tea" at the Irlam British Restaurant on Saturday, October 26th. During the course of his remarks, 1\1r. Kerr said this was the first social event that had been held since the outbreak of war, and he welcomed the members of the Brigade. They had done much good work but had reached a period of slackness due to the aftermath of war. He suggested that the time had now arrived when that should be succeeded by a revival of their efforts to build up to and exceed their former strength. Councillor A. Briggs presented the awards and recorded his thanks to the members of the Brigade for their hospitality. Supt. H. \Veston moved and Amb. OHlcer Watson seconded, that appreciation should be shown to 1\1r. Kerr for his generosity and to everyone who had made the function so successful.

FIRST

MORECAMBE AND HEYSHAM.-The first annual competition for the" ] ean Platten" trophy was held on the Central Pier, Morecambe, during the week 16th-21st September. The trophy was kindly presented by the Mayor of Morecambe and Heysham, Councillor Mrs. M. ]. Platten. Preliminary competitions were held each morning and afternoon from Monday to Friday with a final competition, for the winners of each preliminary session, on the Saturday. Each test consisted of three parts, viz. -team test, individual and practical and "iva voce. Twenty eight teams from Lancashire, Cheshire, West- . morland, Durham, West Riding of Yorkshire and Northern Ireland, both ambulance and nursing competed. The Mayor presented the trophy and prizes of £5 per team member to the Hetton-Ie-Hole (County Durham) Ambulance Division who were the winners with a total of 377 marks out of a possible 400. The venture was brought to a successful end with a Social evening at the Ambulance Hall on the final day when all the competitors and their followers were invited.

A most enjoyable evening was spent at the King's Arms, Moreca'mbe, on Saturday, October 12th. The occasion m3.rked the jubilee year of the Corps and 130 members past and present to.sether with their friends sat down to an almost pre-war dinner. The Mayor of Morecambe and Heysham, Councillor Mrs. M. J. Platten, presided, and District Officer Dr. W. W. M. McKinney was the Toast Master. After the dinner, dancing to the music of Clarence Pickford, a Morecambe Div. member, and his band commenced. A small whist drive was also held. The playing of Old Lang Syne and the National Anthem brought a most enjoyable evening to a close.

County of Stafford. TIPTO:-l AND D1STRICT.-The competition for the M. E. C. trophy for A.mbulance Divisions was held at the Park Lane Council Schools, Tipton, on October 6th. The winning team was from the Tividdl.le Ambulance Division and will represent the Tipton Corps in the Area Competition for South Staffs which will be held in Tipton on a date to be fixed in February, 1947. The Albert Parker trophy was again awarded to the team placed 2nd, this being Tipton Parish Ambulance Division. On Sunday, October 20th, the competition for the President's and ] effery trophies was held at the Locarno Road Schools. The competition was for Nursing Divisions and the winners were the M.E.C. ar.d Ocker Hill Nursing ·Division who will represent the Tipton Corps at the Area Competition for Nursing Divisions which will also be held in Tipton in February next year. The grand finale, the open competition for the Heathcock Memorial trophy and the Kemp trophy was conducted at the Locarno Road Schools, on Sunday, November 3rd. Seven teams competed and the result was as follows : 1, .~i~idale Ambulance Division; 2, Rowley Regis Nursing DIvIsIon.; 3, M.E.C. and Ocker Hill Nursing Division. DUrIng the year the Corps competitions have received a very generous suppor.t from the Divisions in the Corps and also the general publIC, and the prospect of having the area and c~unty competitions in Tipton in 1947 should prove attract Ive.

County of Worcester. DUDLEY AND DISTRICT. -The Dudleyand District Corps

AID held its eliminating round of the" Lechmere " Cup competition on Saturday, October 19th, at Christ Church Schools, North Street, Dudley. The" Lechmere " Cup is competed for annually and is open to teams of 4 members from Ambulance and Nursing Divisions in the County of Worcestershire. Brierley Hill and Stourbridge were the two competing teams. The former gained 201 marks and the latter 196 ) The winners represented the Corps in the Inter-Corps competition. The first Regional com petition of the S.]. A. B. to be held in the Midland Region since the outbreak of war, took place on Saturday, October 19th, at the Edgbaston High School for Girls, Hagley Road, Birmingham. Ambulance and nursing competitions were held, many teams taking part. County Commissioner Sir Bertram Ford said that he was extremely pleased to see so many present. He wished to express his appreciation of the work of the surgeons in setting and judging the tests. He also wished to thank the competitors for the time spent in training and the Officers who had trained the teams. Sir Bertram then announced the results as follows : Ambulance: Staffordshire 290 marks j Hereford 280~ j vVorcester&hire 279; ·W arwickshire 276-t; Birmingham 267t. Nursing: Staffordshire 239t marks; Warwickshire 228t; Worcestershire 210; Hereford 194 ; Birmingham 188t. Amidst applause the County Commissioner presented the trophies to the leaders of the winning teams. Three Worcestershire members were decorated at the recent investiture held at the Mansion House. Cour~ty Commissioner 1)r. F. L. Newton being made a Commander and Corps Officer H. Rose and Amb.' Officer H. Cooper Se:ving Brothers. SOUTI-IERN AREA -The Southern Area held their elimin ating round for the "Lechmere" Cup at the Shirehall, Worcester, on Saturday, October 12th. After a very interesting competition the Redditch Ambulance team emerged the winners and will represent the south of the county in the final. KIDDERMINSTER.-The Cadet Nursing Division held its third enrolment ceremony at the Baxter Hall, Kidderminster, on Monday, October 14th. The ceremony was performed by Mrs. Hugh Robinson, County Cadet Officer, and 10 cadets were enrolled. They were then presented with their preliminary First Aid Certificates. Mrs. Robinson gave a short talk on the history and work of the Order of St. John, and the ceremony was followed by a demonstration in first aid by the newly enrolled cadets. Members of the Brierley Hill Division competed for the Campbell Cup recently. The trophy was given in 1937 for annual competition, by County Surgeon G. C. Campbell when he was Div. Surgeon. There were seven competitors, the winner being Private F. Butterworth. INTER-COUNTY CADET COMPETITION.-The first InterCounty competition between Cadet Divisions in the Midland Region was held on Saturday, October 26th, at the Edgbaston High School for Girls, Hagley Road, Birmingaam. County Commissioner Sir Bertram Ford announced the results as follows :-Cadet Am bulance : Herefordshire 280i marks; Warwickshire 277-t j Birmingham County 267-j Worcestershire 253; Staffordshire 248. Cadet Nursing: Birmingham County 303t marks; Worcestershire 3031 ;

FIRST Herefordshire 243; Staffordshire 241 ; Wa rwickshire 240. Birmingham County were declared winners in the Cadet Nursing cl)mpetition, having gained more marks in the Individual Tests than Worcestershire. Sir Bertram presented the trophies to the leaders of the winning teams, and said th3.t he thought all the teams had done their work well.

West Riding of Yorkshire. SIIEFFIELD. -A competition in first aid and home nursing took piace on Saturday, October 191 h, in Sheffield, between teams from several of the Sheffield Corps Nursing Division8. Dr. Shea adjudicated in the team tests for first aid, and Mrs. Spalding was the judge in the home nursing portion of the com petition. The results were :-First Aid: Sharrow 355 marks; Rockhills 351 ; Stocksbridg-e 3+0. Home Nursing: Sharrow 66 marks; Rockhills 61 ; Stocksbridg-e 57. The " Else" trophy for the first aid team test was presented by Asst. Commissioner H. C. Else (Hon. President, Sheffield Corps), and the home nursing award was presented by Staff Sgt. Carnell (H.Q. Staff, Sheffield Corps). Sharrow Nursing Division are to be congratulated on gaining both trophies, as Lhis is the first occasion on which they have taken part in any competition. All except 3 members, who lost their lives, have now returned from the Forces, and to mark the occasion, a Reunion Dinner took place on November 2nd, at the Cambridge Restaurant, Sheffield, full owed by a Concert. During the 6 years over £270 was collected and sent out to some 50 members in the form of gifts. and Staff Sgt. Carnell and CpI. Butler of H. Q. Staff, Sheffield Corps, did a splendid job of work in dealing with it, which involved the writing of over 1,000 letters. FEATHERSToNE.~:\1embers of the Featherstone Division gathered at the Traveller's Hotel, Purston, on Saturday, October 19(h, for a meal ::lnd social evening. The Toast of the" Brigade" was given by Corps Supt. T. C. Amery who traced the history of the movemen t. 1\1 r. Amery who has served with the Bri!:;ade for 45 years has now retired from his post, but, we und~rstand, will continue to act as treasurer to the Puntefract and District Corp". County Cadet Officer W. Banham who responded, congratulated l\1r. Am ery upon his appointment as Commander of the Order, and also referred to the early days of ambulance work. Several other toasts followed and there were musical interludes. The Chairman, in closing the evening, appealed to all young people to devote all possible interest to ambulance work.

First Aid Quiz. Questions. (1) Why would you give Epsom salts in a case of carbolic acid poisoning? (2) When bandaging limbs why do you start from below? (3) What is a "Greenstick" fracture? (4) Why is sol volatile used in shock cases? (5) What do you understand by "Reactionary Hremorrhag-e" ? (6) What is " Synovitis? " (Answers on page 66.)

AID

FIFTY YEARS AGO. From "FIRST AlD," N ovem ber, 1896:THE HO~lE SECRETARY ON FIRST AID. T~E presence of the Home Secretary, Sir Matthew White Rldl~y, at Blackpuol, on September 29th, and the distribution by hl~n of the certific.ates to the lady students, marks the day

as betng one of speCial interest to all those who are enthusiastic in carrying on ambulance work. To the Chief Constab~e, l\1r. J. C,. Derham, is due the credit of being able to obtam the services of such an important .member of the Government, and of the grand work that ha'> been done at that seaside resort. The ~hief C~nstable,. in the remarks he made, gave some very Interes~ln~ partIculars of the fir&t aid work performed by the poltce m Blackpool since the beginning of the y~ar-no fewer than 118 cases being attended to during the mne fononths, man~ of them being serious, and in some, there IS no doubt, hfe was saved. This is a record to 'v\ hich we, the citizens of London, are unaccustomed, and it is a matter of great reproach to us to perceive that, while Blackpool, a town of small size as compared to London is able to provide some kind of am bulance service for its' accidents t?is huge Metr?polis is at present destitute of any such insti~ twn under offiClal control, and leaves its street accidents to the mercy of the police, who, as a bod\', are not instructed in the principles of first aid. The Home Sec retary, in the course of his speech, made many remarks ~hich wij~ have tbe ( ffect of finally dispelling some erroneous Ideas whIch are held concerning our work. He spoke of the ilT~rortance of tra~sport WOI k, sick nursing, and of the connecl1on of the medical plofession with ambulance work. He quickly destroj ed the illusion that doctors are jealous of the formation of am bulance classes and of ambulance teaching generally; he himself had never seen it, and he averred that the doctors were the great friends He also mentioned that out of 1 SOO of the movement. police in Lancashire, 1,100 had obtained first aid ce~tifi cates. How long will it be before London can boast of such a large percentage of its police being thus rendered efficient, or of a service capable of giving the help that is so needful? The main fact, however, that stands out with such prominence, and which rea lly makes an epoch in our history is that a Cabinet Minister, and one of such influence and power as Sir Matthew White Ridley, has come forward and stood on a public platform and ad\'ocated the claims of first aid. This shows, pre-eminently, that the movement is going ahead, and is commencing to obtain such a hold on the minds of public men that it will in time become the question of the hour, and then we may confidently look forward to the day when ambulance services will be established in London and. provincial towns, and railway lines and all large works will be thoroughly equipped with a proper ambulance plant, and will be up-to-date in all that appertains to the work. In mo&t other matters London leads the \,'a)", and we mu')t confess that in first aid work this city at present lags behind and requires a good deal of coaxing and pressing to make any moye whateyer. May we venture to hope that tbis stigma may 'ere long be removed? J

DUNKERlES AMBL'LAl\'CE LEAGUE.- vVe have received particulars of the above, whose headquarters are at Mansfield, N otts. The objects of t he League ,ye understand are, briefly, tbe furtherance of first aid ~'o rk and the promotion of friendliness and competitions amongst mEmbers of first aid societies within 12 miles of headquarters. Full particulars and a book d rules may be had from the Secretary, W. Hackman, 5, Cross Street, Bilsthorpe, Newark, N otts., for 9d. post free.

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Practical Nursing In the Home. 3

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

B E D MAKING.

Every woman knows how to make a bed. Nevertheless, there are a few points that need to be mentioned with regard to bedmaking for a sick person. It is essential that the bedding should, at all times, be scrupulously clean, and with the present day difficulties with linen replacements and with laundry this is no easy task. The use of a mackintosh and drawsheet for patients using bedpa ns and urinals, care and forethought in giving a nd remo vin g these utensils, the protection of the patient's gow n and top sheet by a diet cloth or napkin when feeds or meals are given, and the ri g ht technique in washing the patient, all help to prevent soiling of the linen. The bed looks neater and the sheets keep fresh longer if they are used properly. The bottom sheet needs to be taut and firml y tucked in with as little creasing as possible. T o achieve this, the envelope corner is used. (See F ig s. 1 and 2.) Then, if the bottom of the top

be taken and the bed must never be jarred or the patient exposed. Most patients may be rol1e~ on to the side for bedmaking and sheet changing, although those who are being nursed in a sitting up position may have to be lifted. PRELIMINARY PROCEDURES.

Whichever method is adopted and whether sheets are to be changed or not, the preliminary proced u res are the same. First, collect all that is necessary. This will include a duster and a soft brush, any fresh linen that is required and a container for the soiled linen. A chair is placed about half a yard from the foot of the bed. If two chairs are available, it is a good plan to place them back to back, for then the bedclothes never drag on the floor and the danger of one chair over-balancing is avoided. Obtain a helper if possible, for thus the procedure can be greatly speeded up and the patient can be moved with practically no effort from himself; and see that the window is closed if there is likely to be a draught of cold air towards the bed.

FIG. FIG.

sheet is turned up over the first blanket and the second and subsequent blankets are tucked in under the foot of the mattress, again using enveloped corners, the sheet can be turned bottom to top when the top has become creased or soiled, and it looks like a clean sheet. M AKING A N OCCUPIED BED.

If the bed is to be made with the patient in it, it is quite obvious that he is not in a condition to get up, even for a few minutes. That being so, it is essential that he should be disturbed as little as possible and the procedure should be carried out as quickly as is consistent with efficiency. All movements must be smooth, no unnecessary steps must

In stripping the bed ~ completely untuck the top clothes, at both sides and at the bottom. Then , in order, fold down the counterpane a third of its length and fold up the bottom portion, lift it off and place it on the chair backs; and remove th e top blanket in the same way. The top sheet is then drawn down and out under the first blanket, the two nurses working very smoothly together. It, too, is folded in three and placed over the chair backs, the patient being left covered with one blanket. The drawsheet is untucked, the lon g;-folded end being placed on the side of the bed, and then the whole of the bottom sheet is untuckedtop, both sides and bottom. The patient's feet are lifted, any crum bs are brushed out and the bed frame is dusted.

So far, the patient has not been moved. From this point the procedure differs according towhether the patient is to be turned or lifted, and whether sheets or pillow slips are to be changed or not. WH E N THE PATIE NT MAY BE T U RNED.

Remove all but one pillow. Roll him towards the side of the bed that has the short end of the drawsheet, drawing the one pillow diagonally to the corner. The nurse on that side gives her whole attention to supporting him, placing one forearm and hand lengthwise down the centre of his back from the neck to the waist, and the o t.her arm over his hips. The other nurse straightens out the under blanket and sheet on her side, dusting out crumbs, and then tucks them in firml y . In all bedma king, it is wise to tuck in the bottom first and work up towards the top. In that way, all the pull is upward and this counteracts the tendency of the mattress to slip away from the head of the bed. W ith the bottom sheet perfectly smooth, the draw mackintosh is straightened and dusted and about a fo ot of the drawsheet is tucked in, the rest being fold ed or rolled against the patient's back. His head is then lifted whilst the pillow is moved to a d iagonal position on the side of the bed that is made, and he is then rolled over to that side. The se cond nurse then makes her side of the bed, unro llin g the drawsheet and tucking it in. The pati e nt is turned on to his back, his head and shoulders are raised, each nurse placing one hand in the patient's armpit and the other behind his s houlder; and then, while one supports him the other shakes up and rearranges his pillows and he is settled back comfortably upon them. If he has slipped down in the bed he can be lifted up quite easily if the two nurses grasp hands under his s houlders and his hips, direct him to fold his arms an d flex his head on his chest, and then lift tog ether. The top sheet is spread on the bed, the blanket that had been covering the patient is drawn do wn beneath it, and the top clothes are replaced. T o CHAN GE THE UNDER SHEET. Unfold the clean sheet and roll it from the side to the centre before stripping the bed. Then, when the patient is on his side, the mackintosh and drawsheet are turned back over hi m, the soiled undersheet is rolled to the centre of the bed, the roll of the clean sheet is placed against it and the rest of the clean sheet is arranged in position and t ucked in. A clean drawsheet is put in in the sa me way, and the patient is rolled over on to the clean sheets whilst the soiled ones are taken out from the other side, and the bedmaking is completed as before. WH E N TH E

PATIE NT

SITTING

AND MA Y

NOT BE TURN E D.

After stripping the top of the bed and completely untucking the bottom as before, the patient's

AID

legs are lifted while the lower part of the bed is made. Then he may be li fted in a sittin g position to the bottom of the bed , and there su p po rted by one nurse whil st th e othe r makes the top part of the bed, rearran g es the mackin tos h an d drawsheet and also the pillo ws . Th e pa tient is lifted back and the bedmakin g is co m pleted. If the patient may not be moved as much as this, the assistance of a thi rd perso n will be required; and then , whil s t two lift him the third brushes out and stra ig hte ns the u nder blanket and sheet and pulls thro ug h the d rawsheet. If the bottom sh eet is to be changed the clean one is roll ed from the top hem down to the middle read y to be inserted . It is bette r to lift the patient and co mpletely re move the mackintosh and drawsheet a nd prepare them for re-i nsertion. The bottom sheet is ro ll ed u p as high as possible under his thigh s, the roll of the cl ea n s heet is placed a g crinst it and the mak in g of the lower part of the bed is com pleted . If the pa tient is heavy or is very h elpless , it is at this stage that a third person is req uired , and wh il st the tw o nu rses lift the third continu es the rolling up and rem oving of the soiled sheet and the u nrolling o f the cl ean one; and replaces th e mackintosh and d raw sheet. The patient is then lo wered a nd is held forward by one nurse whilst the seco nd completes the making of the top of the bed , repl acing the bed rest and pillows, and the patient's posi tio n is arranged against them. -

---. - - -

The Institute of Certifi ed Ambulance Person nel Ltd. T HE above was incorporated on October 2nd, 1946. It is not a t rad e union or protective or~anisation, its main object bein g to create a professional status for ambulance workers. Ex isting am bulance staff may apply for admission before O ctober 1st, 1947. Fellowship may be granted if the ap pli-cant has held an appointment (Ambulance) for a cootinuous period of five years prior to the date of application. Associa te membersh ip Clay be granted to a worker who has held a similar appoi ntment for not less than three years. Those not qua lifying for either of the above may be admit.ted as studen ts, providing they hold the Order of St. John First Aid Ce rtificate ; they can t hen gain promotion to Fellow or Associate by exa mi nation . . Th ose desiring to join the Institute should communicate with the Secreta ry, temporary address, 38, Argyle Square, Lond on, W. C.1 , s tati ng grade of membership applicable. Stamped addressed e n v~ l ope should be encl~sed for reply. Subscriptio ns a re :-Fellow 10/-, ASSOCiate 5/-, Student 2/6 per annum.

Notice to Ambulan ce Secretaries. Will Am bul ance Secretaries please for ward reports of local activities as soon a/tel' the actual event as possible. We regret that owing to the shortage of paper we are not able to includ e all reports subm itted . Preference is given to those of general interest.

FIRST

AID

FIRST

Queries and Answers to Correspondents. - - - - . - . -- Queries will be dealt with under the following rules : 1. -Letters cOfllaining Queries must be marked on the top left-hand corner of the envelope" Query," and addressed to FIRST AID, 46, Cannon-street, London, E. C. 4. 2. -All Queries must be written on one side of paper only. 3 -All Queries must be accompanied by a " Query Coupon" cut frum the currenl issue of the Journal, or, in case of Queries from abroad, from a recent issue. 4. - The Textbook to which reference may be made in this column is the 39th (1937) Edition of the S.J.A.A. Manual of First Aid to the Tn 1urE'd

Haemorrhage from Nose. M.S. (Swansea).-The Textbook on page 138 tells us that in a case of haemorrhage from the nose the patient's head should be (' thrown slightly back." I find that by placing the head in this posi~ion the blood runs down the back of the throa t (where It tends to clot on account of the air reaching it through the mouth) and causes the patient much unpleasantness. If however, the head is put to lean slightly forward -the ~enous return would appear to be facilitated and the blood runs out of the nose instead of down the back of the throat. Is there any reason why the head should not be placed in a slightly forward position please? Your very helpful comments will be much appreciated. The treatment described in the Textbook has stood the test of time and assists in arresting haemorrhage from the nose. It certainly does not increase it. It would, therefore, appear to me, that you have erred by tilting the patient's head too far backwards whereas the instructions tell you that the patient's head should be "thrown slightly back."-N. CORBET FLETCHER.

Examination Howler. M. R. (Cannon St. }.-1n a recent examination I a::,ked a candidate to define an antiseptic; and I was greatly amused when he replied: "An anti sceptic is a chemical substance which reta£ls germs I"

the risk of causing movements of the fra~ture. ~he.n, ho:vever, you are working in a team and .no Inner splint IS available, the injured limb can be stead~ed by one ?f the team whilst bandages A, Band C are applIed; and thIS should be done even if no inner splint is available. I would remind you, however, that Rule 5 in the General Rules for Treatment of Fracture (p. 67) sug-gests such a variety of material for improvisation that i~ is. difficult ~o imagine circumstances in ,-vhich an inner splll1t IS not avallable.-N.C.F.

Crush Injuries. Textbook I noted that on page 7 it states that if a patient is suffering from a crush injury, all<aline drin~s should be given if possible or plain water and the quanttty. noted. This treatment it goes on to say should be carned out before the patient is released. . . Does not this treatment only apply If the pattent has been crushed for a period of one hour or more. In the Medical Research Council War Mell.orandum No.1 (The Treatment of Wound Shock, 1944) it states on page 19, Crush Injury :-Patients who have been trapped for one hour or more beneath debris should be considered as possible cases of crush syndrome and hence likely to develop signs of renal failure. During my training as a male nurse I w~s told ~hat a patient who had been crushed for a long penod of hme should be treated as a crush syndrome and an urine chart of intake and output kept. I should appreciate your advice on this matter. The instructions in the Supplement to the Textbook clearly relate to a patient who has been trapped by a weight across the limb' and in such a case some tIme must elapse before the victi~ can be released. In these circumstances it is most desirable to administer the drinks recommended at the earliest moment, especially as these can do no harm and as it is not possible to forecast the time of release. - N.C.-F.

Treatment of Fractured Leg. R. S. (Bishop Auckland).-Recently the treatment of a fracture of the leg caused a difference of opinion at our First Aid Practice. We know that when single-handed, after extending the lim b we should tie ankles and feet together, dispense with the inner splint and pass the bandages round both limbs in the order shown in Fig 51 of the Textbook. What, however, is the correct treatment if we had only one splint and were working together as a te<l.m? Should bandages A, Band C be passed round the fractured limb only or round both limbs? Meanwhile I thank you for all your advice in the Query Column of FIRST AID. When you are singlehanded, and treating a patient for fractured leg, the first bandage is passed round ankles and feet and for this reason it is not practicable to use the inner splint or to tie bandages A, Band C round one limb without

Plaint of Ambulance Sister. S. E. (London Town).-Why should there be misunderstandings concerning medals, uniforms and drill in a great

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

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Furley Stretcher. R. T. (Moulton).-Doubtless, you have noticed the hesitancy of stretcher squads in ascertaining th e pillow end of a Furley pattern stretcher, when closed. . . I suggest that this would be made easy by pall1tmg white that portion of the stretcher poles at that end, between the canvas and the commencement of the handles about 4 inches. Any error in carriage or placing' of the stretcher would be outright noticea~le. It would also assist those drilling a company carrymg stretchers. Stretchers, open or closed, would be more distinguishable in rough surroundings, and also in a bad light. I do not know of anything to which this would be in conflict and should like to have your views on the idea. It is open to the Officer-in-Charge of a Division to mark his stretcher as you suggest if he so desires. To me, however, this seems unnecessary as the extra thickness of material at the pillow end of the stretcher is easily distinguishable both by sight and touch. -N. C. F.

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FIRST movement such as the Brigade? Your reply in the September issue of FIRST AID to P. M. (Bilton) recalls an incident to my mind. Headquarters issued a notice concerning the Annual Inspection and stated definitely" Medals may be worn." My Superintendent, however, told us that they should not be worn. Also we read in FIRST AID and The Gazette that all members should take turns in drilling squads, but how many members have been allowed to avail themselves of this instruction and how else is it possible to find out who is suitable or not? Again, Headquarters gave permission to Ambulance Sisters to wear black costumes but my Superintendent ruled otherwise and said that, if Ambulance Sisters wore them, it 'would not be possible to recognise who were Officers of the Division. Lastly, would you please state if in the St. Jahn Child Welfare Course there is more than one certificate. I was disgusted when I was awarded an elementary certincate seeing that I passed in Home Hygiene in 1911 and 1938. I thank you in anticipation of your reply j and I ask you not to publish my name and address. The points which you raise relate to matters within the authority of the Divisional Superintendent j and there should be no cause for complaint on the part of members. As to the certificate which you query, it was open to you to ascertain beforehand the type of course being taken and the kind of certificate which would be issued to successful candidates.EDITOR.

Treatment of Wounds. B. T. (Deptford).-The Supplement to the Textbook on p. 22 under" Objects of Treatment of Wounds" reads-" as a clot of blood is Nature's method of stopping bleeding, it should never be disturbed when present over a wound." This surely is a statement which commonsense and experience fully justify. I was, therefore, surprised when, recently perusing the catechism of the B. R. C. S. First Aid Manual No.1, I read the answers to two queries. The first, Question 129, reads" How do you stop bleeding from the tongue?" To this the answer given is "Remove blood clot, cold mouth wash, pressure, &c. !" The second, Question 130, reads" How do you stop haemorrhage after tooth extraction?" To this the answer given is "Get clots away, cold mouth wash, &c." Now I want to know if we are to understand that the B. R. C. S. Manual regards bleeding from tongue and teeth as exceptions to the General Rule laid down in the St. John Textbook. I know that there are slight differences of opinion as to correct treatment between the two organisations. This, however, seems to me to be flat contradiction! Your opinion would be valued and received gratefully to clear up, in the interests of all first aiders, an apparent discrepancy.

Frankly I can see no reason for the instructions relative to treatment of bleeding from tongue and teeth which you quote from the B. R. C. S. Manual, except that these may refer to blood clots which might conceivably be present and loose in t!1e mouth. In these circumstances my advice is that you should stand by the instructions of our Textbook.-N.C.F.

FIRST

AID for the large and small armslings and a man as model for the St. John sling." So may I ask you kindly to state the reason? If you put the advice to the test, you will quickly appreciate the reason for it.-N.C.F.

L. R. (Caxton Park).-In your reply to the query published in the October issue of FIRST AID under the above heading, you did not tell us why you" select a lady as model

Prompt action with the Sparklets Resuscitator IS vital to successful recovery.

First Aid and the Police. A. F. (Kettering).-I would appreciate an authoritative ruling on a statement made at a recent accident by a bystander who said that an injured person cannot be moved until a policeman arrives. The incident was one in which an elderly lady was knocked down and sustained a badly lacerated wound of the scalp and a fractured femur. I said that I should have treated the injuries and moved her into a nearby shop, having first taken the number of the vehicle involved and the driver's name and address-and having sent for police, doctor, and ambulance. I was not at the accident. So I did not run the risk of breaking the law; but it made me realise that I did not really know my position. However, I would risk it to save a life!

No fault is to be found with the action which you say that you would have taken if you had been called to an incident such as that which you describe. After all, a firs t aiders duty is primarily to the patient whose injuries are to be treated at the earliest moment. The Textbook refers to the myth that patient must not be touched or removed before the arrival of a police officer when under treatment of Hanging (p. 157) it tells you definitely not to wait for a policeman before taking appropriate action. - N. C. F.

Prussic Acid Poisoning. B. P. (Plaistow).-Recently a friend said that in cases 01 prussic acid poisoning we should give an emetic at the earliest opportunity. As I am not sure about this, I ask your kind help. The Textbook includes prussic acid (which is a potent nerve poison) among the non-corrosive poisons. Consequently it is good trea(ment to administer an emetic at the outset of treatment provided that patient is conscious and able to swallow.-N.C.F.

Defence Medal Ribbon. F. N. (Paignton).-Members of SJ.A B. Nursing Divisions having enrolled for service in the Civil Nursing Reserve are allowed to wear the C. N. R. badge on the breast of S.J. A. greatcoat or on indoor uniform as required. Will you kindly tell us if we are allowed to wear the Defence Medal ribbon on the uniform greatcoat or a re we only allowed to wear it on the indoor uniform? The ribbon is worn on the indoor uniform.-EDlToR.

Site of Knot of Armsling.

AID

FIRST AID H

QUERIES and ANSWERS COUPON lobe cut out and enclosed wtth all Queriet. Nov. , 1946.

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CALLING ALL AMBULANCE WORKERS. Join your Specialised Trade Union

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66 Answers to First Aid Quiz.

(1) Epsom salts (magnesium sulphate) are reputed to act as an antidote for carbolic acid or Lysol because the sulphates interact with the acid and form harmless salt.

AID

FIRST

EMERGENCY TREATMEN' OF SKIN INJURIES be preDared for an emergency and keep Cuticura Brand Ointment in your First Aid Kit · It brings in· stant soo' bing relief to cuts, burn.3, skin lacerations - prevents "pread of infection. quickly beals . Obtain· able at all Cremists and Stores.

(2) To avoid obstruction of circulation of the limb. (3) A variety usually occuring in children as the bones arc partly made of gristle. A" split" bone.

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(6) A technical term applied to the physical sign of fluid forming- within a joint as a result of injury. A condition requiring medical treatment.

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By N. CORBET FLETCHER, O.B.E., M.B., B.C., M.A.(CantabJ, M.R.C.S. AIDS

FIRST-AID.

Seventh Edition. 1 •• 3d. post 2d. F~r.t.Ald Simpl.lfled a~d Tabulated, wlt~ Ald. to Memory. Col. Str lames Cantlte contrzbutes an tntroductton and we endorse his g-ood opinion ot the book. "-LANCET.

AIDS

HOME-NURSING.

Third Edition . Price 18. 2d., post free. ~ome.Nar.ln. Slm~lIf1e~ and Tabulated. with Ald. to Memory. Thts book wonderfully stntj>liftes a comPlex sub'ect and should be read b" students."-L. & N.W. Rv . GAZBTTE.

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Fourth Edition. Price 18. 3d. post 2td. Problem. In Study, Treatment lind Examination lolved lor Senior Students " Without doubt the book will be Of /{Yeat service in the t1'aining- 0./ those ./0; whom it is designed."-RRITISH 1.1:BDlCAL JOURNAL.

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Third Edition. 18. 3d. post 2d. Error. In Flrlt·Ald Detailed and Explained. This book gives a clearer insight into the metltods and dit/iculties 01 emergency treatment by laymen than the ot/icial Textbook itsel/."- L ... NCBT.

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DECEMBER, 1946.

TO READERS.

GREETINGS. FIRST AID is published on the :3oth of each month.

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EDITORIAL. First Aid in the Factory.

"SANOID" RESPIRATOR FRAME

IN THIS ISSUE.

Registered Design No. 806838 Th Is frame has been designed especially for the pu rpose of secu rely locating and thus preventing slip of Cotton Wool Filters or other Masks when used as Respirators In safeguard i ng workmen against dust arising from Industrial operations. Prices of Respirator It possesses many adFrames and of Filter vantages over other Masks (Respirator articles of a similar Refills) on application. character Inasmuch as: It Is rustproof and smooth, being flexible It readily conforms to contour of the face thus ensuring correct positioning of the Mask. It Is light. easy to adjust. and the lower portion fits comfortably under the chin thus anchor Ing both frame and filter. Sole Manufacturers I

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SIDE LIGHTS ON FIRST AID.

By Sir Henry L. Martyn, K. C. v. 0., F. R. C. S. His energy and spirits are amazing. Simply bubbling over with life. Keeps you " on the go." But you would rather have him that way than peevish, cross and poorly! Mother certainly knows best when she gives an ailing child , California Syrup of Figs.' When he is bilious, sick or constipated, this natural laxative quickly corrects upsets of the system, and the little one is soon "as right as ninepence. "

"California Syrup ~of Figs

AMBULANCE NEWS FROM ALL QUARTERS...

FOR THE FIRST AID ROOM

TilE ROLE OF THE DiViSIONAL SURGEON.

By N. Corbet Fletcher, O.B.E., K.St.J., M.A., M.B., M. R.C . S., &c.

PRACTICAL NURSING IN TIlE HOME.

By Agnes E. Pavey, S. R. N. REMARKABLE CURES WITII

PENICILLIN

QUERIES AND ANSWERS TO CORRESPONDENTS

77 80 82

NOTICE.-Owing to the rise in printing and production costs, we are reluctantly compelled to increase the price of" First Aid" from 3d. to 4d. per copy as from January 1947, The annual subscription will therefore be 5/- post free.

AMBULANCE work, or the rendering of first aid treatment to those suffering from sickness or accidents, enters so much into our daily life and occupations that it is difficult to find any industry, warehouse or factor y where it may not be of the greatest use in saving life or limb. Many manufactures are carried on which are injurious to the health of those employed, others are of a kind in which accidents occur, sometimes owing to defective machinery, but more often due to carelessness on the part of the employee. Many employers have taken a keen interest in the training of first aid personnel and in the provision of adequate first aid facilities within their industries, but we are surprised to find that in some cases little attention has been given to this all important su bject. We hereby plead on behalf of the unfortunate sufferers. We wish every employer to behave like the Good Samaritan, and feel that he is doing more than his duty to his neighbour, by helping to minimise the injuries of those who work for him. See that your first aid posts are fully equipped with modern appropriate appliances, encourage the personnel who serve you, to train and practice in the rendering of first aid to sufferers. You will be well rewarded and you will show your employees that you have thei r interests at heart.

FIRST

AID

Side Lights on First Aid. 31

•

By SIR HENRY L. MARTYN, K.C.V.O., F.R.C.S.

THE routine examination of a patient, which must in every case be undertaken before a diagnosis is possible, is one of the most difficult things to teach the first aider. Unfortunately the subject is dealt with either far too briefly or soldy from the standpoint of competition work. Let me dispose of the latter question at once. Only too often one sees a competition team rush at a recumbent patient and begin to examine him with furious activity, while a series of questions are screamed hysterically at the judge. Nothing could be further from what good examination should be, and in6nite harm could be done by teams who behaved in this way to real cases. ",I:'Almost above all I would urge that however quickly your appmach may have to be made, it must nevertheless be quiet and self-controlled and devoid of all evidence of excitement and fear. I was umfJiring two teams taking part in a big exercise during the war. One team dashed at their cases and dealt with them at amazing speed. The second team was lead by an enormous man whose every movement appeared to be almost lethargic until, by watching him closely, you realised how completely purposeful every action was. He seemed almost to be deliberately wasting time as he knelt beside the blanket-covered figure of a badly injured child just murmuring "All right, sonny, don't worry, we'll look after you and you'll soon be well." All the time his eyes never left the child's face, and his hands continued their gentle purposeful exploration of the tiny body. His team were several seconds longer in completing their work, but there was no question which team was the better trained or which set of casualties would eventually reach hospital in the best condition-but then, the second team had been through the hell of the Plymouth Blitzes and neither life or death had much more to teach them. Remember to get as clear a history from the patient, and an account of his symptoms, as you car" but also remember that he may be in no state to tolerate a succession of purposeless and silly questions. Examination should be as complete as possible, but it should not entail more ex posure or movement than is absolutely essentiaL If your patient is unconscious, you are at once depri ved of his ability to direct your attention to parts of his body which are painful and tender, and you will have to depend entirely upon your eyes and hands. . Note his colour, his pulse and respiration, and get an Idea of the temperature of his body by the feel of his skin. Start then from his head, including his eyes, nose, ears and mouth, and continue downwards, first his chest, arms, abdomen, pelvis and lower limbs until you have an accurate idea of his injuries. Do not be had by failing to spot multiple injuries, and don't try to be clever by being too certain; the dogmatic ~tatement that a twisted ankle is only a sprain may result 111 pe:manent damage to the joint, which has in reality been suffering from a fracture, only capable of demonstration by X-Ray. . Your ~xa~~nation is not only for the purpose of treat109 t~at lOdlvldual casualty, it may perfectly well be essentl~l for the purpose of determining which of several casualties shall 6rst receiv( attention and which shall first be moved.

In the early days of the war, parties at practice used to rush at a bunch of casualties entirely regardless of any organisation whatever, and one found a 6rst aider industriously bandaging a cut finger while a patient bled to death round the next corner. It did not take long to change all that, and to learn all about such things as priority in treatment and priority in transport-which are by no means necessarily the same. Don't let us forget all these things which we learned at the cost of much blood and tears, multiple casualties occur frequently enough in peace to warrant definite training and constant practice in their handling, and it is to be hoped that the fully revised Textbook, reported to be shortly undertaken, will contain refe rence to the subject. We now come to a matter of overwhelming importance, namely, the transport of injured persons. Let us dispose first of all of the question of blanketing a stretcher and wrapping a patient. In the supplGment th e former method as described and illustrated in the Textbook is superseded by that employed throughout the war by the Civil Defence and the R. A. M. C., which I feel is too well known to need further description. Transport of an injured patient other than by means of a stretcher, that is to say by hand seats of various sorts, requires very constant practice to do really efficiently, an d on the whole is much too little used in real accidents, an d the tendency is to call for a stretcher even for very lightly injured patients. The loading of a patient on to a stretcher, the lifti ng and carrying of a stretcher, and the loading and unloadin g of a stretcher on to, and from, an ambulance z's an a?' t which , in my humble opinion, is one of the most important thin gs for a first aider to learn. I am quite sure that nine out of ten of my readers, full y qualified and experienced in first aid, are confident th at in lifting and stretcher work they are perfect. I would a sk only one test, the opinion of the first patient they are called upon to deal with having a fractured thigh splinted with a Liston's long splint. Believe me, he is the best person qualified to judge, and, if his experience has been similar to mine, his comments are likely to be scathing. In a very wide experience of training during this war, of umpiring a vast number of small and large exercises, of being handled myself with a fractured knee joint, to say nothing of two and a half years' experience as a surgeon in the first war, from which I returned on a stretcher, I have seen very few examjJles of what I should describe as first class stretcher work without fault or blemish. One such example was provided by a team of wom en who ran an ambulance and first aid party during the Plymouth Blitz, and subsequently gave demonstrations throughout Devon to prove that women were fully as capable of undertaking the work as men. They were not big women either, in fact their leader was a little below average height, but to see them lift a heavy man on to a stretcher, and the stretcher on to the top runners of an ambulance, was a lesson in the ultimate pefection of trained movem ent and rhythm, of perfectly co-ordinated motion free from the slightest strain or jar. It is to my mind a reproach to the Brigade that stretcher exercises are "for males only." Lifting, providing you

FIRST know how to do it, entails no more strain to a woman than does lifting her own wash-tub. The average woman nowa-days knows that, and regards it as a personal insult that she is not considered as capable of learning stretcher work as a man is-an d, I will just whisper this, when she does learn it she does it infinitely better than the average man, Stretcher work is an art in itself, and every class, male and female, should be trained to the degree of perfection of the R,A. M. C. The slightest jar, the smallest flicker of pain across the face of the patient should be regarded as a re-

AID

proach not easily to be forgotten. Until a class has attained the ability to load a,n a~bu)ance with a full glass of water ba~a?ced on the patle~t s chest, they are not entitled, in my Opll1lOn, to membership of any ambulance service whatever. Go to it, my frien.ds, jJerfection .can only be obtained by constant, weary practlce. Try to picture the meaning to a badly bro~en man of every tiny jolt in lifting, of that unevenness 111 carrying, and that heart breaking bang of the runners roughly slipped into the grooves, however sliaht anyone .of .these mistakes may be, they mean needless ag~ny to the VictIm.

AMBULANCE NEWS FROM ALL QUARTERS. S.J.A.B. No. I (Prince of Wales's) District No. 3G (EAST LONDON).-The annual competitions for the Divisional trophies of the above Division and No. 182 (Tower Hamlet) Division, were held for the first time since 1939, at A,j. Y. House, Leman St., E.1., on Tuesday, November 12th, when the finals of the" President's Cup" and the" Hayman Challenge Shield" were decided. The Cup was won by Pte. 1. Shames who was recently demobilised from the Army; and the Shield winner was Pte. S. Cohen, another recently demobilised member. The Assistant Commissioner of Central Area, No.1 District, Capt. R. V. Steele, M.B., B .S., presented the awards and congratulated the com petitors on their keenness and efficiency. The winners, who hold the trophies for a year received miniatures of the trophies and the runners-up were presented with leather wallets. No.5 (HACKNEY).-On November 22nd, this Division sustained a great loss by the sudden death -of its Superintendent-Mr. Robert Joseph Hayes, at the age of 69. He had been a memher of the DiviSIOn for 52 years. He was made Honorary Secretary in 1896, taking charge of the Division under its then Divisional Surgeon, Dr. Tunstall of " Warwick & Tunstall" fame, and remained in charge up to the time of his death. He was promoted to Div. Supt. in 1927. The deceased held the Service Medal 2nd seven Bars. He was admitted to the Order of SL John as a Serving Brother in 1922, and promoted to 0 fficer Brother at the beginning of this year. No. 119 (EpSOM AND EWELL). -The annual first aid competition for the" Longhurst" Cup was held on November 21st, at Linton's Lane School. Four teams competed: Epsom Ambulance and Nursing Divisions, and the Stoneleigh Ambulance and Nursing Divisions. The cup was won by the Stoneleigh Nursing Division. In the Cadet competition for the" Lauder" Cup, which preceeded the adults, three teams entered, the winners being Epsom Ambulance Cadet team. Mr. Harrison Long-hurst, as president, said that he was very pleased with the evening's display.

County of Berkshire. . READING TowN" A ".-The annual competition for the

" Dr. Hartnett" Individual Cup was held by members of the Division on Monday, November 25th. The practical test was set by County Officer H. F. Skidmore using Casualty Union methods. After a very interesting competition, Staff Sergt. E. Chart, with 88 marks, was declared the winner, with CorpI. L. White second with 78 marks. The Cup was presented to the winner by the County Commissioner, C. A. Poole, Esq. He congratulated Corpi. White on obtaining full marks in the theory test.

County of Leicester. LElcEsTER.-Rememberance Sunday was observed by the Am bulance and Nursing Cadets of the Leicester Corps, by a parade to Clarendon Park Congregational Church. The parade, headed by the Cadet Band, marched from headquarters to the church. The Nursing Cadets were led by County Cadet Officer Nurse Wollaston. Nine officers and 50 Nursing Cadets attended. A very beautiful service had been arranged, and after an inspiring sermon, the parade returned to headquarters for dismissal. On Saturday, November 23rd, a very successful" Bring and Buy Sale II was organised by Nursing Cadet Supt. Miss ' D. N. Poole and members of the Leicester N.C.D. in aid of the N.C. Band Fund. O ve r £40 was raised by the effort. The sale was opened by C.c. Officer Nurse Wollaston , and various presentations were made to cadets.

County of Lincoln (South). BouRNE.-When the County Commissioner (Capt. ]. P. Armstrong-) attended the 6rst annual post-war dinn~r of the Bourne Division, at which Mr. C. C. McLeod preSided, he presented service medals and certificates for 15 years' efficient service to the Medical Officer (Dr. J. A. Galletly), Supt. E. VV. Judge, Ambulance Officer R Sandall, Sgt. H. Wells and Messrs. C. Stubbs, W. Sharpe and W. Packford.

County of Northampton. NORTHAMPTON.-The Northampton H.g, Division have lost a keen and popular Officer by the d~ath o~ Ambula?ce Officer H. Wallington. He was taken 111 while. attendJl1gthe weekly drill and passed away early next mormng. Mr. Wallington joined the Division in 1918, promoted Corporal 1939, Sergeant 1940, Ambulance Officer 1946. . During this year he was a warded the honour of Serv1l1g Brother. Throughout the war years he ~'a~ att~ched to t~e. Ci.vil Defence First Aid Parties and speCialIsed In faked lOJunes

FIR S T

for practice and competItIOn work, his skill was much appreciated in town and county.

County of Sussex. HASTINGS. -The" grandfather" of the Hastings Corps and one of the" grand old men" of Hastings and district, Dr. George Locke, has passed away at the age of 93. His greatest interest was in the S.J.A. B., which owes him a deep debt of gratitude for his intense devotion to its development locally. For the part he took in this work he was made a Commander of the Order of St. John of Jerusalem. Representatives of the Hastings Corps formed a guard of honour at the funeral, which took place privately at the Borough Cemetery.

County of Worcester. The S.]. A. B. in the County of Worcester held the final rounds of the last two County competitions of the present year on Saturday, November 9th, at the Halesowen (Boys) County Senior School, Stourbridge R .o ad, Halesowen. These were for the Lechmere and Newton Cups. The two teams competing for the Lechmere Cup were Rowley Regis Ambulance Division representing the north of the county, and Redditch Ambulance Division for the south. The Newton Cup finalists were Halesowen Cadet Nursing Division representing the north and Redditch Cadet Ambulance Division for the south. County Commissioner Dr. F. L. Newton announced the results as ' ollows :-Lechmere Cup: Redditch, 182 marks; Rowley Regis, 167. Newton Cup: Halesowen Cadet Nursing, 346t marks; Redditch Cadet Ambulance, 308. Dr. Newton cong-ratulated the winners upon th(:ir success. HILL AND CAKEMORE. - A concert was held in the Secondary Modern Girls School, Hill Top, on Thursday, November 7th, organised by the members of the above Nursing Division. The proceeds were for the funds of the Cadet Nursing Division which is in the process of being formed.

AID

FIRST

County Officer]. Pearson gave a very interesting speech on matters of interest to all Brigade members. After the dinner and speeches, the party retired to the concert room, where a very enjoyable entertainment was given by a good concert party.

RAILWAYS. Great Western. SWINDON.-At a meeting of the Divisional Ambulance Committee, Mr. W. H. Bodman, Staff Assistant to the Chief Mechanical Engineer, presented a testimonial in the form of a cheque on behalf of the members of the Swindon Ambulance Class to Mr. G. Culling on the occasion of his retirement after 42 years' service with the movememt. Mr. Culling is the holder of the Company's gold efficiency awards for 40 years'service. In 1945 he was promoted t o the Grade of Officer (Brother) of the Order of St John of Jerusalem. Mr. J. Payne was presented with an electric toastin g rack as a parting gift. He had also had a long ambulance career, and in 1941 was admitted to the Order in the Grade of Serving Brother. YEOVIL.-Mr. R. G. Pole, Div. Supt., Bristol, presided at a presentation of awards held at the Great Western Hotel. In addition to distributing the class awards, Mr. Pole presented to Mr. G. Payne, the Secretary and Instructor, a garden syringe and wheelbarrow in appreciation of his lon g and faithful service to the class, and congratulated him on his admission to the Order in the Grade of Serving Brother. An enjoyable entertainment followed.

London & North Eastern. NORTH EASTERN AREA.-The following number of Lon g Service Gold Medals and Bars were <l.warded in the Nort h Eastern Area for the period ending September 30th, 1946:Medals 43 j 20 years Bars 7, 25 years 7, 30 years 2, 35 years 1, 40 years 1.

BEDWARDINE.-A very successful whist drive orfanised by the members of this Nursing Division was held on Friday,. November 15th, at the Gaumont Cafe. As a result of the drive, Divisional funds have benefitted by the useful amount of £21 3s. HALESOWEN.-The Halesowen Cadet Nursing Division held a party on Wednesday, November 20th, in the Birmingham Street Schoolroom, to celebtate the recent successes of the competition team. County Cadet Officer Mrs. H. Robinson presented silver serviette rings and book tokens to the members of the successful team, also certificates gained during the year to 13 cadets.

North Riding of Yorkshire. I.C. I. BILLINGHAM .-Members of the above Division held their first annual dinner on Wednesday, N ovem ber 27th, at Stockton. Dr. W. McCrawford, Divisional Surgeon, presided. Certificates, vouchers, medallions, and bars were presented to all members present, by Dr. F. W. Hebblethwaite of Middlesbrough, the County Surgeon. Dr. Hebblethwaite remarked about the efficiency of the members in their recent examinations, they were 100 per cent. efficient, something to be v~ry proud of.

Ryde. Mr. T. F. Thompson, Station Master, presided, and Mrs. Wallace presented the awards. A miniature whist drive and excellent entertainment concluded the evening.

District Group 2 Competitions will be held as follows: District. Date. 6 Jan. 19th

20th

22nd 22nd 27th

& 4 3

Place. St. Sidwell's Methodist Church Room , Exeter. "Unity Club," Southampton Road , Eastleigh. Chapel Royal, New Road, Brighton.

Ca'~endish 'Hall, Cavendish St.,'Rams-

gate. District Group 1 Competitions : 2 March 10th Chapel Royal, New Road, Brighton. & 4 " 11th 3 &ladies " 12th " 5 14th Odd" Fellows' Hall," High" Street, " Poole. 6 17th St. Sidwell's Methodist Church Room , Exeter. Southern Final will be held at the Borough Polytechnic, Borough Road, London, S.E.1, on Friday, April 11th. RVDE. -The annual presentation of awards to members of the Class took place recently at St. John's Parish Hall,

For the First Aid Room. THE "SURQULET" STERILIZER.

CHARD JUNCTION.-Mrs. White presented the prizes recently at the Class presentation of awards and social, held at the Staff Canteen, United Dairies, Ltd., Chard Junction.

ESSENTIAL in alJ clinics and first aid rooms is a simple and thorough method of sterilization. The" Surqulet ", a product of R. Maw, Son & Sons Ltd., Barnet, Herts., is not merely designed for the sterilization of syringes, it is also a most useful general purposes sterilizer, and would appear to be ide.al in such es!ablis~ment~ .. It has ~ working capacity of 1. PlOt, overall dlm~?SlOnS 8 ~ !n. by 4~ 10., and is specially deSIgned for portability, a SUitable carrying case being provided. .

READING.-Southern Railway first aiders and members of the Reading S.J.A.B., held a joint event for the purpose of the annual presentation of awards and concert. Mr. F. A. Trott, Centre Secretary, presided, supported by County Commissioner A. Poole of Berkshire and Mr. A. Barrow, Ambulance District Secretary. The Chairman gave a brief outline of the history of the Order of St. John, and County Commissioner Poole thanked the Southern Railway members for their ever-ready co-operation in connection with the work. A most enjoyable concert followed. MERITORlOUS AWARD. - The Company's Meritorious First Aid Certificate has been awarded to Sub Ganger J. Tapper, Well ow, for efficient and distinguished first aid. A lad was looking out of the window of a train to Bath, when he struck his head on a bridge. He suffered from severe cut completely round nose, accompanied by a fracture, also a wound extending from the centre of forehead round the right eye to the right templE>, with a possible fracture. The doctor in attendance at the Royal United Hospital, Bath, was full of praise for the excellent first aid rendered. SUTTON.-Mr. W. Geo. Pape, Chairman Southern Railway Ambulance Centre, presided over a large gathering of first aiders and staff at Sutton Station recently, the occasion of the annual distribution of awards. Mr. E. J. Shepherd, Station Master, presented Messrs. Knight and Wales with wallets containing treasuery notes as a tribute from the staff for their many kindnesses, extending jointly over 92 years. Mr. L. Likeman was congratulated on his receiving the 21 year award, and tribute was paid to the work of Mr. Hulbert, Class Secretary.

The "Surqulet" Sterilizer. The apparatus, which consists of a pertorated m etal basket suspended from a hooked lid inside a metal cylinder having a plastic jacket, will operate on a universal voltage of 200 to 250 volts, A. C. or D. C. It is provided with 6 ft. of cable and suitable plugs, and will boil in 10 minutes, the special heat resisting jacket keeping it cool during use. Our illustration shows the sterili zer, the basket and needle tray of which have been removed. A special syring e extractor is provided, thus it is possible to assemble the syringe without touching any parts liable to convey contamination, no forceps being necessary. This compact efficie nt outfit makes the sterilization of instruments perfectly safe and foolproof. The manufacturers will be pleased to provide interested readers with full details on application.

Southern. COMPETITIONS 1947.

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Owing to the rise in printing and production costs, we are reluctantly compelled to increase the price of" First Aid" from 3d. to 4d. per copy as from January 1947. Th e annual subscription will therefore be 5/- post free ----------

THE TRAINING OF FIRST AID COMPETITION TEAMS 2nd 2nd By

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"Gives clear and constructive advice on selectin~. and training teams for first aid compeUtlOns, and provides useful tips on individual and team behaviour during competItIOnS . . . . . should find a ready

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FIRST

AID

THE ROLE OF THE DIVISIONAL SURGEON. By N. CORBET FLETCHER, O.B.E., K.St.J. M.A., 1\1.B., M.R.C.S., &c., Surgeon-in-Chief, S.l·A.B. at Heme. An address o-iven on November 10th at a Conference of Surgeons and Nursing Officers in Northern Area, 1"> No.1 (Prince of Wales's) District.

----._. - -WI-lEN your County Surgeon- Colonel Norman Hammernotified me that it was his intention to call a Conference of Surgeons and Nursing- Officers in Northern Area, I felt that he was initiating in No.1 District a procedure which would be far reaching in its effects. Further, I remembered how successful in contacts and results were the Annual Week End Conferences of Brigade Surgeons which we held before World War No.2 and which enabled those who attended to get to know each other. My great regret is that, consequent on catering and accomodation difficulties, we were not able to revive the Week-End Conference this year. In these circumstances I am happy to accept Colonel Hammer's invitation and to give the opening address of this Area Conference. COMPOSITION OF BRIGADE. The Brigade, as you know, is a public medical service which is worked by volunteers and which is composed of two sections-(1) technical, consisting of surgeons who give the necessary instruction, guidance and supervision in all things medical and (2) executive, consisting of trained and certificated persons who serve as administrative officers and as members of the rank and file. Further, each section is dependent on the other, since without the surgeons there would be no effective personnel and without an effective personnel there would be no call for surgeons in the humanitarian mission of the Brigade. SELECTION OF SURGEONS. Of all grades of surgeons none is so essential and important as that of the Divisional Surgeon to whom the Brigade owes so much and on whom falls the biggest share of the task of instructing the lay members. Further, while no one can deny the devotion with which the majority of the Divisional Surgeons carry out their duties, experience proves that all too frequently there is a tendency on the part of some of them to come and go after brief service or alternately to hold office without taking part in the activities of their Divisions which suffer from this neglect. This unsatisfactory state of affairs, in my opinion, takes its origin from the way in which these surgeons were first appointed. Some Divisions seem content with a surgeon who is only a figurehead and who, contrary to Brigade Regulations, is told that the duties are negligible or perhaps that one course of lectures each year is all that is required! The strength of the Brigade rests on the happiness and prosperity of each Divisional unit; and the strength of the Division in its turn, rests on the cordial co-operation of the surgeon with the superintendent, the former being the technical and the latter the executive head of the Division. Further, while the surgeon may combine both posts, the lay individual cannot; and the Brigade, as a medical organisation, rightly ranks the surgeon as the senior officer in the Division. By this arrangement the surgeon can concentrate on tuiti.on while the superintendent is left free to deal with the administration, discipline and records of the Division. Incidentally, rumour has it that surgeons are usually slow in their attention to correspondence! Such being the case, the prospective surgeon should be told at the outset what are his duties and privileges. Memory carries me back thirty years to the day when, though not long established in practice, I was interviewed by an

Ambulance Officer who was very frank and said that he was afraid that I could not take on the job and insinuated that I was too busy! Twenty yea rs later I took revenge by getting him appointed to Headquarters Staff as my Secretary!! In this connection the two main duties of the County Surgeon are to make contact with the Divisional Surgeons in his command before and after appointment and to test the instruction given to the Division by conducting the annual re-examination. BRIGADE EFFICIENCY. Before I detail the special duties of Divisional Surgeons I would like to deal with the term" efficiency" which figure s prominently in Brigade Regulations. The root meaning of the word is "the power to produce the result intended" ; and it is used to cover ., the faithful performance of specified duties." Further, it applies to all ranks; and failure to be efficient for two years may involve removal of surgeons an d lay persons from the Brigade Roll, whereas, if efficiency is maintained for fifteen years, it qualifies the individual for the Service Medal of The Order. Moreover, Brigade Regulations require that accurate records of all duties be kept on Form B. F.1 which must be checked personally by the surgeon and the other memb~rs of the Division before it is forwarde d each year to County or District Headquarters. To the Divisional Surgeon, Brigade efficiency includes the proper control of the instruction given to members of th e Division and the proper supervision of the treatment of casualties when on public duty. Further, Brigade Regulations differentiate between those duties which are" 1'equired 0/ surgeons" as essential to efficiency and those which are " expected oj surgeons" but not essential to efficiency. DUTIES ESSENTIAL TO EFFICIENCY. (1) Attendance at Divisional Practices. First, the surgeon is required to attend during the year at least 12 Divisional Practices-that is, meetings at which first aid is taught and practised. Some ten years ago under B.0.637 the Divisional Surgeon was allowed to count towards that total up to six attendances as judge in competitions or as examiner in an annual re-examination. (2) Instruction oj Members oj Division. Seconclly, the surgeon is required to accept responsibility for the instruction of the members of the Division in first aid , home nursing and (if asked) in hygiene. This reminds m e that only once have I given a course of lectures in the lastnamed subject! Incidentally, first aid is a special science which, though based on the same fundamental principles as are medicine and surgery, is not taught in the medical schools. Hence, there is need for surgeons and lay persons alike to study th e subject. The angle of approach, however, is different, since the surgeon must bring his knowledge of emergency treatment and transport down, and the lay individual up, to the standard required by the science of first aid. In these circumstances it is imperative that the Brigade Surgeon should concentrate on the official textbooks on the basis of which all examinations and re-examinations are conducted. (3) Attendance at Annual Inspection. Thirdly, the surgeon is required to attend the Annual Inspection of the Division or, if unable to be present, to send to his senior offi.cer an explanatory letter which will cause him to be excused.

FIRST DUTIES NOT ESSENTIAL TO EFFIClENCY. Apart from the duties just named which count towards the efficiency O'f the surgeon and must be accurately recorded and checked, there are others of great importance.

(1) Attendance at Public Duties. First, the Divisional Surgeon is expected, as opportunity allows, to undertake the medical charge of Public Dutiesthat is the official occasions when under police (or other competent) authority, first aid is rendered to sick and injured patients. These constitute the primary object of the Brigade and vary widely in different localities. They are chiefly centred on emergencies which may arise in London and other big cities when crowds collect and in the Provinces in accidents on the roads or in the transport of patients by the ambulances which are worked by the Divisions. When on public duty, surgeons are required to wear Brigade uniform without which surgeons cannot enter into the full life of Brigade acti vi ties.

AID

(2) Attendance at M eetings oj Divisions. Secondly, the surgeon is expected to attend Divisional Meetings, which may. be held ?ccasionally for sundry purposes and also Com mlttee Meetmgs, of which as the senior member of the Division he is the accredited chairman as is laid down in Brigade Regulations. Incidentally, experience taught me that the latter are best held on an evening other than that allotted to the Divisional Practice and that the surgeon's own house is the most suitable venue, since he/she is immediately available for any sudden emergency associated with medical practice. (3) Attendance at Social M eetings. Thirdly, the surgeon is expected to attend all Social Meetings of the Division, especially those which are of semiofficial importance, such as the annual dinner, dance or con"ert of the Division at whi ch the wi ves (and husbands) and the sweethearts foregather. Bysodoingthe surgeon will make yet better acquaintance with the members of the Division and thus he will cement the friendship and cordial co-operation without which no Division of the Brigade can be truly happy and prosperous.

Practical Nursing •In the Home. By AGNES E. PAVEY, S.R.N., Diploma in Nursing (University of Lond on).

THE

PATIENT'S DAY.

WHEN a person is ill the normal routine of his life is interrupted, and he finds it difficult to accustom himself to new procedures. Good nursing does much to facilitate the necessary readjustments that must be made, and to relieve the patient of apprehension with regard to what is to happen next and the manner in which his personal needs will be met. An understanding of his point of view, together with much tact and patience, may be required. An orderly procedure should be followed, and the patient's usual habits should be considered whenever this is consistent with treatment, and small indulgences which can usually be allowed only on special occasions-such as an early morning cup of tea or, in the case of a woman, some fragrant bath salts in the washing water-do much to compensate for discomfort or pain, and can even make a mild illness a pleasant interlude in the stresses of everyday life. Many sensitive people regard an illness as an indignity; but this feeling can be greatly lessened by ensuring that at no time is a patient allowed to feel at an unavoidable disadvantage. For instance a man need not go unshaved, and a woman should be allowed to use her usual cosmetics and wear a becoming hair ribbon. On waking, and especially after a restless or uncomfortable night, an attractive early-morning tea tray is much appreciated, and then the morning toilet can begin. This will include the giving of a bedpan or urinal, the washing of the patient,

the cleansing of the mouth and teeth, the brushin g of the hair and the making of the bed; and it is important that the temperature, pulse and respiration should be taken and recorded at the commencement of the day.

Nursz'ng Equzjmzent.-Most localities have a branch of the Red Cross or the District Nursing Association, from which equipment for temporary use may be borrowed. Such equipment includes bedpans, urinals, machintoshes, enemata apparatus, inhalers, ice-bags, hypodermic syringes, and so on j but many people do not know of these facilities when they are faced with the necessity to carry out nursing duties in the home. Alternatively , a local chemist or drug store may agree to lend such such articles for a small fee. GIVI

G A BLANKET BATH.

The ideal time for a blanket bath is before breakfast, but the patient may prefer it in the evenina- and this may fit in better with the household ar;dngements. The room should be comfortably warm and all requirements should be collected before the patient's bed is disturbed. These include a bowl of water at a temperature of 105-110 degs. F., soap, two washing flannels, a face towel and a bath towel, a thin blanket that has been warmed, a brush and com b, a mouth wash and a tooth brush, nail scissors, some methylated spirit or ea~-de cologne and some talcum powder. These thmgs should be arranged on a table which is protected

FIR S T by a towel, bath mat or thick sheets of paper, and broug-ht to the beds ide. Any clean linen or clothing that is to be used should be hung before a fire or over a radiator. The water may be changed once or twice during the bath, as required, and if it needs to be brought from downstairs, it is a cyood plan to carry up a large jugful and to have ~ bucket at hand before commencing to give the bath. The P rocedul'e .- The upper bedclothes are removed as when making a bed, leaving the patient covereci wi th one blan keto The th i n blan ket is then rolled under him with the same procedure as when puttin g in a bottom sheet and the gown, or pyjamas are taken off. If a gown is worn it should be drawn up at the back as far as the shoulders j then one arm is drawn out, the head is lifted and the gown is drawn over it and off the other arm. If there is an injured or painful hand or arm, the g own is removed from this limb last , when it IS quite freed from the other parts of the bod y . The face to wer is now placed beneath the chin , the fac e is washed with clean water and is patted dry with the fa ce tov.rel; but often the patien t prefers to do this fo r him se lf. Then the flannel is soaped and the neck and ears washed, rinsed and thoroughly dried , especially behind the ears. Then each arm in tu rn is brought outside the covering blanket, the bath towel is placed under it and is drawn well up behind the shoulder whilst the arm and hand are 'vvashed and rinsed, the towel then being in the easies t position for thorough drying of the limb. Th e patient may like to wash his own hands if the bowl is held in position by the nurse. Next, the blanket is drawn down to the waist if the patient is large, or to the pubes in a small patient, and the chest and abdomen are washed , paying special attention to skin areas beneath the breasts in the case of a woman, and to the umbilicus, and using a little talc um powder after drying. The covering blanket is then replaced, but each leg is brought out in turn, the bath towel is placed under it well to the top of the thigh and over the pubic region whilst the leg is washed and dried. If convenient and the patient wishes it, the bowl may be placed on the bed , the knees well flexed and the feet put into the water. The toe nails are then cut if necessary . If the patient is a man he can be given a soaped flannel and will wash the genital region himself, the nurse lifting the covering blanket so that he can manage easily, or she may leave him for a. few minutes while he carries out the procedure. A woman patient may also want to wash this region herself. but if it is to be done by the nurse, it is often more convenient to do it from the back when the patient is on her side, lifting one thigh so that the parts are easily accessible. This gives much less sense of exposure than when wash-

AID

FIRST

ing this region from the front. The patient's back is washed last because. by so doing, only one turning of the patient is necessary, for the bath blanket can be removed and the under part of the bed made whilst she is still on her side. The patient is rolled over with her back to the nurse , who places the bath towel down its entire length , tucking it under the shoulder and hip. Then the back is washed, using plenty of soap and frictio n with the hands in a circular movement. This stimulates the circulation in the skin, removin g waste products and bringing a fresh supply of oxygenated blood to the su perficial tissues. It will be found that it is better to use the fingers for massaging the shoulders and each side of the spine, whils t the palm of the hand is more convenient for the lower part of the back and the buttocks. The soap must be thoroughly rinsed off, for anything that crogs the pores hinders the excretion of waste products from the skin and renders it unhealthy. After drying, a little spirit or eau-de-cologne is poured into the palm of the hand and is massaged over all bone prominences, followed by dustin g with talcum powder. \Vhen the patien t is rolled on to the other sid e for final removal of the blanket and completion of the bed-making. the shoulder and hip on which sh e had been lying could receive attention. The gown or pyjamas are then put on. If th e patient is helpless, one arm can be put in and the gown lifted over the head whilst she is still on her side, or when she is again on her back the gow n can be rolled up to the neck, her arms put in and the roll then passed under her lifted head. With a long sleeved gown, the nurse should put her own hand in at the cuff end, gather the sleeve on to her wrist until her hand is at the shoulder, and the n grasp the patient's hand and draw it through. The hair is brushed and com bed after the bed is made, placing a towel behind the patient's head if necessary; and she is th~n given a mouth was h and her tooth brush whilst the nurse removes a ll the articles used for the bath and puts the roo m into order.

LONG AMBULANCE RECORDS.-At the S.J.A. B. headquarters on Tuesday, November 19th, in the presence of members and cadets of the Hastings Town Division, Corps Supt. G. Wren presented the following service awards :Div. Supt. V. Marshall, 30 years; Sergt. A. De Gruch y, 35 years; Sergt. G. Plummer, 15 years. BRAVERY AWARDs.-Sergeant Michael John Jordon and P. C. Norman Gordon Hutchins, two members of the Preston Borough Police Force, Lanes., were both presented recentl y with certificates awarded by the Society for the Protection of Life from Fire. The presentations were made by Alderman W. Beckett, in reco~nition of "alertness and promptitude " which' saved a family of three from a burning death, while on night duties.

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"PORTLAND"

AMBULANCE

CEAR

The Gear Illustrated (A.S.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 stre tchers in position .

Shows the top stretcher lowered read y for loading.

C. Illustrates the same Gear with the top stret cher frame h.ing ed down for use when only one stretcher case is car ried.

D. S hows the same pos ition 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.

~"":'I: ':

Full catalogue of Ambulance Equi"ment No. 7A will be sent on request.

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BAILL/fRE'S NURSES' MEDICAL DICTIONARY By Margaret M. Hitch, S.R.N. Every first aider and nurse must have a Medical Dictionary. Bail/;ere's Nurses ' Medical Dictionary contains 462 pages of essential information, giving explanation and pronunciat ion

ANATOMICAL DIAGRAMS AND CHARTS FOR LECTURES

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FIRST

AID

FIRST

Queries and Answers .t o Correspondents. ------ .--. -----Queries will be dealt with under the following rules : 1. -Letters containing Queries must be marked on the top

left-hand corner of the envelope" Query," and addressed to FIRST AID, 46, Cannon-street, London, E. C.4. 2.-All Queries must be written on one side of paper only. 3.-All Queries must be accompanied by a "Query Coupon" cut from the current issue of the Journal, or, in case of Queries from abroad, from a recent issue. 4.-The Textbook to which reference may be made in this column is the 39th (1937) Edition of the S.J.A.A. Manual of First Aid to the Injured.

Fracture of Upper Limb. E. V. (ErdillRton).-May I ask, please, for your ruling as to the exact position ot the hand when putting up a fracture of the upper limb as instructed in the Supplement tothe Textbook? \t'lith the "hand just touching theshoulder," the fingers lie behir.d it. As they may not be completely immobilised, would not movement tend to disturb the muscles l1f~ar the fracture? With many thanks for the pleasure which your Query Column always gives. Your query draws atte ntion to a slip in the Supplement because the hand cannot be placed on the chest and at the same time round the shoulder. What the Revision Committee intended is clearly that the hand should be placed comfortably on the chest with the fingers just reaching the shoulder joint. Further, with the hand in this position there co uld be no disturbance of muscles.-N. CORBET FLETCHER.

Examination Ho wier. O. B. (Exeter).-In a recent examination I asked a candidate how he would classify wounds which are caused by sharp instruments and bleed freely. I could not help smiling when he replied :-" Such wounds are encased!" Good! Next, please! !-N.C. F. Treatment of Fractures. M.G. (Stanmore}.-What advantage, if any, has the general method for dealing with fractures, as described on p. 8, par. 5 of the Supplement to the Textbook, over the emergency treatment, hitherto taught and described on pp. 82, 83 and elsewhere of the Textbook? I suggest that the general method described in the Supplement is less logical and more likely to increase the dangers of aggravation and complication than those methods which, I hope, we have already learned. Your comment& will be appreciated. You will see from the paragraph in italics at the top of p. 8 of the Supplement that the instructions which follow are only supplem entary and that they do not cancel any instructions contained in the Textbook. It would appear further, that the last p"tragraph on p. 8 refers to cases for which splinting facilities are not immediately available, althoug-h this is not definitely stated. -N . C. F. . Cadet Badges ot Rank. C. W. (Swansea).-Would you please help us to settle a couple of vexed questions on Brig-ade Regulations in our Corps?

(1) Does a Cadet Superintendent hold the same rank as a Uivisional Superintendent and wear the same uniform with three pips on the shoulder? Also (2) where should N.C.O. stripes be worn-left arm, the right arm or both arms? I have been a regular reader of FIRST AID for many years j and I should like to thank you for the help and advice which' you give in the Query Column. (1) As a Cadet Division is the offspring of the Ambulance and Nursing- Division, there cannot be equality between the Officers of these Divisions. The Cadet Superintendent is responsible to the Cadet County (or Area) Officer j but it is expected that there will be close co-operation between the Adult and Cadet Divisions. The dress and pips are the same except that Cadet Officers wear white piping- on the shoulders. (2) N.C.O. stripes are worn on the right arm in both Ambulance and Nursing Divisions. It is difficult to realise why the Brigade does not amend this instruction so that stripes are worn on both arms. History tells us that originally the Brigade, when it adopted uniform, took many of its ideas from the Police who at one time wore the stripes on one arm.-EDITOR.

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J. M. (Quebec, Canada).-Will you kindly advise the number of bandages which are to be used in treatment of fractured leg when only one splint is available for three or four first aiders who are working on the case? I know that five bandages are required when two splints are available and six when you are single handed. Meanwhile my best thanks. As you rightly point out, an extra bandage is required for the treatment of a fractured leg when you are singlehanded. The reason for this is that you want to prevent as far as possible any movement of the broken bone during the manipulations which must follow. When, however, you are working as a team of three or four then one of you can take charge of the limb more efficiently that any bandage. Further it is immaterial whether you have one or two splints because in each case the five bandages recommended in the Textbook will do all that you require.~~. C. F.

MANUALS OF FIRST AID

By N. CORBET FLETCHER, O.B.E., M.B., B.C., M.A'(CantabJ, M.R.C.S. AIDS

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Seventh Edition. 1•• 3d. post 2d. Fine-Aid Simplified a-:-d Tabulated, with Ald. to Memory • . Col. Sir lames Cantlie contnbutes an zntroduct,on and we endorse h,s good opinion 0/ tlu book."-LANCET.

AIDS

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I!FFICIENCY

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Compound Fracture of Leg. J. M. (Quebec, Canada).-Also, if we had to treat a compound fracture of the leg with bone protruding, would it be right to place the limb in the natural position or to apply splints to the leg as found in the emergency. We await yo ur ruling-s on these two queries with interest. The instructions of the Textbook are that you should place the limb in as natural a position as possible (1) with great care, (2) without using force and (3) without letting go until the limb is splinted. These instructions hold ~ood whether the fracture is simple or compound. If with the latter the fragments protrude, you would abstain from attempts at extension of the leg. Then having dressed the wound and built up a protective layer round the fracture (as laid down in Rule 8 on p. 2S of the Supplement) you could apply well-padded splints, fix these with bandages and then control the fractured leg in the position as found.-N. C. F.

FIRST-AID.

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FIRST Exercises w ith Closed Stretchers. W.A. (Warrington).-The Manual oj Drift for the St. John Ambulance Brigade on page 54, under Exercises for Closed Stretchers, says that squads will retire, about turn' that all Bearers will turn about, and turn towa rds the stretchers; and that Nos. 2 and 4 Bearers will pass the stretcher from right to left hand. As all Bearers must turn towards the closed stretcher, the above order is correct; but the following order that squads will advance about turn (left about) means that Bearers Nos . 1 and 3 must turn away from the stretcher. This, in my opinion is quite wrong, and the Bearers Nos. 1 and 3 should, I think, turn right about, as by doing so they would turn imvards to the closed stretcher. I await your kind reply to the above and thank you.

The wording in the Manual oj Drill is quite correct as you will fi nd if you practice the movements. You should realise that the order to advance is a reversal of the movements on the order to retire and that "the advance" brings the squad back to its original position.-E. T. M.

March Fracture. G. H. (Thornton Heath).-Having read with in terest, and gained mLch valuable knowleJg-e from your" Questions and Answers" for the past six years, I should like to submit this query to you. I ha ve had a friendly argument with a colleague of mine who is in H. M. Forces, and not being a first aider, tells me that he sustained a March F1'acture. This, he tells me, is a fra cture of the metatarsus, or phalanges of the foot. He states that this fracture is caused thruugh continued undue pressure on the foot, owing to Route Marches or other strenuous exercises in Physical Training. He definitely states that the Army 1'11.0. termed it as a March F1 ac12tre. As I have never heard of such a fracture before, could you please enlighten me if there is such a term used to describe a frac ture. Meanwhile I thank you in anticipation of your kind reply.

To the best of my knowledge the term is loosely applied to injuries of the feet which may result from the strain of prolonged marching-namely tearing of ligaments with possible injuries to bones of the feet. Consequently it is not a variety of fracture additional to those named in the Textbook.-N.C. F. B.R.e.S. Me d al. F. P. (Westcliff).-(1) From 1914 to 191 8 I was with th e B. R. C. S., and at the conclusion of the War was given the B. R. C. S. Medal. My query arises as to which sid e I should wear the ribbon when in Brigade uniform. I had till recently, worn it on the left, but am now told by one of our Officers, that it should be worn on the rig-ht. (2) I shou ld also like to ask you if I was entitled to the British War Medal, or the Victory Medal issued after t hat war, as is the case with the Defence Medal of the last war. (1) It is not clear to which B. R. C. S. award you refer, but as your Offi cer has seen the ribbon we believe that his rulin g is correct. Brief1y, the only ribbons worn on the left of Brig-ade uniform are those of Orders and Kings Medals. (2) Unle:c:s you were in one of H . M. Forces you were not entitled to any of the war medals of the 1914-1918 War. EDITOR.

In jur y t o F e moral Arter y . J. H. (Barnslcy).-When we are arresting haemorrhage from a wound of the femoral artery, which is correct to use

A ID

FIRST

AID

(after d igital press u re) a rubber band (4 feet lo ng and 2t inch es wide) as stated on p. 26 of the Su pplement, or a to urn iquet as stated in th e 39th Edition of t he Textbook? I ask this because in the Suppleme nt we a re told to treat as in the 39th Edition. P lease accept my thanks for solving my difficulty. On p. 19 of the S u pplement you are tol d that the new instructions on t reatment of haemorrhage supersede the General Rules of Treatment of Arterial Haemorrhage in the 39th Ed itio n to the end of Rule 10. The tourniq uet, therefore, mentioned in Rule 5 is cancelled. Further, the reference to the 39th Ed ition applies to digital pressure on the femoral artery at the groin. In brief, the instru ctions in the S u pplement showing the ways in which pads should be used will be found sufficien t for all practical purposes; and it is only when all other me thods fail that tLe elasti c band is to be used.-N.C.F .

Knot of Halte r Bandage. L. Y. (Alvaston).-In the treatment of a fractured lower jaw after we have applied the two narrow bandages, we are not sure whether or no the resulting ends are to be tied off in a bow, a slip knot or a reef knot (Fig. 36 in Textbook). So we ask your kind ruling. \Ve have asked the opinion of our instructor who states that the ends must be tied in a reef knot, and of our sur:.geon lecturers who say that the y will accept either slip knot or bow, because if the patient starts to vomit then he could be released more easily. Under a magnifying glass the knot in Fig. 36 seems to be a bow. We await with interest your final word.

Whilst I agree that Fig. 36 on p. 71 of the Textbook does give the appearance of a bow, it is quite definite that the only kn ot recognised in first aid is a reef knot.-N.C.F.

Artificial Resp ira tion. J. M. (Weymouth). -In connection with the treatment of asphyxia by artificial respiration, the Textbook on pp. 148 and 151 states-" When natural breathing begins, regulate the movements of artificial respiration to correspond with it, and promote circulation by l"ubbing the lim bs vigorously towards the heart and by applying warmth." At a recent Divisional Practice one member gave the opinion that the rubbin g and application of warmth could and should be commenced at once by helpers without waiting for natural breathing to commence and, of Course, without interfering with the performance of artificial respiration . Will you kindly say if this is so and if not, what are the reasons for postponing the application of frictIO n and warmth until natural breathing begins?

The stimulation derived from rubbing the limbs energetically towards the heart occurs only whi le respiration is in progress. Consequer:tly in all cases of asphyxia it is useless to apply friction to the limbs until breathing has been re-started . -N. C. F.

"FIRST AID " QU ER IES and ANSWERS COUPON 1 0 be cut out and enclosed 'Wzth all Quer£es. Dec. , I946.

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The

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Its aim and object being the advancement of Ambulance Work In all its branches, the Editor invites Readers to send Articles and Reports on subjects pertaining to the Movement and also welcomes suggestions for Practical Papers. All Reports, &c., should be addressed to the Editor at the address below, and should reach him before the 8 t h of each month, and must be accompanied (not necessarilJl for oublication) by the name and address of the Correspondent. Subscriptions, Advertisements and other business Communications connected with FIRST AID should be forwarded to the Publishers. DALE, REYNOLDS & Co., LTD., 46, CANNON STREET, LONDON, E.C·4·

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LETTERS TO TH B EDITOR

F IRST AID QUIZ

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INCURVED EDGE OF SOCKET

THE

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F OR THE FIRST AID

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QUERIES AND ANSWERS TO CORRESPONDENTS

AND

96 97

Sir Henry L. Martyn, X.C.V.O., F.R.C.S. Just as we go to press we learn with profound regret of the passing of our valued contributor Sir Henry L. Martyn, who died suddenly at his home in Devonshire on the evening of 7th January. \7iJe feel sure all our readers will join us in expressing our deepest sympathy to the widow and all who mourn in this very sad loss.

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COAL nINES.

INJURIES

By J. W. SCOTT.

I HAVE entitled this important subject "Injuries in Coal Mines," and I should first acknowledge my great indebtedness to the late Dr. C. Devereux Pile, M.D., B.Ch., etc., etc., upon whose knowledge I have not hesitated to draw, and also to many excellen t very advanced first aid books and many other authorities too numerous to mention. I ask you to regard this paper as being, shall I say, a plea, a specialised piece of pleading, for the better care, the first aid care, of those injured, for one is dealing with the lives of men. We need more first aid workers, so I hope that you will induce others, if you can, to take up this work. The principal causes of death from Injuries can be placed in the order of their importance as follows : (1) Wound shock. (2) Haemorrhage. (3) Infection of the wounds. (4) Tetanus-if all the wounded do not receive anti-tetanus serum. Now these cases will have to be considered in some detail, commencing with wound shock. Wound shock does not differ in any way from surgical shock, as already known to first aid workers. The most important indications of its presence may be brieRy stated as a pale pinched face, a cold clammy body, quick weak breathing and a quick weak pulse. Great thirst is the patient's most usual complaint. It is well that y~u should note here that during an accident, fflght, exposure to cold, and a ghastly appearance due to a layer of dust, may suggest a state of severe shock in persons who have only sustained minor injuries, like trivial cuts and bruises. It is a common error to mistake those people who are only frightened, cold and covered in dust, as suffertng from shock, a state which is quite unjustified from the minor injuries from which they are found to be suffering. Regarding shock treatment, I cannot in this place deal fully with the treatment of shock, as that more properly belongs to the first aid course, but I woulct remind you of the importance of first arresting haemorrhage, of the value of complete rest of the patient's body, with the head at a lower lev~l than the rest, of warm coverings over the patient, and layers of blankets beneath him drinks of.water or milk, or, better still, warm sw~etened drtnks are of immense service, but they must not

be given in cases of internal injury, or if the person is wholly or partly unconscious. Unnecessary handling and movement of the patient must be avoided, and his body ought not to be exposed to chill by taking off clothing when this is not really necessary. H h: MORRHAGE.

Continued severe bleeding leads to the death of the patient, so that it is the duty of persons engaged in first aid work to seek cases of haemorrhage amongst the injured, and to apply immediate treatment. It should, however, be understood that bleeding, even when a large blood vessel is damaged, may cease of itself. . Continuous oozing of blood from ~ moderately Sized wound may be more dangerous to life than haemorrhage from a severed limb, because the wound is sometimes inefficiently bandaged, whereas the stump received very careful attention. THE TREATMENT OF Hh:MORRHAGE.

.It is not within the scope of this talk to give detatls of the treatment of haemorrhage in general, but there are a few points to which attention is drawn. (1) A patient suffering from severe bleeding must be put lying down at once, and kept lying down until the bleeding has been controlled. There ha~e already been many cases of collapse when patients have been treated in some other position than lying flat, so I wish to impress upon you the importance of putting the patient lying down at once and keeping him lying down until the haemorrhage has been controlled. (2) The usual first aid book differenitates between arterial, venous and capillary bleeding, but all are often seen in the larger wounds, which nearly always damage all three kinds of blood vessels, so that it is extremely difficult to distinguish what is the real nature of the bleeding. . (3) T~e method of stopping bleeding that wtl~ most Itkely b~ su.ccessful, and will harm your patient the least, IS direct pressure applied to the bleeding place. In urgent cases, fingers or thumbs should at once be used to check the bleeding, in spite of the danger of further infecting the ~vound. A suitable dressing in the form of a pad IS the~ firmly ba~daged in place. If direct pressure IS not posslble, because, say, of a piece of coal or metal firmly embedded in the wound, or if for some reason direct pressure fails, then pressure can be applied by means of pads and bandages, your banadges laying as close to the wound-s

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FIRST

as possible, on the heart side if the haemorrhage seems to be more markedly arterial, on the side away from the heart if the bleeding seems to be mainly from the larger veins, but you will find that more often than not firm pressure on both sides of the wound will be necessary. (4) I n the few cases where pressure by pads and bandages is not successful, or for some reason cannot be employed, pressure with the thumbs on the appropriate arterial pressure point can be tried with some hope of success. (5) The tourniquet is a dangerous piece of apparatus, which has caused more loss of life and limbs than the wounds upon which it has usually unnecessarily been applied. If a tourniquet must be used, attention should be drawn to it by marking a large capital' 'T" on the patient's forehead. When other means of making a mark on the skin are lacking, a somewhat gruesome but effective method is to use the patient's blood for ink and your finger as a pen. I NTERNAL H .fEiVIORRHAGE.

It is often difficult to distinguish a case of internal haemorrhage from that of severe shock. A restless patient whose condition is steadily worsening, and whose pulse rate is increasing, is probably bleeding. If a rapid examination does not reveal a cause for the haemorrhage, it may be safely concluded that the bleeding is internal. The rapid removal of the casualty to where expert s urgical attention can be given, affords the patient his best chance of recovery. Failing immediate transport, do your best with shock treatment, but so long as that bleeding continues, you are fighting a losing battle, but still you can do your best. Remember the danger of giving the patient anything at all by mouth in these cases. W OUND INFECTION.

All wounds resulting from injuries in coal mines should be considered as infected by germs from the moment of their inRiction, but nevertheless the ill-effects of that infection can be reduced considerably if a suitable dressing is applied to the wound as soon as is practicable. It is a good rule to dress a wound as you find it; cleansing of the wound, the removal of small fragments of coal, metal, or cloth, and the application of antiseptic to the wound is, in my opinion, more properly the work of the surgeon. Lastly, the fourth important cause of deathTETANUS.

All persons who are wounded should receive anti-tetanus serum, no matter how trivial the wound may seem; in that way only can the death rate from tetanus be lowered. So much for these instances in general, and we can now deal with them rather more particularly, beginning with wounds.

AID ABRASIONS.

Here the outer laver only of the skin is damaged, so that although they are extremely common, abrasions are of little importance from the first aid point of view. INCISED WOUNDS.

Usually encountered in the form of ·a clean slit, and produced more frequently by flying coal or metal. Sometimes a fall on the knee or elbow or a heavy blow on the bony part of the body will make a wound as clean cut as if a knife had been used. These incised wounds may bleed very freely, because the blood vessels are clean cut and remain wide open, and the edges of the wound tend to gape apart so that a considerable amount of blood may be lost. LACERATED WOUNDS.

These are found as great gashes in the flesh, limbs entirely carried away, body organs exposed and destroyed. Although often frightful in appearance, haemorrhage is not usually great as the inner and middle coats of the damaged blood vessel curl up inside the outer coat, and for the time being obstruct the flow of blood. Unless early attention can be given, this obstruction may disappear and, later, bleeding becomes severe. Because of the intensive destruction of tissue, wound shock is grave and will require urgent treatment. I would like to emphasise the importance of firm bandaging of these wounds, and, when it is possible, the secure splinting of large lacerated wounds even when a fracture of bone is absent. It is unfortunate that first aiders think only of splints in connection with broken bones. It is just as important to splint in some way to prevent from moving, a large lacerated wound as it is when a fracture is present. CONTUSED \VOUNDS.

These injuries are usually caused by crushing of the body by falling coal. The actual destruction of the flesh is often less extensive than in the preceding type uf wounds, but serious compound hactures are very frequent-good shock treatment and adequate splinting are needed. PUNCTURED \lV-ou DS. Punctured wounds are common from small pieces of coal. The outer opening of the wound may be small and insignificant, and may even escape notice altogether, but much damage to deeper and more important structur~ is often fou~d. A bit of coal no larger than a spItt pea, entering the thigh, has been known to splinter the femur into fragments. If the object passes through a part of the body, the exit wound is usually more extensive and destructive than the entrance wound, so that very careful examination of the patient is necessary.

(To be contz'nued.)

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AMBULANCE NEWS FROM ALL QUARTERS. S.J.A.B. MR. D. G. MONTEITH. ~1r. Duncan Gilbert Monteith retired on December 31st last. He had been Assistan t Secretary of the S . J. A. A. for 35 years and in addition Assistant Secretary of the Order of St. John for 33 years . He was also Competition Secretary of the Inter-Railway and Police National Competitions; the former for some 24 years and the latter since irs inception in 1928.

No. I (Prince of Wales's) District CAPTAIN WILLIAM GOODLEY, O. B.E. , M.C., K.St.]. "V.e ~egret to anno unce the .death of Capt. W. Goodley, CommIssIOner of the No.1 (Pnnce of Wales's) District, on January 3rd. At the cremation ceremony held on January 8.th at the City of London Cemetery, Manor Park, representatives of the Order of St. ] ohn, the Association and Brigade were present. No. 151 (MOLESEY). The competition fina ls for the Divisional individual efficiency cup were held by the above Division recently before an audience of 40. ' . The test was very ably staged and judged by Supt. WIlloughby of Twickenh::tm Di vision. The cup was presented by the donor, Mr. V. G. Moss, to Pte. Witch. Pte. Ca.rbines was runn.er-up j and a ve ry interesting evening was enjoyed by competitors and onlookers alike. . . ~bo~t 200 people spent an e njoyable evening at the DIVISIon s first post-war social function at the "Casino" Taggs Island, dancin~ to the" Alvians " dance band. ' .During the evening, District Officer F. E. Stratton, in a brief address thanked those present for their support, and expressed the hope that they would attend further social gatherings which the Divisio n had in mind for the future. ~o.

86 (HORSEFERRY).

This Division held its fi rst post-war dinner and dance at the Tavistock Restaurant, 21, Charterhouse St., E. C., recently, when past and present members and wives O'athered together for a very enjoyable evening. b 0 /0 H. Dunford presented trophies and promotions to members, and Supt. F. James received a sil ve r mounted cane from members of the Division for his devotion and untiring efforts durin~ the difficult years of the war. The company enjoyed a concert given by the Diamonds Concert Party, after which dancing followed to the music of Ray J esters Band until 11 p. m. No. 124 (KINGSTON). The a nnua l co mpetitions for the Divisional trophies of the above Division were held at the Headquarters the Clinic Grange Rd " Kingsto n, on Monday, Dec. 16th. Distric~ Officer F. E. Stratton judged the competitions, and the results we re as fo ll ows :_ Zoft Cur, wi nner, Pte. A. W. Smith; runner up Pte. H. Hammond. ' Recruits Cup, winner, Pte. W. Trotman; runner up, Pte E. Noakes.

District Officer F. E. Stratton congratulated the com petitors on their keenness, and stressed the importance of training for future competitions. The winners hold the trophies tor one year.

County of Berkshire. S.J.A. B. COUNTY OF BERKS. FUND. On Friday, December 6th, a dancing recital was given by the Beryl Jarvis School of Dancing at Palmer Hall, Wes t Street, Reading, the proceeds being in aid of the above fund . The items in the programme were many and varied. During the interval the County Commissioner, C. A. Poolp., expressed his gratitude to Miss Jarvis for her wonderful show, and for the help the recital would give to the Brigade. Among those present were the Assistant County Com missioner Mr. F . A. C. Jarvis, Mrs. Jarvis and Miss Betty Jarvis. READING NURSING CORPS. On Tuesday, December 10th, a Christmas Fayre was held at the Ambulance Hall , Reading, in aid of the Medical Comfort Depot funds. The Fayre was opened at 6.30 p. m . by the County Presidep.t, the Marchioness of Milford Haven. The sum of £67 105. was raised by this effort.

County of Devon. TOPSHAM. At the quarterly meeting on Thursday, Dec. 12th, which was well attended, a pleasant event took place when Mrs. E. Widing, ]. P., of Topsham, presented the Service Ribbon to Cpt. Brown for service in " C" Division, Sheffield S.]. A. B., and who has lately come to reside in Topsham. His record of service showed a fine total of drills and public duties performed, and was loudly applauded. Members were delighted to know t hat Cpl. Brown has no intention of resi g ning his membership from the Brigade and will join the Topsham Division. This news was warmly welcomed.

FIRST activities, the re now bein~ at the Club a mans' Divi sion , also a boy and ~ir l Cadel Division. H e t hen presented a desk li~hter La the Divisional Surgeon, Dr. P . Hughes, in reco gn ition of his valuable services to the Division. Dr. Hughes t ha nked a ll for the present, wh ich he much appreciated and looked forwa rd to t he success of the Division in the future. Di v. Supt. Hames said he hoped to see the President's wish of a ladies class come true, and all would do what they cou ld to achieve it. BRAUNSTONE. A very su ccessful sale of wo rk was held at Cort Crescent Youth Centre, on Sat., Dec . 14th, organised by N. e. S. Mrs. Toone, N e.0. Miss West and the Braunstone Nursing Cadets. The result was £26 towards N.C. Band funds and their own Divisional funds. The sale was opened bye. e. O. Nurse Wollaston. LOUGHBOROUGH. On S at . . D ec. 7th, the finals of the N. e. competItIon . were h eld at Limehurst Schools, Loughborough. The r es ul ts were : -Team T est: 1, South Wigston j 2, Arthur Faire (Leics.) ; 3, Mkt. Harborough . Bed Making: 1, Shepshed j 2, Arthur Faire j 3, Leicesters; 4, Loughborou gh. Cups were presented to the winning team of each competition.

County of Norfolk. BOULTON & PAUL (NORWICH). A dinner, given by the directors, was held on Friday, December 13th, and was attended by the twenty-five members of the Division and three ladi es of the Nursing section . Mr. S. Howes , President, was in the chair. The occasion was marked by a presentation to l\1r. H. A. Towlson, Vice President, on his retirement. The Assistant County Commissioner for Norfolk, Dr. W. E. Rutledge, S. B.St.J., commended the Division on its ~ood work durin g the bombing of the factory, and expressed hope that other factories would form works divisions for their own benefit. He stated that he "vas closely associated wi, h the Division, which was founded in 1928. Mr . S. Howes toasted tbe Division, and Div. Supt. S. Cogman suitably replied.

County of Warwick.

County of Lancashire. ATHERTON. At a social evening Mrs. F. Wardley, J.P., Vice-President, presented awards to Officers and members of the Atherton Division. Service Medals-5 ; Bars to Service Medals- 36 years, 1, 32 years, 1, 25 years, 2 j Grand Priors Badge-1. . The President, Capt. C. Fletcher, O. St. J., has been preSident for 29 years and obtained his first aid certificate in December 1895. A concert and refreshments followed the presentation.

County of Leicester. GIPSY LANE. Th~s Ambulance Divisi~n held a very enjoyable supper and SOCial recently, at the GIpsy Lane W. M. Club, Leicester. The President, Mr. L. Miller, said how pleased he was to see so many members and friends present, and hoped in the near future they would add a ladies class to the St. John

COVENTRY DISTRICT. Friday, December 13th, was by no means an unlucky day for the central Divisions in Coventry, when a very bappy gather ing assembled at the "Vhite Lion Hotel, a somewhat bomb battered hostelry adjacent to the levelling stone wh ich marks the centre of the future city. The occasion was an informal dinner organised by a joint social committee formed of members of the City of Coventry Men's and Nursing Divisions, and the Three Spires Nursi ng Division. The attendance of about 80 after disposing of the meal, settled down to dancing- and games with the goodwill typical of the Ch ristm as season. In brieOy proposing the toast of the Central Divisions, Supt. Taylor (City of Coventry) welcomed all guests and spoke of a coming programme of events which will extend the co-operation between the Divisions. Supt. Goldby, (Three Spires Nursing) replying to the toast, expressed her pleasure at th e attemdance and said that she looked forward to seeing many simi lar social gatherin gs. It was a nnoun ced that a more formal function wi.1l take

AID r l ~ce early th is year, at which lon~ service, and other awards will be presented .

County of Worcester. WORCESTER. The Worcester ursing Division held a "BrinO' and b Buy" sale at their headquarters on Friday, Decemb£:-r 13th. As a resul t of the sale £50 was realised. It was arranged to hold a whist drive early this year. FOWICK. The above Cadet Nursing Division held their second enr olment ceremony in the Village Hall on Monday, December 9th. County Cadet Officer Mrs. Hugh Robinson enrolled tIle 13 successful cadets, to which she presented certificates. Two small sketches were acted by the newly enrolled cadets. PYE. The Officers, N.C.O. 's and members of this Ambulance Division, together with a good' number of subscribers and friends, -held their annual dinner at the Ambulance Hall on Saturday, December 7th. Presentation of awards to members was made by l\1r. Schofield and an entertainment foHowed. HILL Mm CAKEMORE. A very interesting ceremony was performed in the Girls Hall, Hi.ll and Cakemore Secondary Modern Schools on S<'l.turday, December 7th, when 11 girls were enrolled as members of the new Nursing Cadet Division. County Cadet Officer Mrs. Robinson perform ed the enrolment ceremony, and Div. Supt. M iss Dye presented to each cadet, as a personal gift, a copy of the New Testament. Refreshments were served to all present.

West Riding of Yorkshire . BRADFORD CORPS. On Wednesday evening, Dc'cember 11th, a "\Velcome Home" dinner and social was given at Benson's Cafe for the members of the Bradford Corps who had returned from the Forces, about 150 members and friends being present. Dr. \V. N. \Vest \Vatson. Assistant Commissioner ,,·as present, along with Dr. R. Chester the newly appointed Corps Surgeon, and Dr. R. G. Crawford (Tramway Division). After the dinner the party were entertained to a social which was very well appreciated. On Sunday, December 15th, the Assistant Commissioner opened a series of \Vinter Lectures with" Discussion on the Supplement to the 39th Edition of First Aid to the Tnjured," this was followed by a lecture on ] anuary 19th, hy 1\\ r. H udson of the Radiology Dept.. BrFldford Royal Infirmary (' n "The Alimentary TrFlct from the Radiographic Point of View." On February 161 h, 1\1 r. \\'hyte 'Watson will lecture on "Head Injuries, " and on March 16th, Dr. R. Chester on " First Aid in the Factory."

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RAILWAYS. Great Western. PRESENTATION . l\lr. E. D. B. Keefe, wl10 has resigned from the position of Div. Amb. Secretary (London" B" Division) on retire-

FIRST ment, was invited to attend a recent meeting of the Divisional Ambulance Secretaries' Conference, during the course of which Mr. H. Adams Clarke, the Chairman, thanked him for his work in the London" B " Division and for the movement generally. Mr. w. J. 'Waite, Worcester, paid tribute to Mr. Keefe's service and asked him to accept on behalf of the members of the Conference an umbrella and fountain pen. Mr. Keefe gained his first aid certificate in 1904 and holds the Company's long service medals and bars for 40 years efficiency. In 1923 he was admitted to the Order of St. John of Jerusalem in the Grade of Serving Brother and was promoted to the Grade of Officer (Brother) in 1945. He was secretary to the Oxford Class from 1910 to 1922 and was also a member of the Divisional Ambulance Committee during- this period. He has acted in the capacity of Divisional Secretary since 1928.

L.P.T.B. (Met. Line). ANNUAL REPORT 1945-46. This was presented by Mr. J. A. Gravestock, Centre Secretary, who stated that the figures would not balance those of the previous year owing to the fact that the lectures which during the war years were held during the spring are postponed until the autumn months. The result was : Baker Street Class. First Aid Vouchers Medallions Labels Total 4 7 128 139 Home Nursing Certificates Pendants 7 14 21 Chis wick Works Class. First Aid Vouchers Medallions Labels Total 2 40 1 43 Home Nursing Certificates Pendants 3 18 21 Child Welfare Certificates 15 15 Other items from the report were : Special Certificates for the most efficient first aid rendered during the year ended September 30th, 1945, from 1,790 reports received, were awarded to Mr. Harold Burrows, Mr. Richard Weekes and Miss E. Gooden. At the Baker Street Class 1,813 attendances were made at the weekly practice classes, and at Chiswick Works, 1,050. During the year ended September 30th, 1946, 2,191 cases of first aid rendered, were reported.

Southern. REDHILL. An interesting competition was held at the Technical College, Redhill, on Monday, December 30th. Spectators were very interested in the work, which was of a high standard. Mr. S. W. S. Winnifrith, Station Master, announced the result :-1st, Mr. H. Hunneybell, " Anstey Chave " Cup and biscuit barrel; 2nd, Mr. A. James, two cut glass pickle jars; 3rd, Mr. F. Dash, butterdish. Mr. F. Trott, Centre Secretary, extended a hearty vote of th'tnks to Dr. Offord, for his valuable assistance as class lecturer. HALF A CENTU~Y OF SERVICE. Engine J?river.W. S. Mason of New Cross Gate (70 year old stalwart) III retIrement continues his interest in first aid as an active member of the New Cross Gate Class and an Officer in the S.J.A.B. No. 120 New Cross Division.

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FIRST

He remembers the day when, in the Brigade uniformpillbox hat, black tunic tight buttoned at the neck, and drainpipe trousers-he was referred to as one of the" poultice wallopers " and with others was ordered off the street by the police. In reaching the year that marks 50 years of am bulance work, first aiders throughout the Southern Railway gladly join to congratulate him and wish him well in the hobby that has become his very life. ASHFORD WORKS. The annual competition for the "Maunsell" Cup took place at Ashford Works recently. Six teams competed and the winning tearn consisted of G. Holtum, A. Cowell, H. Edginton, F. W. Paine and S. Knight (Captain) with 212 points, the runners-up scoring 192 points. The winners each received a clock and the runners-up, lighters. The prizes were presented by Dr. Sheila Niall, who in . addition, handed a framed certificate to Mr. B. J. Green for 30 years' continuous ambulance work. Tea was served by the canteen staff. OKEHAMPTON. A most enjoyable evening was spent at Okehampton on Tuesday, December 10th, the occasion being the first of its kind, when the Class held its presentation of prizes and concert. Mr. Weaver who presided, said that he was willing to help them make Okehampton Class the largest in the District. After entertainment and refreshments, the evening was concluded with "Auld Lang Syne" and an expressed hope that the event will become an annual affair. MERITORlUVS FIRST AID. The Ambulance Centre Committee have awarded the Meritorious First Aid Certificate of the Centre 10 Ganger W. Mitchell, Chard J ct. for the efficient treatment of a Lengthman suffering, as a result of an accident, from an incised wound of the right thigh and lacerated wound of right arm with severe bleeding. The Medical Officer receiving the patient at hospital stated that the efficient and comprehensive manner in which 6rst aid was carried out, materially shortened the convalescence of the patient.

OVERSEAS. Rhodesia Railways. " BIRCHENOUGH" SIIIELD AMBULANCE COMPETITION. The popular contest for the above Ambulance Shield was held at Bulawayo in the presence of a large gathering of spectators. A typical workshop accident was realistically staged for the team test, and in addition the competitors underwent an individual practical test involving an imaginary dining-car mishap, and an oral examination. The Shield was last competed for in 1938. but despite the intervening war years the general level of efficiency was good. .A particularly high standard has always been demanded in this competition. Six teams, including two non-Railway teams, competed. There was a separate trophy for the non-Railway teams; and the final results were: Bulawayo Railway, 239~ (out of a possible 294) ; Umtali Railway, 216~; Bulawayo City, 200; Salisbury City, 195; Livingstone Railway, 184-t; Salisbury Railway, 172l. Drs. K M. Rodger and C. Dawson were the adjudicators. Both are very experienced in St. J ohn Ambulance competition work, and the former adjudicated several of the pre-war contests for the" Birchenough " Shield.

Letters to the Editor. We are in no way responsible for the opinions expressed, or the statements made, by Correspondents.-EDITOR. WORDS OF PRAISE DEAR SIR,Permit me to say how much I appreciate the course of instructive articles by Sir Henry L. Martyn. His remarks in the December issue re stretcher work, while pungent, are most appropriate, and his advice should be written large on the walls of every first aid lect ure room. Let me add also my praise (0 our Dear" N.C.F."-his " Answers to Correspondellts" are a continual pleasure to read.-Yours, &c., J. C. Cumberland. DEAR SIR,Several members of my Division regret to note the concl usion of those splendid articles-" Side Lights on First Aid" by Sir Henry L. Martyn, KC.V.O., F.R.C.S. Far fro m being bored (as he stated in one issue) we humble st udents grab at the crumbs that fall from the rich man's table, and in spite of having a good meal, like Oliver Twist, we would like a second helping. May I ask you Mr. Editor, to convey our thanks to that <.Ye ntleman, and acquaint him of our request? !'> Compliments and best wishes.-Yours, etc., " SKIPPER." Surbiton, Surrey. January 5th, 1947. FIRST AID FOR ANIMALS. DEAR SIR,I am often approached by the owners of animals that have met with accidental injury and asked "What is the best thing to do?" It occurred to me that 6rst aiders might, like myself, be interested to read something about animal injury, and I sug-gest that you could interest your readers with some articles on this subject.-Yours, &c., J. BRINKLEY. Ilford. [We are anxious to comply with the wishes of as many readers ar possible. Would YOU like to learn something of first aid for animals? If so, please write and let us know.- EDITOR.]

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practItIOner in an industrial town of 30,000 population. During this time many extra nurses were employed by the Council, e. g., health visitors, maternity and child welfare nurses, school nurses, visiting sick nurses, infectious disease hospital nurses and clinic nurses. These changes in the extra employment of nurses have taken place all over the country, so that without extra recruits entering the nursing profession, a shortage of trained nurses must necessarily follow. In the town I have mentioned, about 5,000 children are educated in the elementary school. About 400 each year becoming old enough to leave school. If, before leaving school, they had been taught a sound theoretical and practical knowledge in the subjects I have mentioned, I am inclined to think that many of the girls would have become inculcated with a desire to take up nursing as career. This school training would also be of national benefit, as nearly all the homes in this community would have a member of the family able to give useful help in times of sickness and accident. This knowledge in the home would alleviate much suffering, and in my opinion many cases of death, especially among children. After this course of. instruction, the students could be examined in these subjects and obtain certificates of proficiency. The examining bodies of the St. John Association and the British Red Cross are already carrying out this work. I have spent 40 years in connection with the St. John Ambulance Brigade, thereby coming in contact with Ambulance, Nursing and Cadet Divisions, and I have been impressed by the keenness of these young cadet members. If, when they leave school, they could obtain certificates of efficiency, they could then join Divisions of St. John or Detachments of the British Red Cross, and so keep in touch with this important and useful work, and the foundation of a nursing career will have been laid. Much is said to-day of youth becoming useful citizens. My experience leads me to think that many of those who are voluntarily engaged in this work have already become useful citizens in the place in which they reside. If in all towns with a population of 20,000 or over, a properly designed and equipped Ambulance Hall was erected this would in itself raise the standard of work and ensure' mem bers meeting at regular intervals to revise and practice their work. The main hall of the building could be used for social events and entertainments, with antirooms from the main hall for lectures and practical instruction. These halls, I feel sure, could be self-supporting if used at times when not needed for ambulance work.

Yours faithfully, ]. WELLS, l\l.R.C.~., L.R.C.P.

THE

URGENT

NEED

FOR

NURSES.

DEAR SIR,After reading your Editorial, "First Aid Movement," in FIRST AID, November, 1946, I venture to send you a few suggestions which I think may be worthy of consideration. . How c~uld a constant flow of recruits be brought into the nursing profession? In this very important matter, could not the Board of Education be of great help? The school leaving age is to be raised, and during this extra time at school a foundation could be laid with a knowledO"e of first aid, home nursing and hygiene as a preparatio~ to further knowledge in these subjects, if they were in the school curriculum. The lectures in these subjects could be carried out during school hours at definite times by medical practitioners, assisted by school nurses in practical instruction. One has only Lo study the syllabus of first aid, home nursing and hygiene of either St. Johq or the British Red Cross to appreciate to what usefulness this knowledge could be used. I myself spent 35 years as a general medical

Prestatyn, Dec. 2nd, 1946.

------.---.------First Aid Quiz. Questions. (1) In hanging, what are the three possible causes of death? (2) A bleeding ear must not be plugged-why? (3) Name the bones of the Idwer extremities (5 individual and 3 groups). (4) What are the signs of frost-bite? (5) How would you treat a frost-bite case? (6) 'What is a " spica" bandage? (Answers on page 102.)

FIR S T

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FIRST

Practical Nursing in the Home.

asked to flex the knees, dig the heels into the bed and raise the pelvis whilst the nurse rolls up the gown at the back, or draws down pyjama trousers.

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

Ca1'e of tile lIIoutll and Teetlz.- This is most i m portan t, not on I y for the com fort of the patien t but also for the prevention of inflam matory conditions of the mucous mem branes and the accum ulations of crusts or "sordes" on the teeth and lips. A patient who is very ill or is helpless cannot carry out the toilet of the mouth for himself, so the nurse must assist him. If he is on fluids only, the mouth is apt to become unhealthy because the structures concerned lack exercise, and in many illnesses the mouth and lips are uncomfortably dry. Artificial dentures irritate the gums, especially if they are not kept scrupulously clean, and septic particles from the mouth can be swallowed with the saliva and lead to gastric upsets and a disinclination to take food. Many substances are recommended as mouth washes and dentifrices, but mechanical action rather than chemical effect is the chief factor in cleansing the mouth, so the toothbrush should be used whenever possible, the nurse brushing the patient's teeth if he cannot manage this for himself. \i\Then, however, a toothbrush cannot be used, COlton wool can be wrapped around orange sticks or the ends of forceps and dipped in to glycerine and borax, or glycerine and lemon juice, and carefully rubbed over the surfaces of the teeth, gums and lips, after which the patient may rinse out his mouth with weak salt solution or with a mild antiseptic, such as glyco-thymoline. This should be done in seriously-ill patients before and after every feed is given. Cold cream applied to the lips will keep them soft and prevent them from cracking. Dentures should be scrubbed under runlJing water with the patient's own toothbrush, and, unless they ~re to be replaced immediately, they should be put Into a cup or glass containing fresh, cool water or a mild solution-of salt or boric acid-that will preserve the vulcanite. BEDPANS AND THEIR USE.

There are three types of bedpan availablethe circular pan with a handle, the slipper pan and the "Perfection" pan. The " circular shape is conv~nient .for patients who can sit up, the slipper pan IS easier to use when lying down, but the " Perfection" pan has advantages over both types and can be used in either position. It has a large opening, and is so shaped that the pressure comes upon the sacrum when the pan is properly ad-

justed. Rubber bedpans and porcelain bedpans with a rubber rim are obtainable, and are an advantage when nursing incontinent patients. \i\Then a divided mattress is available these bedpans can be left in position. Urinals are flask-shaped and are intended for male patients, but a type with an expanded opening is designed for women

wipes off the parts with toilet paper and then washes them with warm, soapy water, dries them thoroughly" and dusts a little talcum powder between the buttocks and the thighs, taking the opportunity to inspect the lower part of the back and the hips for redness or any other symptom of pressure, and giving the necessary treatment for the prevention of bedsores.

The Standard Type of Bedpan. (Allen & Hanbury.) Then the nurse places her left hand uneler the patient's pelvis, assisting him to lift up, and slips the bedpan into position with her right hand. If the patient is helpless, the bedpan should be placed on the side of the bed close to the patien t, the nurse then lifting the hips with both hands a nd, whilst using the left for support, slips under the bedpan with the right hand. It is important that the position of the pan should be correctly adjusted, the top of it coming just below the hip

" Perfection" Bedpan. By Down Bros. Ltd. patients who cannot easily be placed upon a bedpan-for example, when in a plaster jacket or suffering from a condition such as fractured pel vis or spinal injury, which makes lifting and other movement undesirable. In the use of bedpans more than any other procedures a nurse needs to think for her patient and to offer a bedpan or urinal at regular intervals; many people will suffer discomfort rather than ask for such personal attentions, especially if they feel that the time may not be convenient. To G£ve a Bedpan.- The utensil must be warmed, either by placing it on a hot radiator in the bathroom or by running hot water over it. It must be thoroughly dried, for not only is a damp bedpan difficult to adjust but it makes the undersheet damp. It is carried, together with a urinal if the patient is a man, into the sickro0m covered by a thick piece of old I inen or a towel that is kept specially for the purpose. A toilet roll is also taken to the bedside. If the patient has a moist skin, the rim of the bedpan should be powdered in order that it may be slipped into position easily, and if his skin is tender or in danger of being bruised or abraded, the rim of the bedpan should be padded. It is essential to secure privacy, to avoid any suggestion of hurry and to explain to the patient just how you want him, or her, to help. The bedclothes are untucked from the right side of the bed and folded back. The patient is

AID

The Male Urinal Bottle. (Allen & Hanbury.) bone (see illustration). Unless the patient is very ill or likely to become faint, the nurse should leave the room for a few minutes in order to spare em barrassment and to allow the patient to relax sufficiently to be able to empty the bladder and rectum satisfactorily. It is a good plan to place a s mall hand-bell within reach. The nurse returns with a bowl of warm water, soap, flannel and a towel. The patient is allowed to use the "toilet paper if able to do so, the nurse assisting him to lift clear of the bedpan, which

The Female Urinal Bottle. (Allen & Hanbury). is then removed. The patient is given the water with which to wash the hands. If not able to attend to himself, the nurse rolls him over a little to the left side when removing the pan,

'T he Correct Position of Bedpan. The bed pan is covered and carried out of the room, the contents being inspected before they are emptied into the lavatory pan. The bedpan is thoroughly cleansed, dried and p:..lt ready for further use. Unless a male patien t is extremely ill, or has lost the use of both hands, he is able to mani pulate a urinal for hi mself. If he can not do this, and there is no other man in the household who can assist him, the nurse must slip it into position under the coverings and hold it in place whilst it is being used. After sanitary utensils have been used, the patient should be protected from draughts whilst the room is thoroughly ventilated in order to remove any unpleasant odour. THE USE OF SPUTUM M UGS.

Normally, no sputum is expectorated, and in disease in which there is sputum produced the amount may vary from a minute quantity to about half a pint each day. When a standard type sputum mug is not available, a small jar with a lid or cover will often prove most suitable. If the sputum is likely to be infective, as in tuberculosis, cardboard cups should be obtained, for these can be burned with their contents and so avoid the risk of disseminating infection. A little water or weak disinfectant solution should be placed in the mug before giving it to the patient. This obviates the drying of the sputum and makes the container much easier to empty and clean. Sputum may be put into the lavatory pan, care being taken not to soil the sides when emptying the container, and, after rinsing, the mug can be washed in warm soapy water containing soda. This dissolves any remaining mucus and facilitates the cleansing of the utensil.

FIRST

AID

FIRST

For the First Aid Box. AN ANTISEPTIC CREAM. A SOOTHING, antiseptic and non-greasy cream is produced by 0.0.0. Company Ltd., 3, Fleet Lane, London, E.e.4., under the name of D. D. D. Balm. We are informed that this preparation is being widely u d by the nursing profession and that many testimonials have been received giving testimony as to the value of the product for the skin ailments of babies and children. Interested readers are invited to write to the makers for further particulars at the address given above. TREATMENT FOR "ATHLETE'S FOOT." THE return of a great number of Service men from overseas has greatly increased thf' incidence of Athlete's Foot and other fungoid infections; therefore it is specially interesting to note the appearance of a new prep~ration "Aero-Ped" (Aero-Ped Ltd., 35, Bessborough Place, London, S. W.1) which is specially designed to deal with this intractable infection. Although this disease was first noted amongst athletes, it is by no means confined to them as is evidenced by the variety of names by which it is known, i. e., Foot Rot, Singapore Foot, Tinea Pedis, etc. The principle symptoms are intense irritation, soggy, peeling patches and cracks between the toes as well as tiny blisters, while in chronic cases the infection may spread to the nails and involve other parts of the foot. The causative organism is a fungus which is very resistant to ordinary treatment. .. Aero-ped" incorporates a powerful yet harmless fungicide which, it is claimed, kills the fungus and gives prompt, lasting relief.

Ambulance Services in England, Wales and Scotland. IN the Health Services Act (England and Wales) the duty of running the future ambulance services to be provided has been placed on County and County Borough Councils. These Councils, however, may delegate these functions to some other body, such as local authority, voluntary agency or contractor. The terms of the arrangements to be made by this delegation must, however, be approved by the Minister, who has stated that he will see that proper standards are maintained. The Scotcish Health Service Bill has now been issued, presented to Commons on 31st October, 1946. A different position arises in Scotland . Under the provisions of the Bill the" duty of providing an ambulance service" in Scotland is placed on the Secretary of State. It obviously will be a co-ordinated service. The terms of the provisions are somewhat elastic, but the intention is clear. The relevant clause says ;" It shall be the duty of the Secretary of State to make such provisions as he thinks necessary for securing that ambulances a[jd other means of transport are available for the conveyance of persons suffering from llIness or mental deficiency or of expectant or nursing mothers. " Regulations and schemes under section 12 of this Act may provide for the administration of the services under the last foregoing subsection as if those services f0rmed part of the hospital and specialist services." . " Illness " ~s .defined as including" lunacy, mental Illness and any IOJury or disability requiring medical or dental lreatment or nursing." The Scottish provisions indicate a more co-ordinated service than that planned in Eng land and Wales. Doubtless comp~ete co-ord~nation ~ill have to follow after a few years expe.nence, partIc.ulady If. the service is to provide "free" medical and hospital serVice for every citizen.

Uniforrn by Garrould The cut, style, and fine workmanship always distinguishes a Garrould Uniform from any other. Great care and attention is given to every detail. We have such a wide range of SCientifically graded stock sizes that 90 per cent. of our customers are able to obtai n a perfect fit. Prices of Officers' Uniforms and other items not mentioned in this advertisement sent on request.

S.J.A. APRONS for Ambulance Sisters. Made from hardwearing linen ·finished apron cloth. Price includes cross. Waists 26, 28, 30 ins. .. 7/ 11 Waists 32, 34,36, 38 ins . .. 8/ 11 In Lengths 26, 28, 30, 32 ins .

Ambulance Sisters . In Ivory Tricoline 22/ 4t (4 coupons). Extra Collar 3/6 (I roupon). S,zes 13! , 14, 14.\ ins. Size IS ins. 23 /4 ~ . Extra Collar- 36. (Civilian coupons must be surrendered for blouses) . HAT for Officers an d Ambulance Sisters. 18/6. Box and postage 211. Badges obtainable only from H.Q . Hats stocked in si zes ;6!, 6g. 6 ~ , 6i , 7, 7k, 7L 7}. Storm Cap 17/ 11 . Box and postage 1/4. S.J.A.

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2. -All Queries must be written on one side of paper only. 3 -All Queries must be accompanied by a " Query Coupon" cut from the current issue of the Journal, or, in case of Queries from abroad, from a recent issue. 4. -The Textbook to w hich reference may be made in this column is the 39th (1937) Edition ot the S.J.A.A Manual of First Aid to the Injured.

Examination Howler. M. B. (Cambridge).-In a recent exam inati on I asked a candidate to tell me the way in which the knee-cap is commonly fractured. I was amused when he replied; " rVlzen the joot slips the thigh muscles act 7Jigorously to p1'ecipitate a fall and so map the knee-cap! "

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Queries will be dealt with under the following rules ;1. -Letters containing Queries must be marked on the top left-hand corner of the envelope " Query, " and addressed to FIRST AID, 46, Cannon-street, London, E.C.4.

With reference to this change assume that there was a typographical error in ('opying out the original instructions fo r the Rocking Method and that our Revision Committee realised that two seconds was too sbort a period for the feet do wn position. It should be understood that in no form of artificial respiration does air enter the lungs immediately the pre!:>s ure is relaxed and that a brief space of time must elapse befo re this takes place.-N. CORBET FLETCHER.

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Rocking Method. H. E. (Northampton).-Page 32 of the Supplement to the Textbook gives instruction in the Rocking Method. Para. 4 tells us to regulate the rate to IO double rocks per minute, i.e., 4 seconds head down, and 2 seconds feet down. Brigade Circu lar 3/ 46, however, states that the 2 seconds feet down !:>ho uld read;-" 3 seconds ff'et down." I shall be very pleased to have your comments and observation on this change.

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AID

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

Fracture of Lower Limb. A. C. (Selby).-With reference to the instructions on p. 9 of the Supplement to the Textbook regarding fracture of lower limb when splinting facilities are not available, should the bandages be tied on the uninjured limb or in the middle line of the body? Your kind reply will be appreciated. The position of tIlE' knot is not of great importance except that this should not be tie d over the fracture. You will probably get the best result by tying knot as you s uggest on the outer s id e of the injured limb.-N.C F.

Fractures of Femur and Leg. e. F. (Thornton).- The Textbook in Rule 5 on p. 67 tells us that splints must be firm and lon g enough to keep the joints immediately above and below the fractured bone at rest. Such being the case, will yo u please defin e the

correct treatment and position of bandages with fractures at neck of femur and at ankle joint? Whether the fractures are at the ends or the shafts of the thigh or leg bones tbe treatments are as given on pp. 88 and 91 of the Textbook.-N.e.F.

Contraction of Heart. C.F. (Selby).-Will you be kind enough to describe the contraction of the heart? Do the ventricles contract and then the auricles? If not, please put me right on this point. The normal contraction of the heart passes from the auricles to the ventricles. Between the contractions of each of the cavities of the heart, there is a slight pause but the contraction spreads so rapidly over each cavity that all cavities appear to contract simultaneously. - N. e. F.

Dying from Thirst. G. W. (Busseltoi, Western Australia).-The members of our J ursing Division, Brigade Overseas, would be grateful for your comments on the following paragraph taken from a newspaper ; " A man lost in the bush in this State was found almost dead from thilst. Instead of being given uater to drink it was thrown over him, the reason g iven being that the water would be much more quickly absorbed in that way." There is no evidenc e to show that water thrown oyer a patient dying from thirst would be more qui ckly absorbed inlO the body. Personally, I think that water given by the mouth would be more effective but in the circumstan ces stated iL must be administered in sips and not swallowed in large quanlities.-N e. F.

Treatment of Crush Injury. W. S. (AbertiIlery).-The Supplement to the Textbook tells us in par. 8 on p. 7 that in the event of crush injury involving a limb the patient should be given as much alkaline solution as he is able to swallow, before the stirn ulant treatment laid down in par. 7 on p. 6, is administered. Recently at a lecture on this subject a member of the class asked what other alkalies could be used if no bicarbonate of soda was available. The answer given was first chalk and secondly salt on the grounds that these are named in Chapter XIX of the Textbook as antidotes for acid poisons. As a keen first aider I challenged this statement as being incorrect and welcome your kind ruling on this matter. With a severe crush injury certain acid poisons are thrown off from the crushed muscles and circulate in the blood stream. Th ese in turn may c~use permanent damage to tbe kidneys. Bicarbonate of soda when absorbed into the blood stream helps to counteract the acid poisons. Chalk and magnesia have a beneficial effectwben broug ht into direct contact with acid poisons taken by the mouth but would not produce the same result as bicarbonate of soda in the blood stream. Incidentally, salt is not mentioned ('n p. 171 of the Textbook as an antidote for acid poisoning but is named at the foot of p. 171 as an emetic! !-N. e. F,

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FIRST

Humour in First Aid. M.B. (Cambridge).-Recently a member of our ambulance class asked me how 1 would treat a patient who had split his side while laughing. When I gave it up, he replied :-' , Make patz'ent run until he gets a stitch in his side /" Good! Next, please! !-N.C. F.

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Revised Edition of Textbook. G.H. (Rugby).-In the revised edition of the Textbook whiCh is about to be published 1 should like to suggest the inclusion of too extra diagrams in connection with the circulation of the blood. (A) First, a coloured diagram showing the arteries in red and the veins in blue, with the veins 'running alongside the arteries and the capillaries connecting the two-in short something like the Figure on the Frontispiece but without the bones. (B) Second, a good diagram of the heart showing the 4 chambers and especially the S. V.C. and the I. V.C. entering the right auricle. I think that these would greatly assist a student. (A) With reference to your first diagram, I fear that your suggestion is not practicable because any attempt to show in one diagram, veins and the capillaries, would give so much detail that the position of the arteries would not be clear. (B) The Textbook does not attempt to teach anatomy and physiology but merely seeks to give sufficient information through which the principles of first aid may be understood. In these circumstances, Figs. 57 and S8 provide all the essential details which, in my opinion, would not be enhanced by a diagram such as you suggest.-N.C.F. Other Suggestions for Textbook. G.H. (Rugby).-Two other changes which I should like to see made in the revised edition of the Textbook are :(A) I should like to couple together the parts at bottom of p. 143 of current edition (" Interference with breathing very soon may produce a dangerous state called asphyxia") with the part at top of p. 156 (" a continuous want of fresh air produces a condition known as asphyxia.") (B) I would like to add to "foreign body" as a cause of asphyxia on p. 156 of current edition of Textbook-a statement that the tongue may fall back into the throat and cause lingual asphyxia. Meanwhile please accept my thanks for your helpful notes in FIRST AID and elsewhere. (A) The reason for (and the advantage of) combining these two paragraphs is not obvious. On p. 143 the Textbook is describing the physiology of respiration and on p. 156 it deals with the causes of asphyxia. Hence arises the need for retaining the paragraphs as they now stand. (8) The instructions of the Textbook are based on broad principles and the first aider is expected to master the details of the Textbook as a whole and not to restrict his study to one section or chapter. If this is done, the reference to the tongue in Rule 2 on p. 149 would be remem bered when reading sub section (c) among the causes of asphyxia on p. 156. Incidentally, the possibilities of first aiders being called upon to treat cases of " lingual asphyxia" are very remote! ! - N.C.F. Different 'riming in Rocking Method. A. M. (Shirley).-(A) During our last Divisional Practice a question was raised regarding the different timing in the Rocking Method of artificial respiration as laid down in the Supplement to the Textbook. Having explained the two seconds pressure for expiration, and the three seconds relaxation of pressure

AID

to allow for inspiration as laid down in the Black Book for Schafer and Silvester Methods (the three seconds including approximately one second as Nature's pause between the two movements) it is difficult for laymen like myself to know how to explain the sudden chanO'e to four sec~nds press.ure, by gravity pull on contents of ~bdomen agatOst the diaphragm, and two seconds relaxation with !eet down as laid down in the Supplement for the RocktOg Method. Also the change from twelve complete double movements per minute in Schafer's to ten complete double movements per minute in Rocking Method. (B) In para. 2 on p. 32 of the Supplement to the Textbook, it says" Without breaking the continuity or rhythm of Schafer's Method," and then in para. 4, it breaks t?at rhythm alt.ogether. We were taught Eve's Method.tO ~.R.P. dunng the War, and practised until we got It fairly perfect, right through from Schafer's to stretcher, and continued at two seconds head down three seconds feet down, without breaking rhythm at all: Can you explain for us please? Thank you, Sir, in anticipation for your answer, and also for the many helpful answers that we get in FIRST AID. (A) It is immaterial whether or no the full movements are performed precisely at twelve or less times per minute ' but it. is essential that the movements should be performed effectIvely. In practice it is realised that in the case of the Rocking Method, time must be allowed for the abdominal contents to move and so to exert pressure on the diaphragm, whereas in Schafer's method this movement is produced by downward pressure in the lumbar region. (B) The instructions given in par. 2 on p. 32 of the Supplement to Textbook relate to the period prior to the starting of the Rocking method and remind us that the method used must .not c~ase during the time spent in loading patient and secunng him to the stretcher. The reason for the change in the rhythm is given in the answer to your other query.N.C.F.

Sundry Queries. S. R. (Everton). -(A) Could you tell me if there is any manual that one could study to assist in the diagnosis of conditions not mentioned in the Black Book, e. g. :-Collapse owing to 1, cardiac weakness, 2, a abnormal loss of blood (as peculiar to woman), delay in treatment of diabetic patients and many other conditions. Apart from the treatment for insensibility a first aider cannot help but feel helpless when having to attend such a case, and although they are all cases for a doctor it is a first aiders duty to preserve life until expert medical attention is available. (B) Do Home Guard Services count along with other First Aid Service when entering for the medallion and other service a wards? (C) Is it too late to apply for the Defence Medal ? (D) I joined the Cadets at 12 years; took my firs t Senior Certificate in 1939; did 3 years with the Civil Defence F.A. P. and 3 years as first aid instructor with the Home Guards, passing six examinations with them , all in accordance with the Black Book and given by S.].A.B. doctors, and leaving as a Sergeant Instructor first aid. I return to my Division and find that I have to begin afresh after 14 years. I have already taken my re-examination for this year and am entering an N. C. O. 's course; but it grieves me to think that my medallion is still two years off, when others who joined after me and even during the War have service stripes up and have medallions. I am sorry that I have taken up so much time and hope you will be able to answer my queries and put my mind at rest, as you have done many others.

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(A) The conditions to which you refer are all cases of illness and ou tside the scope of first aid. I n an emergency therefore, all that you can do is to keep patient quiet and comfortable until you can get medical aid. (B) No. (C) You should apply to the C/O of your Home Guard U nit for information regarding the issue of the Defence Medal. (D) Whilst I sympathise with you, I fear that you must conform to regulations and pass the requisite St. J ohu examination before you can obtain your medallion.-N. C. F.

Cadet Regulations. S. H. (Oldham).- Would you please give me a right definition of B.O. 714, June 1943, which reads as follows : "Cadets Superintendents and Officers who have taken their promotion examination and obtained their warrants are permitted to instruct their Cadet Division without having to obtain the Lay Instl uctor Certificate." The reason I am asking this is to find out if I am allowed to instruct a new class of Probationary Cadets. Also having been admitted to the Roll of Assistant Nurses, I think that I am in a position to instruct Cadets. Whilst we sympathise with you in yo ur desire to assist, we fear that you will not be permitted to give a course of lectures to Cadets unless (and until) you have qualified as laid down in B. O. 714.-EoITOR. Medallions and Labels. F. R. (Weston-super-Mare).-Can you please tell me and other St. John personnel why Military Hospital Reservists, who in 1939, were due to take their examination for the medallion, but unfortunately owing to war breaking out, were ordered to report for duty with R.A. M.C., we, on rejoining our Brigade units, are told that OUI re-examination this year is for our medallion? This means that we have nothin!; to show in respect of labels. Yet others who were not called up will, in due course, get their medallion for 1939 and labels for service in the Brigade during the war. I think that St. John M. H. R. personnel should get labels to the medallions, as we all had lectures and examinations on first aid and nursing during our service with R. A. M. C. The label is issued as evidence that its holder has passed a re-examination subsequent to being awarded the medallion. Much as we sympathise with you, therefore, it seems obvious to us that it is not possible to issue a label which may be attached to a medallion if the latter has not been issued.EDITOR'.

War Service and Medallion. R. B. (Weston-super ·Mare).-A query has arisen in our Division of the Brigade, re the return of ex-servicemen who were members before )oining H.M.F. I understand that our war service years were counted towards the Service Medal and that we were considered efficient throughout those years. How do we stand with regard to medallion and bars? Our Divisional Secretary informs us that we carry on from where we left off prior to joining up. Many of us have been in the Medical Branches of H. M. F. and we consider that it is unfair that we should have to lose those years of training and start back where we were in 1939 or 1940, more or less as new members. Your opinion and comments are eagerly awaited on this point. The teaching in the Medical Branches of H. M. Forces (where you have full equipment) differs from that of S.J.A.A.. which concentrates on thett-eatment of patients in emergencies for which little or no equipment is available. The Associa-

AID

tot

tion, therefore, requires members to prove their knowledge of the Textbook before the issue of the medallion. On the other hand, the Service Medal of the Order is granted to members of the Brigade on the grounds of efficiency and the Order has ruled that members of the Brigade on a~tive se~vice shall be allowed their efficiency for the years dunng whIch they were in H. M. Forces.-EDITOR.

Nursing Star. C.D. (Fulham).-I have been a member of the Brigade since 1934 and have now sat for my Home Nursing Certifica:e. I have, however, served with the R.A. M. C. from September 1939 until December 1945. As Nursing Orderly Class 1, I am now employed at a London Hospital as assistant male nurse, having registered with the General Nursing Council as such. I have been informed that this qualification does not entitle me to wear the Nursing Star on my uniform. Surely a member of the Brigade who has had actual hospital training is entitled to be recognised as such. The Nursing Star on Brigade uniform is an indication that its holder has passed an examination in home nursing under the auspices of the St. John Ambulance Association. It cannot, therefore, be used to indicate any other form of qualification in nursin g .-EoITOR . Treatment of Wounds. H . S. (Wembley).- With reference to the Query which was published under the above heading in November FIRST AID, it occurs to me that the following explanation, given to me some years ago by a B. R. C. S. Med~cal Officer, might be useful in further amplification of your reply to " loose blood clot" in the mouth ;" A wound-cavity in the mouth, such as that produced by a tooth extraction, sometimes fills up with a jelly-like substance containing saliva and blood. This is not true clot, and hinders rather lhan aids arrest of haemorrhage. It should, therefore, be removed before applying the small wad of wool or gauze. There is, of course, nothing in B. R. C. S. textbook indicating that true fibrin-containing clot should be removed from a wound." Best thanks for your letter which readers of FIRST AID will find most interesting.-N . C. F. Bleeding from Nose. A. K. (Cheadle Hulme).-In his illuminating article "Side Lights on First Aid," in the September 1946 issue of FIRST AID, Sir Henry L l\1artyn, F. R.C.S., suggests " his head leaning slightly forward" as part of the treatment for haemorrhage from the nose. As you state in your reply to M.S. (Swansea) in the November 1946 issue of FIRST AID, this is not in accordance with the St. John Textbook on p. 138, where it states "the head should be thrown slightly back." Will you kindly elucidate? Thank you for your helpful replies to queries month by month. It is a matter of opinion as to whether the head should be slightly forward or backward. My advice; however, is that first aiders should abide by the instructions in the Textbook.-N.C.F. NOTE.-Owing to the large number of queries received, and our limited space, a number have unavoidably been held over. These will be published in due course.-EDlToR.

FIRST AID" QUERIES and ANSWERS COUPON H

7 0 be cut out and enclosed wtth all Quer£es.

Jan., 1947-

FIRST

102

FIRST

AID

18th fdit/on. Fully Revised 232nd Thousand. 313 lIIus. Some coloured.

Answers to First Aid Quiz. (1) Asphyxia, fractured dislocation of the spine, strangu-

laton. (2) If the flow of blood is obstructed, the bleeding becomes more severe a nd the risk of co mpression of the brain is increased. The less severe the bleeding, the greater is the risk of sepsis. (3) Hip-tone, femur, patella, tibia, fi bula, tarsus, metatarsus, phalanges.

('-f) At first affected part ting-Ies, a ches and feels cold; it becomes red in colour, with a bluish hue; later becomes numb, insensitive to pain and dead white in appearance. (5) Restore heat and blood gradually. Bathe affected part with weak antiseptic lotion. Avoid rubbing. Protect with several layers of cotton wool. Treat for shock. (6) Similar to a figure- of-eight, but that one loop is Used for hip, shoulder very much smaller than the other. and thumb. BOOKS OF REFERKNcE.- '1 Aids to First Aid." N. Corbet Fletcher. "Why and Wherefore in First Aid." N. Corbet Fletcher. " Handbook of First Aid and Bandaging." Belilos, Mulvany and Armstrong.

w. H. BAILEY & BAILEY'S

t Min. Mag. each 2/6

GUARANTEED CLINICAL Complete ID Cue.

SON, Ltd. THERMOMETERS.

III!!!IIII~ t

' ~ "Diska" Min. each 2/6

Bailey'S" Premier" Splint Set,

comprising 3 Finger, 16 Fore Arm, 16 Upper Arm, I Set (3 sizes) Angular Arm Splints, 6 Assorted Leg and Thigh ranging from 24"-54", (44 Splints in all) • - - PRICE 21/-.

A HINT TO HELP

SI(IN

:TROUBLE HEAL QUICKLV.

WARWICK

Stiff Soords. net. TO THE INJURED & SICK. Posto,e 4d. An Advanced Ambulance Handbook. fdlted by NORMAN HAMMER, M.R.C,S"Major,lateR.A.M.C.,T.A. FIRST AID JOURNAL.-" One of the most concise works on the subject published at a popular pr ice.

FIRST AID" WALL DIAGRAMS H

46, OXFORD STREET, LONDON" W.1. ' Gram., "Bayle.f. LondoD. " 'Phone: Gerrard 3185 "2313 .

Classified Advertisements. Advertisements with remittance should be s en t to First Aid. 46. Cannon Street, London. E.CA. Rate 3d. per word . minimum 45. 6d. Trade advts. 4d. per word minimum 6s. Box numbers Is. extra.

250 :,ick~ts 7/6. Posters, Hats, Memos, Rubber Stamps. A TICES, 11, Oaklands Grove, London, W.12. F IRST AID Competition and Practice Tests. Three different . seri~s each of 6 Team, 6 Individual, 6 Oral. Excellent t~stlO:oOlals. State w hich series required. Price 2/- eacq senes, postage 1d. From: Robinson, CM / Superb London, W. C.t. ' HO W to Stop Smoking. Save Money. Safeg-uard health. Thousands cured. Send stamp for Booklet of 'W orld Famous Remedy. Stanley Institute Ltd., (Dept. 75) 265, Strand, London.

-.~.

RED

STAND

MODEL

s::r ~ ;<

(Size 2 ft. 2 ins. by 3 ft. 4 ins.) Complete Set of 19 sheets on tough cartridge paper with Roller , 63/- net. postage IOd . ; or Mounted on linen, 90/- net, postage 1/1 d.

1"\

-:;-:..--~

_ .-'..... ...!.

LECTURERS & A.R.P . CLASSES.

comprising Anatomy. Physiology, Haemorrhage. Dislocat ions and Fractures. Mounted on linen with roller 27/6 net ; postage 7d .

JOHN

WRIGHT

SONS

LTD.

Gaunt House, 28 Orchard Street, Bristol, I

--_.- ----------------_---!

GLODI E -FIRST-AID

PROTECTIVE

ANTISEPTIC

It is the penetrating power of Germolene which enables it to sink right in through the top skin into the true, living skin below-and so to reach the tortured nerve endings-which brings such wonderful relief.

II-EMORRHAGE ........". _-,-...... _-_ .... .._ .........

INFRA

Special Set of 6 Sheets for the use of

What a gratifying experience it is to find I that the skin no longer irritates, and has become clear and heal thy again, Germolene has helped many a skin sufferer to get rid of his, or her, complaint ... and it is interesting to know why this should be so.

PENETRATING

..-.-

10 3

The PIRA

336fJo,ea.

, , FIR S T A I D" 3/6

( Post and Packing 2/-.)

Tunstall Bandage Winder each 6/6 Spllnter Forceps, paIr 3/6 St. John's Pattern Tourniquet 1/9 each Solid Steel Scalpels 4/6 each N.P. Scissors from 7/6 paIr Artery Forceps, N.P. 6/- pair Fitted Pouches and Haversacks always in stock. Let us quote for your First Aid reqUirements.

& TUNSTALL'S

AID

Use Germolene for ECZEMA, PIMPLES, IRRITATING RASHES, CUTS, SPOTS, BURNS, SCALDS, ABRASIONS, Etc.

BE WITHOUT

Iglodine can be applied to an open wound without pain. This safe, but powerful antiseptic cleanses and heals cuts, wounds, bruises, scalds and burns.

The PAINLESS Antiseptic Used by Factories, Hospitals, and Ambulance Authorities. PROFESSIONAL SAMPLE SENT ON REQUEST

From Boots' and a/l other Chemists-

1/-. 2/-. The Iglodlne Co. Ltd., Newcastle upon Tyne •.

BE TALLER!

Increased my own height to 6 ft. 31 in . CEYLON CLIENT, aged 20 gains EIGHT inches. OTHER PUPILS REPORT GAINS IN AGE GAINS IN 3 ~ ins 16 d.ys! 34 3 ins. 6 months! 5 ins. 6 weeks! 40 I ~ Ins. 6 weeks ! 5 in s. 5 m'ths ! I 16k passed 6 ft . mark! 11 ins . 4 weeks! 18k passed 6 ft. 2 in mark ! AI>I'I.IJ\NCES- NO TAB' ETS-NII DIElING ROSS SYSTEM GETS RESULTS Fee 50s . Complete . Denils 6d. stamp

Especially designed to meet demands for Infra Red apparatus for the surgery, the Fira Infra Red Stand Model has proved to be one of the most popular in the Perihel range of Sunray appliances. The Chrome Nickel element has a loading of about 600w at ts and is mounted in a reflector which is qu ickly and easily adiusted to any position required. The Telescopic stand makes it possible to use the lamp for patients standing. sitting or lying on a couch. The in ner surface of the reflector is chromium plated or, in the case of aluminium reflectors , IS treated by modern high pol ish electrolytic hardening processes to ensure high reflection and resistance against tarnishing The apparatus is light and easily mlnoeuvrable. Consumption of current is 05-0'7 kilowatts (3 amps) which corresponds to a bout .\ d . for treatment c.f 20 minutes if the rate for electricity is 3d . per unit.

Specification. The Pira Infra Red'Stand model with telescop ic stand on tripod and castors incorporating 600 watt Infra Red element complete with flex and switch. Price £12. 12. Net weight 24 Ibs Height 5 ft 6 In ' Guaranteed for 12 months. Write for leaf/ets of the ful/ range of Perihel appliances to Dept. F.A.

PERIHEL LTO., Specialists in Sunray Equipment 17-19, Edge Street London , W .8.

MALCOLM ROSS, BCHME~Gy~~. ~~~~!!,W.~:I 1

~:a~Stt t~~I~oN:~~..o~ .~.~ i.t.eo~ ~I~in p apel'. !

l ~~~il~rs·. se~d ~: Address ' " . .. . . .... . .. ::' ::

1::!

1 close 6d sump.. ...... . ... ...... . ........... . 1 It!fi" Malcolm I{OSS, BCM/ Hl'TE, London,

w.e I .

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OINTMENT

Rtg'd Trade Mark

FIRST

104

ADAM, ROUILL Y & CO., Human Osteology, Anatomy, etc., 18 FITZROY STREET, FITZROY SQUARE, LONDON, W.I TELEPHONE:

MUSEUM 2703.

THE HOUSE FOR

HUMAN SKELETONS . \ ~rticulated & Disarticulated)

HAlF.SKELETONS, ETC., ETC.

FIRST

AID

S.J.A.B. POSTERS

AID

STOCK

Si ze- 30 in. x 20 in.

Printing Space- 16 in. x 14 in.

Suitable for Concerts, Meetings, Socials, or any other function. A local printer can fill in the blank space with any required matter.

Of!

lie sin

YOUR han d s

If you do not see what you want amongst the advertisements in

"FIRST AID"

Intelligent men and women who are prepared to study an hour or two each day can become expert practitioners in Swed ish Massage. If First Aid is a subject in which you are interested, then, you will readily understand the value of SWEDISH MASSAGE and how it can assist in healing the sufferer.

write and let l1S know your requirements and we will have full particulars sent to you. You can save postage by using this service if several items are wanted.

Some Causes of Baldness -and Facts about Successful Treatment Baldness often arises from causes that leave the natural capacity to grow hair little if at all affected. Dand ruff, or scurf, often chokes the hair sheaths, dwarfing the growing hair and causing premature hair loss. Or, while the hair itself rem a ins strong and healthy, the h air sheath

tal

A. Healthy Hair may b e She at h tightly weak and

This offer does not apply to Ei reo

~:~t!itn~e;i~:::

: ..... FILL IN & POST THIS FORM .......

rei a xed.

Robbed of sup port, the hair soon falls (See Diagrams A and B) .

B. Weak and relaxed Hair Sheath. ~~:f-:~~~ hair to

out.

The removal of these indirect causes of baldness by scientific treatment should bring about renewed luxuriant growth.

Nearly 30 years of teaching experience has enabled the S.M.A.E. (Swedish ~ Massage and Electrical) Institute to secure for its Gr?-duates in all parts of the world an assured future in a profession of fascinating and absorbing interest.

These and other facts about the hair are revealed in "How to End Hair and Scalp Troubles," by Mr. Arthur J. Pye, the Consulting Hair Specialist of Blackpool. A copy of this book and other literature, and particulars of the treatments supplied for the different types of hair trouble, may be obtained by any reader who fills in and forwards the form below (or a copy) to Mr. Arthur J. Pye, 5, Queen Street, Blackpool, F. 87, enclosing 3d . in stamps to comply with Government regu lations.

entitlec " Manipulative Therapy as a Profession" tells you how many of the World's leading Masseurs and Practition~rs of Manipulative Therapyhave been trained bytheS.M.A.E.lnstltute.

Write for FREE copy of booklet to:-

To A. J. PYE, 5, Queen St. Blackpool. F.87. Please send book and other litera. ture, .and particulars of treatments supplied. I enclose 3d . in stamps ~~ti~~r;pIY with Government Regu·

NAME . . ..... . ... . . . . . . (B lock Letters) ADDRESS . (BlockL~i[~r~)"" .. . . . . .. ... • .

.. Fir;t' Aid. ' .. .. ...... ... 26'. i :47"

PRICE., post free: 5s. 6d. per dozen. Remittances

MUST

accorn pany all orders.

DALE, REYNOLDS & CO., LTD., 46, Cannon Street, London, E.C.4. _

. _ "PI!"

I!!

FIRST

AID

A POST·WAR fJONVERSION £s.r:-..:'·...,U CIt

•

the NEW APPROVED HOME SERVICE AMBULANCE converted from the AUSTIN W.D .

HIS

PI .LCH ERS

AMBULANC E.

ANTIPEOL ;~~~E~~; OINTMENT contilin s sterile vaccine filtrates (antivirus) of all the common strains of STAP HYLO COCCI , STREPTOCO CCI and B. PYOCYANEUS in a lanoline,zlnc-IChthyol;ase. SPECIR C AGAIN ST the micro.organisms causi ng abscesses, boi ls, eczema, d ermatitis, erysipelas, ha:morrhoids. impetigo, ulcers and alii nflammatory cutaneo us a ectlons.

We solicit enquir ies from all who need a conversion of this or any other description . Our service is backed by 35 years experience in all types of ambulance construction and we can unde rtake delivery in all parts of the world.

PILCHERS • AMBULANCE BUILDERS 3 14, Kingston Road, Wimbledon, S.W.20 & 47, High Path, London , S.W.19

T elep hon e; LIBERTY

2350 & 7058 Telephon e: LIBERTY

3507

ANTI PEO L LIQUI D for infections of the ear, septic cavities and suppurating wounds .

OPHTHALMO-ANTIPEOL coma.tns in a

semi.fluid

GONOCOCC I. rNDICATI O NS:

base,

the

sterile

vaccine

filtrates of

STAPHYLOCOCCI,

STREPTOCOCCI,

B.PYOCY ANEUS. PNEUMOCOCCI

FRAEN KEL and

Conjunctivitis, blephar itis, keratitis, dacriocystitis and all inflammatory conditions and letions of the eye.

RHINO-ANTIPEOl

. . ., . . . f PN EUMOCOCCI P NEUMO-BACILLI, ENTEROCOCCI, M.CATARRHALIS A nasal immunising cream, contains A ntlpeol LiqUid as well as the antiVirus and autolyslns 0 ' B.PFE IFF ER and calmative and decongestive ingredients. tNDtC ATIONS! Coryza, rhinitis , hay fever , catarrh, influenza, colds and other nasopharyn geal Infections .

ENTEROFAGOS

. . f . • f h .' I k k d neys and bladder RAP IDLY EFfECTIVE polJvalent bacteriophages specific ag~i~st 1. 5~ stra ins of m.i 7ro ·o~ganISmS h~-:ndm"J~ t:l In cCt~O~~ :'r~ bas~r~;~net:~~';e~t~~:~a~d 'para.i~testinal infe·ccions. Oral ad""i~lstra RESULTS in enteritis, dysentery, colitiS , d,arrhoels, B.o lI ·n reCtl01S, typ 31 an p:lra-typ .:11 ev. ,an tion. No reaction. No shock.

DETENSYL

.... egeno.polyhormonic hypotensor ensures gentle and regular reduction of arterial tension. - _ rNDtCATIONS: High blood pressure, arthritis, arteriosclerosis, palpitation, o cu lar and J.ud,tory troubles of hyper-tension.

N o"'.:on cra-i ndicatlons_

CLINICAL SAMPLES AND LITERATURE FROM Printed and Published by D ALE, R.JrrNOLDS & Co : , L TD., 4, 6 Cannon-street, L ond on, E.C.4, to whom all communlcatlons . . should be address ed

T elegrams-

T wenty-lour, London."

Telephone-City 17 IO

T o be had of all :Newsagcnts, Booksd lers and Bookstalls in the United Kingdom and at all Railway Book~talls of Messrs W .H. Smith & Sons.

LABORATORI ES, LTO., Carg reen Ro a d,

~~~:;,r-~----

FIRST

AID

Every Nurse and First Aider should have Bai II iere' s MALE and FEMALE ATLASES

}je prepared for an emergency and keep Cuticura Brand Ointment in your First Aid Kit. It brings in· stant soot hing relief to cuts, bu!n", SKID lacerations - prevents spread of infection. quickly heals. Obtain· able at all Chemists and Stores.

Printed in colours, these atlases are clear and easy to follow. The Female Atlas has lift· up-parts which plainly show the various organs and structures and their relative positions and sizes. The text gives a concise and accurate outline of the anatomy and physiology of the human body and each Atlas is complete in itself.

Price 5s. 6d. each. Postage 6d. or 11/7d. the two, post free.

Bailliere's NURSES' MEDICAL

BE TALLER! 3i

Increased my own height to 6 ft. in. CEYLON CLIENT, aged 20 gains EIGHT inches. OTHER PUPILS REPORT AGE GAINS IN AGE GAINS IN 20 3&- ins . 16 days! 34 3 ins. 6 months! 19k 5 ins. 6 weeks! 40 U ins. 6 weeks! 21 5 ins. 5m'ths! 16} passed6ft,markl 27} I J ins. 4 weeks 1 18 ~ passed 6 ft. 2 in. mark! NO APPLIANCES-NO TABLETS-NO DIETING ROSS SYSTEM GETS RESULTS Fee 50s. Complete. Details 6d. stamp

DICTIONARY

COUGHS & SNEEZES ~~~~tJ;""-,/ few drops

MALCOLM ROSS, BCH~~Gy~~, ~~~~!~'~~:I

PENETROL

i I2if' Post this Coupon or write on plain paper. i Without obli- Name .. . ... . ... . . .. . . . . . .. .. . 1 ~~~i~ls'. se~d

:0: Address...... ..... .. ...... .. .

1 close 6d . stamp .. . .... . ........... .. ... .. .... .

L.~~~.~~~!.~__~~.~_~?_~~.~L~~.!.~~.. ~.?~~.?~~~..~:.~...~...!

MANUALS OF FIRST AID By N. CORBET FLETCHER, O.B.E., M.B., B.C., M.A.(Cantab'), M.R.C.S. AIDS ~",venth

FIRST-AID.

Edition. 1•• 3d. post 2d.

F.lr.t-Ald Simpl.lfled and Tabulated, with Ald. to Memory, CD/. Szr lames Cantlu contnbutes an zntroduction and we Indorse his g-ood opinion 01 tlu book."-LANCET,

AIDa

HOME-NURSING. -

Third Edition. Price 1•• 2d., po~t tree. Horne-Nanln. Simplified and Tabulated, with Ald. to Memory. This hook wD1Sder{ully sit1/.j~~jiu a complex sub.ect and should he read 01' stUde1StS. -L. & N.W. Rv. GAZBTTB.

I!FFICIENCY

~~" ~~~o~

COMMON

ERRORS IN

Third Edition.

FIRST.AID.

AMBULANCE

COMPETITION

TESTS.

Stretcher, Individ~al and .Quest~on-Six Folde~s). Price 6 for 3•• post 3d .. Ea~~ Folder co~talns special article on C?mpetitlOn~: - No. I, Training of Com. petltlon. Teams , ~~. 2, Conduct of Team In Competl ' lOn Ronm ; NO.3 Common Errors ID CompetitIOn ; ~o. t, Further Errors in Treatment; No. s. History of Competition rests; No.6, Preparation of Tests.

AND

WHEREFORE

FIRST-AID.

Fifth Edition . 1•• 3d. post 2d. "Dlftlcultle. 10 S~ady . ,1 d Treatment .olved by Que.tloe and Anlwer. We crnnmeHd thu book to Lecturers and Students who will ji1Sd it 01 rut serviCI."-FIRST AID, &

FOR

HOSPITAL ORDERLI1!8.

Send your name and address and postal order and please be sure to quote Sales Dept. F.A. 2.

ADAM, ROUILLY & CO. J Human Osteology, Anatomy, Etc., 18. FITZROY STREET. FITZROY SQUARE, LONDON, W.I Telephone: MUSEUM 2703.

FOR DIVISIONS OF THE

NEW!

HOBSON & SONS (LONDON) LTD.

" HEALTH RAY SUNLAMP" ULTRA-VIOLET or INFRA-RED

UNIFORM CLOTHING & EQUIPMENT

£6 COMPLETE .

READY

FULLY

MANUFACTURERS.

P01tace ld. Orderly Dutee. Simplified an~ Tabulated, with Aid, 10 Memory. & m()st compact brochur, . ,contazns much IUI./ul in./onnatioll."- PRRSCRlBBR.

·Phone I

'Gram.,

To be obtained from DALE. REYNOLDS & CO., LTD.

Hop 2476 (" linea)

.. Hoblon. BOfOh, LondoD."

AID

FRACTURE

and

DISLOCATION

CHARTS,

COLOURED. FIRST AID FRACTURE CHART

USE.

Size 28· x 40·

GUARANTEED.

Price 17/6d,

BUY DI~ECT F~OM THE MAKERS. NEVER

LONDON BRIDGE, S.E.I.

FIRST

ULTRA VIOLET RAYS t an the skin, form vitamins in the tissues , create new blood cells, and so fortify the whole body . Persons deprived of these rays get sallow and anaemic. INFRA-RED RAYS relieve Rheumatism, Sciatica, Neurit is, Skin Troubles, etc. Made for Home Use. As safe and easy to use as electric light. A. C. or D .C ., 200(2 50 volts. PRICE

154- 164, TOOLEY STREET,

JUST ISSUED

MADE UNDER THE SUPERVISION OF PROFESSOR C. F. V. SMOUT, BIRMINGHAM UNIVERSITY.

can be OBTAINED from

PrIce ed.

46, Cannon Street, London, E.C.4f.

HOME TRIAL!

FREE

Sf. John Ambulance Brigade

1•• 3d. post 2d.

Error. In Flnt·Ald Detailed and Explained. TAis book gives a clearer insig-ht into the. methods and dit/iculties 01 emergency treatment by laymen than flu ot/iczal Textbook itseif."-LANCBT.

Postage 3d.

BAILLIERE, TINDALL & COX, DALE, REYNOLDS & Co, Ltd., I 7 & 8, Henrietta St., London, 46, Canno~.C~;." London, \ W,C.2.

Price 1 •• 3d. post 2kd.

Fourth Edition.

" Wrthout doubt the book wlll be Of g'reat service in t/u trai1Sing- 0./ those ./or whom it is designed.' -BRITISH MBDICAL JOURNAL. :'

HINTS

on your handkerchief

Price 4/-

;!; i~~' t~~~Tsa:s Inhale freely and prevent infection

FIRST-AID.

Pr~emlln Study, Tr..tm~nt.nd Examination lolved lor Sanlor Student ••

WHY

This pocket dictionary is an invaluable help to the First Aider. It contains 462 pages of essential information, giving explanation and pronunciation of thousands of words in common use and a compendium of 21 sections of valuable information. Over 500 illustrations.

SOLD

SHOPS

IN-BETWEEN

PROFITS

.--------------------------,I Health Ray Co., Dept. F/A, Southampton

I I

POST

I COUPON

I TO-DAY

FIRST AID DISLOCATION CHART

Size 20· xiS·

Price 7/6d.

Please send details of your Health Ray Sun Lamp

P-ostage 1/- extra.

NAME .. . .......... .. .. . . ...... .... . ...

ADDRESS·... .. .. ......... .. ...... ...... ..

Two charts, coloured, on cloth, with rollers,

L________ ~_...:~~_.:..:..;.:.~~· :.,:.:;.;...;..:....:;..·;.;.·___ ._J

FIRST

106

AID

FIRST A.ID B

PATENT

"PORTLAND" AMBULANCE

CEAR

NOTICE

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

Shows the two stretchers in position .

Shows the top stretcher lowered ready for loading.

FEBRUARY, 1947.

No. 63 2. -VOL. LIII.

The Gear Illustrated (A.B.C.D.) carries two stretchers on one side of Ambulance, leaving other side clear (or sitting patients.

TO READERS.

FIRST AID is published on the ~oth of each month. Annual Subscription is 55. post free; single copies 4d.

The

Its aim and object being the advancement of Ambulance Work

In all its branches, the Editor invites Readers to send Articles and

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

Reports on subjects pertaining to the Movement and also welcomes suggestions for Practical Papers. All Reports, &c., should be addressed to the Editor at the address below, and should reach him before the 8th of each month, and must be accompanied (not necessarily for Dublication) by the name and address of the Correspondent.

D. Shows the same position as in .• C ·' only with cushions and back rest fi tted for con valescent cases.

Where Ambulances are required to carry (our beds two Gears are fitted, one on EITHER SIDE, and the same advantages apply as described above.

Subscriptions, Advertisements and other business Communications connected with FIRST AID should be forwarded to the Publishers. DALE, REYNOLDS & Co. , LTD., 46, CANNON STREET, LONDON, E.C.4.

Full catalogue of Ambulance Equ/Oment No.7 A will be sent on reauest.

~----------------

Teletr aphic Address-I( Twenty-jour, London." Telephone-City 37 IO •

GREAT PORTLAND ST., LONDON, W.1

Telegraphic Address:-

•Pirone:

Langham 1049.

KARVALID. W£SDO. LONDON

S~l't0nal

Editorial. Sir Henry Martyn.

ANTISEPTIC f, OINTMENT For Works, Factories and Ambulance Outfits.

Septonal cleanses and heals wounds with amazing rapidity . Prevents and arrest5 inflammation . A safeguard against blood-poisoning. Poss~sses extraordinary styptic properties . In liqU id form Septonal is supplied in 16 oz . bottles at 3/-, quart 6/-, ~ gallon 9/6 and 1 gallon bottles at 17/ - per bottle , and in concentrClted form in 2 oz. bottles , for making up 1 gallon , at 14/- per bottle. Septonal Antiseptic Ointment !h.is . ointment is most useful. for boils, minor InJurres and skin troubles . Available in i lb . jars at 2/3, ~ lb. 4/- and 1 lb . 7/6 per jar. Make sure you include Septonal in your ambulance outfits. We hold stocks of Surgical Bandages Dressings, Lint, Cotton Wool and all First-Aid requisites.

. . and equally are the facts that a Pre-heated engine means instant and effiCient lubrication -thereby saving cylinder bore and piston wear -an aI/-round saving of time and money-and what's more-your battery charges and stays ',up,' for instant, easy staiting ! " N o ENGINE Comp let e Wit h 0 U t Pre - h eat.

Be on the "safe " side- Septonal will meet every First-Aid need.

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N o o ne was more quali fied to w rite on first aid than S ir H en ry Marty n , K .C. v. a., F.R.C.S. , whose su d de n dea th o n Ja n ua ry 7th we brie fl y noted in the las t iss ue . H e h a d a brilliant ca reer culminat ing in his app o ir.tm e nt as surgeon apothecary to H. M . Household a t Windsor, and creation as K . C. v. a. for his servi ces to Ktng Georg e V . Born in 1888 in London, he qu a lified M.R . C.S. , L. R . C. P. : a t London U ni vers ity and later took the deg ree of M .B., B. S . , w ith honours in 'medicin e, surge ry , and fore nsic medicin e, winnin g the unive rsity g old m ed a l. T wo y ears late r h e was elected F . R. C. S . , and before the 1914-1 8 war held posts a t Kin g's Co ll ege H os pita l, a nd Kin g Ed ward VB H os pita l, Windso r. Th e first w orld war saw him in the R.A. ·M .C. with the rank of Captain, his jo b surg ica l speci a list to the B.E.F., and after the wa r he settled in practi ce in \ V indsor, and became su rg eon, la ter con s ultin g surg eon, to the ear, nose, an d throat de partm e nt of the Kin g E dward VII Hospital. He was al so consultin g aural surg eon to the Maidenhea d Hos pital, the Stain es, Chalfont, \V indlesham, and I ver cottag e hospitals, the Staines Joint Fever Hos pital, a nd Cippe nham Fever H ospital. His appointment to H. M . Household

E,.t,,,,d Ha at] [S tatio,.,,,s' ll

PRICB FOURPENCE lSI· PER ~NNUM, .t'O:'T FREB

in W indsor ca me il) 1936, and he was in attendance when Kin g G eorge V suffered from bronchitis in 19 31, a nd he was also one of the doctors who signed th e official bull etins during the late King's serious illness in 1929. \Vith this considerable experience and wealth o f knowledge it was no wonder that the articles which he contributed to this Journal should ha ve a rou sed s o much interest and appreciation. His s e ri es enti tled" Side Lights on First Aid" will lon g be remembered as outstanding contributions to th e literature of the subject, and the many letters we received from readers testified to their value. It was in respo nse to this wide enthusiasm that another se ries was p rojected, and at the time of his death Sir H e nry was compiling it. His interest in first aid was p ut to practical use in the last war when he org ani sed a Fi rst Aid Post at Dittisham, where he resided af ter h is retirement from active practice. He was a lso Area Casualty Staff Officer for' 'G" Divis io n , Ci vil Defence, and ledical Officer to the local Hom e G ua rd. A correspondent in the local newspaper the re describes how Sir Henry never spared himself g ivin g lectu res and training the village men and women in fi rst aid, and was always ready to help an y one w ho was in need of medical attention before a doctor CO LI ld get out to the vi JJa~ e. "I have k now n hi m to turn out in the middle of the ni g ht " (w rites this cor respondent) ,. and to do what he could for a ny vil lager, and there is one young lad y who very defin itely owes her life to Si r Henry who got her to hospital and organised a rota of blood donors f rom the village." Such an action was ty pica l of that kind ly and human man, and is an in s piration to all workers in th~ am bulance service.

IN THIS ISSU E. SI R H ENRY :,\1 ARTYN INJU RI E S I N COAL MINES.

By J. W. Scott AMBULA NCE N EWS FROM ALL QUARTERS . .. FIRST AID QUIZ P HYSIO LOGY CHARTS PR ACTICAL NURSING IN THE HOME.

By Ag nes E. Pavey, S . R. N. C ASUALT IES UNION R EVIE \ \.'S

Q UERI ES

AND A NSWERS TO CORRESPONDENTS

107 108 110 112 112 113 11-+ 116 118

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INJURIES IN COAL MINES. By

J. W. SCOTT.

( Continued from page 89) FRACTURES.

Sim pIe fractures are rare. Serious compound fractures are to be expected, and these compound fractures are accompanied by severe shock which demands immediate attention. It is obviously futile to concentrate on the splinting of the fracture while the patient is dying from shock. On the other hand, it is necessary to splint the fracture with the least possi ble delay to avoid increased shock, which is caused by the movement of the bone fragments on each other. No person with a serious fracture should be moved until an effective splint has been applied, unless there is an immediate risk to life, say from fire or drowning, or when the rescue of the person from the debris is an important consideration. It has been found that the first aid splinting of these cases has not been good enough. I wish to impress upon you the importance of really good splinting before the patient is moved in the case of a serious compound fracture. The actual treatment should follow along the lines taught in first aid courses, but special attention must be given to the following points : (1) Ascertain at once if there is serious haemorrhage. Bleedi'ng of any significance will make itself apparent on the ground or on the patient's clothing. (2) If there is bleeding, expose the site by cutting the garment, if possible along a seam, but do not deliberately undress the patient, because, by so doing, shock will be increased . by movement of the broken pieces of bone. (3) Arrest the haemorrhage by direct pressure of an antiseptic dressing, or the cleanest available pad and a firm bandage. The tournig uet is seldom required in the case of lim bs, but will have to be applied if the pressure of the dressing is not effective. . (4) If the limb is much deformed, pull it straIght gently, but do not try to restore it to its. original length.. You will most certainly fad and perhaps serIously harm your patient in attempting to do so. Even when a piece of bone is projecting through the wound, the limb should be straightened by a gentle pull, so that a normal shaped

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splint may be applied. The objection to attempting to straighten a compound fracture when the bone is sticking through the skin is large ly theoretical; the ad vantage obtained by being able to use an ordinary splint overbalances any increased danger of infection. (5) VJhen possible all fractures of the lower limb, from the ankle to the hip, should be placed in a Thomas splint. The use of the Thomas splint during the last war, as a "front line "-that is first aid treatment-of fractures of the lower limbs reduced the mortality from 70 per cent. to just under 30 per cent. in a few months. That is sufficient proof then that the Thomas splint is the only rational method for treating severe fractures of the lower limb, and indeed it should be used also for all serious wounds of the lower limbs, urJless the buttock is involved and the wound prevents the fitting of a ring in the normal way. The use of a long wooden splint or tying the legs together is a very poor substitute for the Thomas splint, so it is to be hoped that sooner or later this splint will be made more generally available and first aid workers trained in its use. SEVERE BURNS AND SCALDS.

The advice which has so far been given to first aid workers for the treatment of severe burns and scalds has been so varied that there is danger that the patient may suffer from misguided efforts to help given with the best of intentions. When it is understood that shock accounts for 80 per cent. of deaths from these injuries, and tlJat pain, loss of body heat, and loss of body fluid are predisposed to that shock, then the pri nci pIes of sound first aid treatment can be set forth in a series of orderly steps :(1) Immediate attention should be given to patient. (2) He should be wrapped in blankets, which are placed both below and over him. If hot-water bottles are obtainable, these ought to be outside the covering the blanket. Large amounts of hot sweet tea must be given; at the worst, water is better than nothing at all. (3) When a doctor is at hand, he should be informed without delay so that morphia can be administered to the patient. (4) Clothing must not be removed to expose burned surfaces. .

(5) Any burns exposed should be covered by a soft dressing-failing a prepared dressing, a clean cloth, a clean sheet or clean towel can be used. (6) Cases of extensive burns must be taken to hospital without delay, and all burns of the face and hands, unless very trivial, should go direct to the hospital rather than via the first aid post. (7) Many surgeons now agree that preparations of tannic acid, strong tea, infusions and substances containing dies like gentian violet, brilliant green, ought not to be used as a first aid treatment of severe burns. All are now agreed that the preparations which I have mentioned must not be applied to burns involving the face, hands or feet. In an emergency, if it is thought that the patient cannot receive prompt surgical attention, vaseline, preferably first sterilised, is probably the safest and most useful preparation. INJURIES

FROM

THE

BLAST

EFFECT

Ex-

PLOSIONS.

In most instances the injuries from these ca uses are fatal immediately. Examination of the body may not reveal any evidence of damage except a small trickle of blood that has flowed fro m the corner of the mouth. Some casualties may be found to show signs of severe concussion of the brain, or of serious brain injury with the ordinary signs of compression. The usual first aid rules are oberved in their treatment, but a few patients may be found insensible and who are no longer breathing. Now, as the lungs have collapsed, ordinary methods of artificial respiration are unlikely to prove of value at first. Mouth to mouth breathing can be tried with some hope of su ccess. The method is first to close the pat ient's nostrils by pinching them together with the fingers, next put your lips to his, if you wish ove r a piece of gauze or thin material, finally breathe hard into his mouth to inflate his lungs, an d breathe lightly back into your m\rn chest after each inflation. Continue in this way until the patient shows some sign of reviving. That sign is usually twitching of one side of the face, which is drawn up in a state of spasm and begins to twitch slightly. Then begin artifitial respiration in the Schafer method. SPECIAL INJURIES.

Head b~.iU1"'ies.-Elaborate first aid treatment is not required, and over-enthusiastic assistants must be restrained. Within the limits of common sense, the le~s interference with the patient the better. Simple procedure such as arranging the patient in the most suitable position, the 100seninO" of tight clothing, warmth and • a careb ful watch for obstruction of the breathIng are

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usually sufficient. I will return to that again when I deal with depressed fractures of the skull. Scalp Wounds.- These bleed furiously for a short ti me, but rarely is the total loss of blood great, and the person's appearance is much more alarming than his general condition. In nearly all cases the haemorrhage can be controlled by the pressure of a firm dressing and a tight bandage. In exceptional cases, a few minutes pressure with the thumbs on the occipital or temple pressure point may be needed, but in a few cases only . . These scalp wounds are rather frightening because of the furious bleeding which occurs at first, but often that haemorrhage stops of itself, and, if not, it can practically always be stopped by a firm bandage. Scalp wounds must not be plugged . .vith dressing because of the danger of an underlying fracture being present. Depressed F1'actures.-A depressed fracture of the curved parts of the skull, accompanied by a large lacerated seal p wound is perhaps the most usual form of serious head injury. Contrary to what might be expected, some of these patients are fully conscious and complain only of a slight headache. Others are found ly ing in a deeply insensible condition, and some may seem very drowsy only and will grunt or even speak a few works if disturbed. There are those three possibilities then. A person with this kind of injury should be placed lying down on his side with his head slightly raised on a folded coat or blanket - this is to avoid the danger of choking from vomiting matter, as vomiting is very 90mmon. Tight clothing round the upper part of the body must be undone and warm clothing applied. If the patient is deeply insensible, it may be necessary to hold the chin forward or to pull out the tongue to prevent obstruction of the breathing, and in any case the mouth ought to be examined for broken artificial teeth or for fragments of food that have been vomited and "not spat out. The dressing for the wounci may be applied over a ring pad to prevent what you might consider undue pressure on the fracture. Ep£lept-ic Fits following a Head Il1/,ury.-In a few cases an epileptic fit may follow soon after a head injury. This is not necessarily a da.ngerous complication and requires routine first aId treatment, and a note should accompany the patient stating whether the convulsions were general all over the body, or whether they affected one side more than the other-this will be of great assistance to the operating surgeon. (To be concluded)

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AMBULANCE NEWS FROM ALL QUARTERS. S.J.A.B. Brigade Headquarters The annual competitions of the St. John Ambulance Brig-ade, last held in 1939, will be held in London on June 13th next. The annual National Inter-Railway First Aid Competition for the trophy and prizes presented by the Order of St. John, and last held in 1939, will take place this year in London on June 20th. H. R . H. The Duchess of Kent (Lady Superintendentin-Chief, W dIes) will be present at the Dedication of the Colour of the Sussex County St. John Ambulance Brigade to be held in Brighton on May 18th. ORDER OF ST. JOI-IN. His :'I1ajes ty The King, the Sovereign Head of the Order of St. John, h<ls approved the wearing of a small silver eightp.:>inted cross on the riband of tbe Order. The cross is not inrended to bi'! worn with the Insignia of tbe Order, but only on those occasions when the riband of the Order is worn without insignia either in uniform or plain clothes. The Viscountess Mountbatten of Burma has consented to become Lady President of Nursing Divisions of the St. John Ambulance Brigade Overseas in Malta cluring the period of her husband's appointment tbere.

No. I (Prince of Wales's) District No. 143 AND 106:-.1 (RUISLlP). These Divisions beld their annual dinner-dance recently, at the Rainb,)w Ballroom, Eastcote. Lieut.-Colonel E . J. Selby, O . B. E. (County Surgeon), was among those present. During tbe evening, Lieut. -Colonel Selby presented the warrant of appointment and bad~e of office to Mr. Saywood, President of the Ambulance Division, who, in returning thanks, said he greatly appreciated the honour and would do his utmost to uphold it. Councillor Gibson , Chairman of the Ruislip-Northwood Council, said he was very pleased that the function had taken plaCe during- his year of officA, as it gave him an opportunity of expressing the thanks of the public for the good work done, more especially when it was remembered that it was done voluntarily and in the spare time of the members. After dinner, dancing took place to the music of \Vhittington White and his band.

No. 135 (HARLEC;DEN). On January 18th, a party from members of the above Amb~lance Division and 50 :-.1 ursing- Divi<;ion, visited Guy's Ho<;plt<ll, a'> arran~ed by Supt. S. Green of the 135 Division

and the As<;istant Medical Superintendent of the hospital. The ~arty s~ent an ~our and a half in the Casualty Dept. coupled WIth an InstructIve lecture given by Mr. Munro one of the House Surgeons, dealing mainly with what happens

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to a patient after treatment of first aid has been given and the patient sent to hospital. The party were then shown a small girl who had sustained a very bad scald from boiling water, and the large blisters which had formed in consequence After this the party were tah:en to the Medical X-Ray Dept. where they were shown the apparatus for the detection of ulcers in the stomach amongst many other complaints. Upon It.aving the hospital, Mr. Munro was warmly thanked by Supt. S. Green for the most enjoyable and instructive lecture and tour. CHEAM. On Saturday, January 18th, the Ambulance and Nursing Divisions in Cheam held their first annual party at Chatsworth Road School. Cadets from Mitcham, Carshalton, Thornton Heath, Epsom and Ewell were also present, making in all a party of over a hundred. During the evening 19 boys and 11 girls were enrolled into the Cheam Divisions, and Cadet John Kenneth Young was presented with a copy of the ., History of the Order of St. John" by Area Cadet Officer Lowe, for being the most efficient member of the Cheam Ambulance Division for 1946. A first aid course is to commence shortly for new recruits to the Cadet Nursing Division, and will be held at Chatsworth Road Girls' Schoool on Mondays at 6.30 p. m. Girls between the ages of 11 and 17 years will be welcomed. No. 175 (TEDDIl'\GTON). At the annual general meeting of the above Di\'i~ion held at the Civic Restaurant, Teddington, on Monday, January 20th, it was stated that lack of suitable accommodation was still a cause of great worry. Sergeant L. J. Taylor (secretary) said the Division strength was 25 members, and public duties performed numbered 70e. The cadets had distinguished themselves by winning the Western area shield at Wimbledon the fir~t time the trophy had been up for competition in the area. The total strength of the Cadet Divisions was 24; total number of drills was 655.

County of Berkshire. READING SOUTHERN DIVISION. This Division gave a dinner and concert to weJc;ome back their members who had returned from serving with H. M. Forces. Some 70 members with .their families met at the People's Pantry. Reading on January 23rd. After the Loyal Toast, proposed by Mr. F. A. C. Jarvis, Assistant County Commissioner in the unavoidable absence of the Commissioner, had been honoured, Div. Supt. Pope in a very happy and well worded speech, extended a hearty welcome to those members who had returned, saying how proud he was to be the Superintendent of such a happy Division. Before resuming his seat, he asked all present to stand in silence in memory of Sergt. Wyatt who died on active service. After dinner an excellent concert wa'> presented.

County of Hertford. WARE. On Tuesday, February 4th, the Division held their annual general meeting when Supt. T. H. Burgess presided.

During 1946 the motor ambulance had travelled over 5,000 miles and conveyed 360 patients. Members who had . returned from the forces were welcomed by A/O F. Woodhouse who' stated that Ware Division was registered in 1902, and that 4 mem bers had over 20 years efficient service to their credit. The total membership was 35. Pte. A. Allen reported on the cadets progress during the year. The medical comforts depot was becoming known to the townspeople who were taking advantage of the comforts as the need arose.

County of Lancashire. MORECAMBE AND HEYSHAM. It is with deep regret that we announce the death of A/Ambulance Officer F. J. Peek, who was evacuated from the Prince of \Vales's District during the war and was a ttached to the Morecambe Ambulance Division. He was a hard working, loyal member, and could be reliecl upon to do any duty assigned to him with efficiency. He did very. valuable work with the 1946 first aid competition, and it was through his untiring efforts, it was a huge success. His position will be very hard to fill. The interment took place froq:! his mother's house in London.

OLDHAlIl. On Saturday, January 25th, the Oldham Corps held a re-union tea party and social for Ambulance and Nursing Cadets. Among the distinguished guests was District Officer Graham Halbert, and one hundred and twenty cadets a nd guests sat down to tea. . The social evening included games and a "Yes-No" Quiz. Mr. Halbert presented a cup and medal to Cadet Murray of Equitable Ambulance Cadets for all-round efficiency, also merit certificates and preliminary first aid certificates to other cadets. The evening closed with entertainment and dancing.

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County of Oxford. WVCHWOOD. Wychwood S.J.A.B., at a ceremony at St. Michae' Home, Shipton, on Saturday, January 25th, received the new ambulance and a cheque for .£180 towards its maintenance. Nearly five years ago Mrs. D'Arcy Hall, of Shipton Court, took an active part in raising funds for the provisi on of an ambulance which was presented to the Government. At the end of the war it was returned to the Wychwood, but as it was regarded as unsuitable for work in a country area it was sold. The first aid party who had served during the war took a hand, and with the help of their old leader, Mr. W. Beck, who is now the Div. Supt., and Dr. Gordon Scott, the Div. Surgeon, the Wychwood Brigade was formed. The Ambulance Committee, with Mr. Eric Meecham at their head, continued their good work and the new ambulance was purchased.

County of Worcester. PRESENTATION. A very interesting event took place at Messrs. T. VV. Lench's canteen, Blackheath, recently. The Corps and Divisional Officers and N.C.O.'s of the North Worcestershire Corps had subscribed to a fun:! and purchased heavy cut glass vases for presentation to Assistant Commissioner T. C. Lench and County Sergeant Major E . F. Preece, in honour of their promotions. ANNUAL REPORT. The annual report of the Worcester Nursing Division states that there are now 30 members in the Division-a slight decrease since 19-t5. To offset this decrease, 3 cadets have asked to be transferred to the adult Division. The re-examination was held in May, and the ele\'en members who presented themselves, all passed. The Cadet Division keeps steady in numbers, there being 24 members.

West Riding of Yorkshire. TODMORDEN. The annual meeting of the Todmorden Amhulance and Nursing Divisions Medical Comforts Committee was held in the Ambulance Hall recently, District Cadet Officer Mrs. Bayley presiding. Steady progress marked the year, 422 articles having been loaned. In J uty another sub-depot was opened for the convenience of people living on the outskirts of the town. There are now three sub-depots as well as the central depot. No charge is made for the loan of these comforts, which range from an eye bath to a folding bed. The outstanding- feature of the year was the presentation of a self propelled chair by ex-prisoners of war in Japanese hands in memory of their comrades who did not return.

County of Leicester. GIPSY LANE. The above Ambulance Division with members of the Nursing Cadet Division presented the pantomime Cinderella by Div. Supt. T. Hames, Gipsy Lane Ambulance Division, at the Gipsy Lane W. M. Club on January 16th and 17th. Both nights the Hall was crowded, many patrons having to be turned away. The pantomime was directed by Mr. L. Cooke and .director of music was Mr. P. Glover. Owing to the many requests the show will be given again at a later date.

HARROGATE. The annual general meeting of this Division was held on Thursday, January 9th. Sergt. Bradley, han. secretary, said that 793 duties were undertaken by members during the year. The strength of the Division was only 29 at the moment-there were some 40 members when war broke out. Cadet Supt. W. Binks said th~. strengt~ of the C~det Division was 24, with six boys waltlOg to Sit for examl.nation ; 236 duties had been undertaken in 1946. The shield for the smartest cadet had been won by Cadet D. Patterson.

RAILWAYS. Great Western. INCREASED MEMBERSHIP. During the 1945-46 session there were 25~ recruit~ (0 the movement-an increase of 156 over the prevIOus sesSIOn. The number who passed first aid examinations was 5,3?9. During the year 460 gold efficiency awards were gal~ed. For exceptional first aid rendered., 1 gold medal, 1 stiver medal, 2 bronze medals, and 4 certificates \\-ere awarded. BALA. . The presentation of awards was held at the White LIOn

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Royal Hotel under the chairmanship of Mr. T. R. ] ones. Mr. N. H. Briant, Div. Traffic Supt. presented the awards and stated how pleased he was to see a successful class which was so well supported by the foremost citizens in the county. Entertainment followed the presentations.

DRINNI CK

LILL.

Mr. ]. S. P. Pearson, District Traffic l\1anager, Plymouth, presided at the presentation of awards to members of this class. A cheque was presented to Mr. W. Stevens, who had recently retired after 50 years' service with the Company, during which time he had given 25 years' service to the am bulance movement. After (he presentation an enjoyable social was held.

LLANTRISANT AND LLANHARAN.

Mr. C. L. Simpson, Div. Locomotive Supt., presided at the presentation of awards and supper and concert held at the Llantrisant Canteen. Mr. H. H. Swift, Div. Traffic Supt., presented the awards.

London, Midland and Scottish. A~IBULAN C E MOVEMENT IN SCOTLAND.

This work has been carried out under the auspices of the S. A. A. A. There was a small increase of first year students during the last twelve months. During the year 31 classes were held in the 68 sections. The Final Ambulance Competition-1946 was won by Edinburgh with 247t marks out of a possible 300. The InterRailway Competition-1946 was won by L. M.S. Edinburgh with 270~ marks out of a possible 300. The International Ambulance Competilion-1946 was won by Crewe Machine Shop" B" with 575t marks out of 660. In the Worn ens' Ambulance Competition-1946, open to female staff throughout the L. M. S. line, Horwich were the winners with 258 marks out of 345 possible. The number of Long Service awards to members of the staff in Scotland now total :-Long Service Medal, 15 years, 1,313; Bars-20 years' service, 788 i 25 years', 481 i 30 years', 315; 35 years', 154 ; 40 years', 39 ; 45 years', 7 ; 50 years', 2.

Southern. OPEN COMPETITION.

An annual "event in pre-war days, the" Russell" first aid cup competition was revived recently at Tonbridge, when teams from Police, S.].A.B, and Southern Railway took part. Two teams tied for first place, but according to the rules of the competition, the team with the highest marks in the individual section of the competition took first place'. The result was :-1st and cup, Tonbridge No.1 Southern Railway; 2nd, Tonbridge Police i 3rd, S.J.A. B. Each member of the team received a prize and the team received a replica cup which it will keep.

PLYMOUTH FRIARY.

The annual presentation of awards of the above class was held on Thursday, January 16th. Dr .. ~cLean in presenting the awards, congratulated each recIpIent and expressed the hope that their numbers would grow. A first class concert followed, and refreshments were served.

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NEWPORT.

Mrs. Gardener presented the awards at a social gathering held at the Metropolitan Hall, Newport, I. of W. Mr. G. H. R. Gardener presided and was welcomed back by Mr. W. Bale, Class Instructor, who said that the members of the class were delighted to have their President back with them after his long period of service in. the Army. A capital programme of entertainment concluded the evening.

OVERSEAS. Rhodesia Rail ways. During the past year there has been a marked extension of St. John Ambulance work among Africans on the Railways. Progress is naturally slow in comparison with European classes, as many of the Africans lack the advantage of a basic elementary education, though this disadvantage is countered to some extent by the painstaking efforts of the EUlopean instructors and the keenness of the Africans themselves. The policy being followed at the present time is to train the Africans for the preliminary first aid certificate of the S.].A.A. and then to form African Ambulance sections with a view to gradually advancing their knuwledge. The African trainees, when they have acquired a certain minimum standard of efficiency, are allowed to attend injured Africans in the Railwayworkshops and yards under European supervision. Some really creditable work has been done by trainees without supervision, in one or two mishaps they have come across out of working hours. African sections of the S.J.A.B. have been formed at Umtali, Salisbury, Bulawayo, and Livingstone. It is hoped to establish a similar section at Broken Hill in the near future.

First Aid Quiz. Questions. (1) In the dislocation of a joint, why is numbness present? (2) What are the four main parts of the brain? (3) In "stomach bleeding II why should nothing be given by way of mouth? (4) Is iodine an "irritant" or "corrosive" poison? (5) vVhere is the " glottis" ? (6) Why apply heat in the case of a strainerl muscle? Answers are on page 116.

---._.--Physiology Charts. A SER~ES of eight physiology charts which, it is stated, have won hIgh approval from the medical profession, is available from Messrs. E. J. Arnold & Son Ltd., Leeds, 10. The diagrams consist of the skeleton, the muscles, the brain and nervous system, the circulation of the blood, the organs of digestion and assimulation, the structure of the eye, the structure of the ear and the skin and excretory organs. These charts will be found very useful in the conduct of a first aid course. A leaflet showing facsimilies may be obtained on application to the publishers.

Practical Nursing •In the Home. By AGNES E. PAVEY, S.R.

., Diploma in Nursing (University of London).

THE PREVENTION OF BEDSORES.

A bedsore, or a pressure sore, is an ulcer caused by interference with circulation to the part affected, this interference being due to continued pressure or diminished nerve supply to a given part. All the su bstances necessary for the 1ife of the tissues are carried to them in the blood, so that if the blood is prevented, for longer than 20 to 30 minutes, from getting to any part. that part becomes weakened and finally dies. The same principle applies 'vvhen a tourniquet is left on too long. The dead tissues will undergo changes similar to those that take place, in the autumn, between a dead leaf and the little stalk that attaches it to the branch, and, like the dead leaf, the area of dead tissue separates from the living tissue and comes away as a slough, leaving a cavity, or ulcer. This may widen and deepen until it involves a considerable area and may even expose a bone. So it will be seen that, although no changes except a premonitory redness are apparent at first, when the blood supply has been cut off for a given time, the formation of a bedsore is inevitable whatever treatment is subsequently given. It therefore behoves the nurse to use every effort to avoid continued pressure by every means in her power, and to remember also that anything that irritates the skin or renders it unhealthy-such as dampness or continuous contact with excretionspredisposes to the formation of bedsores. Folds of the nightdress, rucks in the undersheet or mackintosh, crumbs in the bed, badly fitting bandages, imperfectly padded splints, and even a c~relessly given bedpan may start the mischief.

Condit-iol1s Predispos-ing to Bedsores. - In paralysed people the nerve supply that controls the circulation is impaired. In these cases, and in these cases only, bedsores may be tfnpreventable, but their occurrence may be delayecl by careful nursing. I n elderly people suffering from heart disease, and in very heavy patients, bedsores are liable to form, and also in very thin people when there is very little covering to bony prominences. Any person who is helpless may develop bedsores if allowed to lie too long in one position, especially if there is any cedema (dropsy) of the tissues. Parts Most. Lz'kely to be Afjected.-Any area in which there is very little other than skin over a

bony prominence may be the seat of a bedsore. The lower part of the spine is the most frequent site, for this is the area most su bject to pressure. The hips, shoulders, ankles, knees and elbows are likely to be affected, and so also are the back of the head and the ears in small children. In extremely thin and debilitated people, bedsores may occur over the spinous processes of the vertebrce throughout the entire length of the column.

Pl"eventz've lIIeasU1'es.-These include (1) a suitable and perfectly made bed, (2) absolute cleanliness of the skin, (3) great care in lifting, turning and the giving of bedpans, (4) maintenance and improvement of skin nutrition and function, (5) frequent change of position, (6) correct adjustment of bandages, splints or any other apparatus the patient needs, and (7) the relief of pressure by air or tow rings, sorbo mattresses or air or water pillows, or beds. Details of bedmaking, the washing of back and pressure areas, and their treatment by massage with spirit, followed by the application of talcum powder, have already been given.. This treatment must be carried out at least twice daily for all persons who are not allowed to get up. The spirit cools, refreshes and hardens the skin , but it may cause it to be too dry and so increase the tendency to crack. This must be watched, and, if necessary, an oil or emollient preparati.on must be used instead. For patients who are Incontinent, the skin must be protected by a thin coatina of a areasy preparation-zinc ointment b b . 1 with castor oil being one of the most sUltab e. All stale ointment must be carefully washed off before applyina fresh, and powder and ointment must never be ~sed together, for they will combine to form small, sharp, flinty particles that can become embedded in the skin. Chancre of Positzon.- Unless quite unavoidable owin~ to disease or injury, no patient should remain continually lying upon her back, but when turned on to her side she may need to be supported in this position. To turn her, she is asked to fold her arms across her chest and the nurse passes one arm under the patient's wa!stline and the other under her hips. Then she lifts, draws the patient towards her and rolls her ov~r al.l in one movement. The position may be malntalfled by placing a pillow under the draw-sheet and

I I4

FIRST

against the patient's back. Care must be taken that the legs are not pressing against each other. The upper leg should be flexed and a small pillow should be placed between the knees. Two rings and heel pads may be used as required. For acute abdominal or chest conditions involving difficulty in breathing, it may be necessary to nurse the patient in a sitting-up position, • supported by a back rest and pillows. One of the first essentials is then to see that the position is maintained without effort on the part of the patient, for if she is slipping down and trying to wriggle back into position, friction will be increased. If the patient is redematous-as with chronic heart or kidney conditions-the fluid in the tissues migrates to the most dependent part, so that it is absolutely necessary that the patient's position should be changed frequently. She can rest on the lower part of her back for an hour or two, and then be turned slightly on to her side so that the hip is the most dependent part. The redema will disappear from the back and the uppermost hip and will collect in the one upon which she is lying, distending the skin and causing an internal pressure upon -it; then, when she is turned, the fluid will drain out of those tissues to the other side. Attention to pressure points, in the form of washing, massaging with spirit and applying powder or ointment, must be carried out every time the patient is turned.

Apparatus jar the Rel£ej -o f Pressure.- The ordinary air ring not only takes the pressure off the lower part of the back, but it helps to prevent the patient from slipping down in the bed. It must not be blown up too hard, and it should be encased in a linen cover-a pillow slip serves quite well. Care must be taken that the screw is at the side, for if at the back it will press into the patient's skin.' A soft pillow under the knees will h~lp in maintaining a sitting-up position, and may give comfort when the patient is lying upon her back. Small tow or wool rings may be needed to take pressure off the heels and elbows. These are quite easily made. A roll is made of tow or wool, about 9 to 12 inches in length; this is drawn round into a .circle and then a 2 in. bandage is bound round It. The centre hole should be just !arge ~nough to take the prominence that the ring l~ deSired to protect. If necessary, it can be ltghtly bandaged in position. . Air beds are made in sections that may be lnflate~ separately, and are very like those used by holtday makers when sun bathing, except that they are large enough to cover the entire mattress; they are expensive and difficult to procure. So also are water .beds, b~t these are practically o?solet~, and their use IS fraught with many difficultIes, so that there is no point in describ-

FIRST

AID ing them. Both air and water beds have been largely superseded by sponge rubber, or sorbo, mattresses. Symptoms of Impend£ng Bedsores. - The patient may experience a sensation of pricking or burning in the region, which is increased by the application of spirit, but she may be too ill to feel any discomfort. When inspected, the area may be reddened or it may be dark in colour like a bruise. At this point the tissues are congested and damaged, but still living, and the chance of their recovery is good if immediate and constant care and attention are given, provided that the patient's general health is satisfactory. Treatment.-All pressure must be taken off the part and friction must be prevented. A nurse must never prescribe for a bedsore. She must report it to the doctor and ask for instructions. Nevertheless, she should know what treatment is likely to be ordered. _ The 'skin may he protected by painting it with collodion flexile-which forms an additional skin over it-or, if it is abraded, by applying a small dressing of lint or gauze soaked in compound tincture of benzoin (Friar's balsam) secured in position by Elastoplast or strapping, as are all dressings for bedsores. Cotton wool and bandages are never used for the dressing of bedsores, for they tend to slip or ruck up and themselves become additional sources of friction and pressu reo The sore must be kept surgically clean like any other wound. When a slough has formed, its separation may be hastened by the use of antiseptic fomentations or eusol dressings. These should be cut exactly to the size of the sore, and should not extend over the sound skin. After separation of the slough, the cavity may be packed with gauze soaked in flavine and paraffin or with a lotion containing zinc oxide. Exposure to light rays may be ordered to hasten the healing process.

115

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Casualties Union. " THE fifth annual reunion of the above is to take place at the Chiswick Road Transport Depot by kind permission of the London Passenger Transport Board on the afternoon of Sunday, Ju·ne 22nd. The programme will consist of two competitions, followed by a demonstration. The competitions are open to all comers. (1) First Aid competition for teams of 4. (2) Diagnosis competition for teams of 2. These competitions will be run concurrently, so that competitors cannot take part in both. Entries should be forwarded to the Hon. Org-aniser, Casualties Union 64 Chiltern Road, Sutton, not later than iIst March. Tea~ entry fees will be 10/- for the First Aid, and 5/- for the Diagno~is competition, which should accompany the entry. It IS hoped that all competitors will take part in the demonstration by rendering first aid to the casualties.

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IT 6

Reviews. Aids to Tropical Nu.rsing. . ~y Dor?thy E. Cocker, S'.R. ~., S. C. M. London: Badllere, Tindall & Cox. Pnce J /-. Post 1d. . . This little book, which is now in its second edItIOn, ~l1s a much needed gap since there are very few manuals whIch deal with its subject. It is written by an expe~t, fo~ nurses in the tropics, and describes accurately and. 1OteIl~gent~y, diseases which they are likely to enco~nter .10 theIr d~dy work. Consequently the nurse who studIes thIs book.durIng her training, wiII acquire a sound knowl~dge rega~dlOg the causation and the nature of th~ common d,seas~s whIch occ.ur in the tropics. In short, this book accompltshes ~ell ItS purposes and has established a well-deserved reputatIOn for usefulness in the training of nurses. Aids to jJ1"edical NU1'Sing. By Margaret Hitch, S. R. N. London: BaiHiere, Tindall & Cox. Pr£ce s/-. Post 1d. This book has proven itself not only as a useful textbook but also in very truth as an aid to medical nursing; and in this, its third edition, it continues its successful career as a work of instruction. It has proven itself as a prop and support on which the individual nurs~ can build and dhe!op her own observation and understandlOg- of tlW cases wlllch come within her notice. This edition has not been greatly altered beyond some amplifications and additions which seemed to be desirable, but it has been revised carefully, improved and made more complete. It will therefore continue to be a real help to the student nurse and a useful reference for those who are qualified.

-----------------------Aids to Tuberculosis NU1'sing. By L. E. HoughtoIl, M.A., M. D. and T. Holmes Sellors, D. M., F. R. C. S. London: Bai.lliere, Tindall & Cox. Price 5/-. Post 1d. This useful book, which is the work of a physician and a surgeon, sets out for the nurse a straightforward account of the pathology of tuberculosis together with a description of the main features of that disease as it is encountered in the tuberculosis clinics and wards. The warm reception which has been given to this work has been most gratifying to the authors who hope that this, its second edition, will continue to be of value to nurses and others interested in this important subject. Some minor alterations have been made in the wording of the text and a special Chapter on "Tuberculosis in Children)) has been added with the aim that the book will cover all aspects of tuberculosis without losing its compact character. Nurses' Pharm.acopoe£a. Compiled by H. L. Heimann, M.D., M.R.C.P., and Dora Wilson, R.N. (S.A.). London: Bailliere, Tindall & Cox. Price 4/- net / by post 1/6. This is the fifth edition of a most useful little book; and it has been extensively altered and improved. Each section has been revised and additions have been made to almost everyone. The section on weights and measures and that consisting of Posological Tables have been rewritten with emphasis on the metric system. The section on Biological Tests has been enlarged to include all recent tests. Beyond doubt the book will continue to prove useful to Nurses and Students.

Owing to the fuel crisis the printing machines were stopped and the production of " First Aid" much delayed. We regret this inconvenience, both to Subscribers and advertisers, and hope that the situation will improve in the near future and allow us to publish punctually next month.

AID

FIRST

Answers to First Aid Quiz. (1) The head of the displaced bone presses on the nerves and blood-vessels. (2) (i) Cerebrum; (ii) cerebellum; (iii) pons varolii; (iv) medulla oblongata. (3) Because aggravation of the bleeding may result therefrom. (4) Irritant. It stains but does not burn. (5) At the back of the tongue-the opening into the larynx. (6) This dilates vessels at the seat of the injury and draws the blood therefrom, thereby relieving pain.

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The above First Aid Competition will be held on the Central Pier commencing Monday May 12th to the 17th inclusive. Entries are invited from the following areas: Lancashire, West Riding of Yorkshire, Cumberland and Westmorland, Cheshire, Co. Durham, Northern Ireland, and Northumberland. The Ladies Day is Wednesday only, May 14th. Puticulars may be had upon application to the Competition Secretary, Ambulance Hall, Alice Street, Morecambe.

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Il8

Queries and Answers to Correspondents. QL1eries will be dealt with under the following rules : 1. -Letters containing Queries must be marked on the top left-hand corner of the envelope" Query," and addressed to FIRST AID, 46, Cannon-street, London, E.C.4. 2. -All Queries must be written on one side of paper only. 3.-All Queries must be accompanied by a " Query Coupon" cut from the current issue of the Journal, or, in ca~e of Queries from abroad, from a recent issue. 4. -The Textbook to which reference may be made in this column is the 39th (1937) Edition of the S.J.A.A. Manual of First Aid to the Injured. Artificial Respiration. W. P. (Burnley).-I refer to your answer to a query published under the above heading in the December issue of FIRST AID. You state-" It is useless to apply friction to the limbs until breathing has been re-started." I assume that, in this case, it is natural breathing to which you refer. Since artificial respiration would be useless unless the probably weakened heart was still circulating oxygenated blood to the brain and tissues requiring it, I was of the opinion that anything that would assist circulation would be beneficial and, providing personnel were available, it would be advantageous for them to apply warmth and friction to the limbs, upwards to the heart, whilst A. R. was continuing. Incidentally, I believe that one of the claims Dr. F. Eve makes for his rocking method of A. R. is a degree of A. Circulation consequent on the alternate feet up and feet down position of the body. In conclusion, I must thank you for your informative answers to our queries and hope to have your valutd comments on the above, in due course. Yes. The action of the heart will improve with the return of normal respiration; and it is only then that the heart would be able to deal with the increased quantity of blood returning to It as the result of friction applied to limbs. -N. CORBET FLETCHER. Examination IIo wIer. W.l\1. (Pownham). -At a recent examination the doctor asked one ca ndidate what he would do if he had to treat a patient who had a moth in his ear channel. 'A' hen the candidate replied that he would pour oil into the ear, the dOClor asked his reason for so doing; and we all laughed when the candidate replied-" To stop the moth fluttering! " Good!

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

Pulling Tongue Forwards. ].1\1. ( loorthorpej.-Please tell me through your valued Queries Column what is meant in several textbooks by the instruction in the case of an unconscious patient whose tongue has gone back into his throat-" Grasp the angle of the jaw and pull it forward." I have tried this on my own jaw without effect and, I have asked a Hospital Staff Nurse who could not offer me an explanation. So I turn to you; and I feel sure

FIRST

AID

that a full answer t6 this important question would be helpful to many first aiders. If you pull the lower jaw forward, you cause a slight movement forward of the tongue; and this is more marked if all the vol untary musc'es are relaxed as they are when patient is in a state of insensibility. Nevertheless, I am of the opinion that this method of treat~ent is best left to doctors and trained nurses.-N.C.F.

Treatment of Wounds. A. F. (Kettering).-In the new" direct pressure" treatment of wounds as taught in the Supplement to the Textbook there is no mention of indirect pressure while proper examination for fractures, etc., is carried out. Would pads of linen, with cotton wool tight]) sl uffed inside, be as effective in stopping bleeding from a large wound (with fracture) as a large ring pad, made with several triangular bandages? Your query is answered in the Supplement to the Textbook which in Clause 12, p. 26, tells you that, when it is impossible to apply direct pressure successfuIIy, indirect pressure, should be made on the carotid subclavian or femoral arteries as the case may be. Incidentally, a ring pad made of "several triangular bandages" would be unwieldy and likely to defeat its purposes.-N.C. F. Rubber Bands. A. F. (Kettering).-Further, with reference to the use of rubber bands as described in Clause 9, p. 26 of the Supplement to Textbook, can you please give me some idea of the pull which is to be applied? To me, rubber bands seem so painful in their application. Please accept my thanks.

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Inhalation of Prussic Acid. P.N. (Lowcstoft).-Please tell me what is the treatment of a patient suffering from the effects of inhaling prussic acid vapour.

Incised Wound ot Scalp. M. N. (Brixton).-Please tell me if I am correct in diagnosing a wound of scalp caused by a chopper, as a deep incised wound.

1I 9

OXYGEN &.C0 2 RESUSCITATION APPARATUS

For first aid purposes the rubber band should be stretched just sufficiently to control the haemorrhage. The application of a rubber band will always cause pain when patient is conscious; and this is one of the reasons why you are told to relax band every 20 minutes with a view to dispensing with it at the earliest moment.-N. C. F.

Whether swallowed, inhaled or applied to a wound the effects (and therefore the treatment) of prussic acid poisoning are identical since the poison may act in all three ways. Thus, the symptoms of poisoning may come on during the act of swallowing or immediately afterwards; and people have fallen down unconscious from merely smelling the vapour. The key to the problem is the potency of the solution of prussic acid which may vary within wide limits.N.C.F.

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120

FIRST

Violence applied to head and face is apt to C"luse incised wounds as the result of impact on subjacent bone. A chopper, therefore, might cause an "incised" wound which would be as "deep" as the tissues in the region affected allow.-N.C. F.

-AID

FIRST

It looks as if you have taken my previous replies too seriously. Of course, the armslings, if properly applied, are just as neat and just as effective whether the model be man or maid. My point was that first aiders, when applying the large and small armslings, must place their arms round the patient's neck to get this in the right position.-N.C. F.

AID

S.J.A.B. POSTERS STOCK

Rupture of Muscle. O. M. (Felixstowe).-Please tell me if a muscle can ruptured without an external wound.

Rupture of a muscle may occur" without an external wound" as the result of spasmodic muscular effort. A common example is rupture of plantaris muscle, which is a small muscle in the calf of the leg and which may be torn right across during acts of jumping and running.-N. C. F.

Treatment of Fractured Pelvis. N.P. (Finchley).-The Textbook op p. 87 tells us that in the treatment of fractured pelvis a broad bandage is to be applied" in line with the hip joints." I am in doubt as to whether this bandage is to be tied with a knot or fixed with a safety pin. If it is to be tied, then what is the position of the knot? Your kind ruling in this matter will be much appreciated. The bandage is to be tied; and the best position for the knot is in the middle line over the symphysis whereby the wide parts of the broad bandage are placed round the hips and the mouths of the patient's trouser pockets are c1osed.N.C.F.

Silvester Method. A.H. (Dagenham) .-The Officer in charge of our competition team has requested me to write to you for explicit instructions on the Silvester method of artificial respiration ; and we thank you in anticipation of your kind reply. The instructions given on pp. 1+9 to 151 of the Textbook are perfectly clear; and I cannot imagine how they can be made more clear except on one point, namely the way in \vhich the elbows are made to touch the ground. Such being the case, my modification of Section (a) Rule 3 on p. 149 reads as follows :-

(a) Induce inspiration.-Kneel at a convenient distance behind patient's head and place his forearms on lower chest at right angles to arms. Grasp his forearms just below the elbows with your fingers placed above and your thum bs below the forearms. Then draw the forearms outwards, upwards and towards you (O.U.T.) and press the elbows on the ground behind patient's head. -N. C. F.

Site of Knot of Armsling. F. G. (Windsor). -A discussion took place at our last Brigade Meeting regarding your replies in the October and November issues of FIRST Alb to queries on "Site of Knot of Arm<;ling." We were of the opinion that the reason you chose different sexes for demonstrating different slings was in order to present a much bett~r and neater bandage. We would like your confirmalion that this is so. If this is true it is hardly fair on the ordinary members as Brigade regulations do not permit mixed practices and we have to practise on whatever material we have available as patients.

Comminuted Fracture of Leg. E. E. (Hednesford).- Will you please settle a difference of opinion between myself and two first aid colleagues. A man has a simple fracture of the leg just below the knee and another just above the anlde. My friends maintain that the correct classification is a "comminuted fracture of leg" whereas I maintain it to be "double (or two) simple fractures of the leg." We have agreed to accept your ruling as final and thank you in anticipation of your reply.

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The Texthook tells you that a simple fracture is one in which a bone is broken. This obviously implies that the bone is broken into two pieces with jagged ends which may cause further injury. On the contrary, a comminuted fracture is one in which the bones are broken into several pieces and therefure require special care in handling. This applies to the case which you quote, since you have two fractures with four jagged ends likely to cause injury to the surrounding tissues. In short, the combination of injuries quoted, falls within the category of a comminuted fracture.-·N. C. F.

If First Aid is a subject in which you are interested, then you will readily understand the value of SWEDISH MASSAGE and how it can assist in healing the sufferer.

Copying Ink Pencils. E.G. (Hull).-I shall be grateful if you will please tell me what are the peculiar dangers attaching to the use of copying ink pencils. I seem to remember warnings being given out about their use, as they are poisonous. In fact, I read some years ago in a trade journal that the introduction of copying ink into the blood stream is liable to cause some kind of growth. Is this correct, and of what d;)es the poisonous substance consist?

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In view of the general use of these pencils, does the danger apply to any particular class of them, or to all ? Seeing that there is always a chance of anyone getting a stab from the sbarp point of any pencil (let alone sucking one, a very prevalent habit !) what would be the appropriate first aid treatment in the case of any accident with datiger of the poisonous substance entering the blood stream? I gather that antiseptics would be useless in such a case, and if the danger is so great, "Forewarned is Forearmed! "

Good Incom~~ c:;:an be made

by studying this fascinating subject. Low tuition fees can be paid by easy All instal ments, while you learn. necessary Text Books, Charts and Examination Fees are included in the Tuition Fee.

Tbere is a risk of a septic condition arising fr~m the puint of a copying ink pencil being driven into the skin as with any other object which penetrates the skin. I am not, however, aware of any special dangers being asc;ociated with injuries caused by copying ink pencils.-N. C. F.

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FIRST AID Prompt action with the Sparklets Resuscitator is vital to successful recovery. LIGHT WEIGHT LOW COST - Ip/6d.

No. 633.

VOL.

LUI.

MARCH, 1947.

The

Its aim and object being the advancement of Ambulance Work In all its branches, the Editor invites Readers to send Articles and Reports on subjects pertaining to the Movement and also welcomes suggestions for Practical Papers. All Reports, &c., should be addressed to the Editor at the address below, and should reach him before the 8th of each month and must be accompanied (not necessarily for vublication) by th~ name and address of the Correspondent. Subscriptions, Advertisements and other business Communications connected with FIRST AID should be forwarded to the Publishers.

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"We are all capable of dealIng WIth an I?Jury to some person, especially when that p~rson IS able to give US some valuable in:ormatlOn. as to history, pain, etc. , but an animal lS somethIng totall y different and if we are able to relieve. ~hem of any undue suffering by virtue of our abl.ltty to deal .effectively with their injury, we are dOing somethIng worth while." With that sentiment we are sure that all our readers will most c.ordially agree. Other correspondents ask partlc~larly for so~e details of how best to bandage anImals, and hlOts on the correct way of holdin g pets. In. sh o rt, there seems to be a genuine need for som~ Instructi,o n on ~his important s ubj ect, and we are lIkel y to dIsappOInt a number of readers if we do not pro vide it. Fortunately, we are g lad to a ssure our correspondents, there will be no disappointment, for we have arranged for som e articles to appear in future is .mes. In co-operation with the Peoples Dispensary for Sick An imals we shall shortl y be publishing these contributions, and all those interested in the subject are asked to loc k out for a further announcement in the near fu ture .

First Aid for Animals.

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MANY of our readers must have had the experience at one time or another of being asked to render first aid to some injured animal and feeling rather at a loss as to how to tackle the case. It is a subject about which the majority of us know very little, yet first aid for animals is often needed, a nd people will expect first aiders to know how to t reat their injured pets. It is evident from the letters we have received in response to Mr. J. Brinkley's suggestion (printed in the January issue) that we should publish something on the subject, that there are a great many people who would welcome instruction on how to deal with animal casualties. Mr. Brinkley, it will be remembered, said that he was often approached by the owners of animals that had met with an accidental injury and asked what was the best thing to do, and he went on " It occurred to me that first aiders might, like myself, be interested to read something about animal injury." We asked readers to comment on this suggestion, and the large number of replies received (a selection will be published in the next number, space permitting) leave no doubt in our minds that there are many who will welcome articles dealing with first aid for animals. As one

IN THIS ISSUE. FIRS T AID FOR A NI ;vIALS.

COURSE IN AD \, AN CED FIR ST AID

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

124 124 126

REVIEW S

"SEPT ONA L "

123

A NT ISEPT IC.

AM B ULANCE N EW S F RO M AL L Q UA RT ERS . ..

126 127

PR ,\ CTl C AL NURSIN G IN T H E HO ME.

By Agnes E. Pavey, S. R. N.

129

INJURIES IN COAL MINES.

By J. W. Scott QUERIES AND ANSWERS T O CORRES P ONDENTS

130 134

124

- - - - - ------

FIRST AID ---------------------------------------------------------

COllrSe in A(lvanced First Aid. By A. D. BELILIOS, M.B., B.S.(Lond.), D,P.H.(Eng.),

THE science of medicine is divided broadly into two main branches-medicine and surgery. Medicine, practised by physicians, is the art of restoring health by the use of drugs, diet and special methods of nursing. Surgery, on the other hand, practised by surgeons, consists of healing the body largely by manual procedures-operations and manipulations. First aid can also be divided into two branches, medical and surgical. Medical first aid comprises the diagnosis and treatment of various emergencies by methods which do not involve a manual procedure. Illnesses of this kind incl ude apoplexy, infantile convulsions, fainting and epilepsy. Surgical first aid, however, like surgery, is essentially practical, and consists of the treatment of injuries such as wounds, haemorrhage and fractures. There are, of course, a number of conditions which belong to both categories, and in medical work are studied eq uall y by physicians and surgeons. Medical first aid has been rather neglected in the past, hence it is the object of this series of articles to go a little more fully into the medical ailments which are already included in standard first aid, and for the benefit of more advanced readers, to describe some of the morecommon medical emergencies about which until now the firstaider has learnt little. Some instructors will not approve of teaching the first aider about illnesses such as heart attacks perforated gastric ulcers, appendicitis, etc. I~ must, however, be remembered that the scope of first aid to-day is very different from what it was even ten years ago, and the modern first-aider is expected to know very much more than was originally designed. Nowadays, possession of a first aid certificate is sufficient qualification for its owner to be put in ~ha~ge .of the first aid department in quite a big Inst.ltutlon .such a~ a factory, school or place of busIness; 111to thiS department may be brought any emergency, ranging from a scratched finger to a case of diabetic coma. Although the actual amount .of first ai.d that c~n be done for many of the medical cases IS very httle, obviously the more general knowledge that a first-aider possesses the better, for it increases his insight into medical wor~; moreovtr, it enables him to appreciate the possible diagnosis in a case of sudden illness and save him from' 'dropping a brick" as occurred in a factory recently when a worker was allowed to con~ tinue his job after having had a heart attack the possibility of which had been overlooked. '

It must be clearly understood, however, that many of the ailments which will be described do not call for active first aid. In many instances all that is required is to apply general principles and provide for medical aid. Very often, indeed, the less that is done for the patient, apart from these general principles, the better; for this reason, every first-aider must learn to practice what is called by doctors' 'master! y inacti vity", which means doing absolutely nothing beyond general principles and watching a patient, appreciating the fact that in many cases additional treatment, such as trying to give stimulants and medicine, may do more harm than good. Masterly inactivity is one of the most difficult treatments to adopt in medical work, for it is only human, when a patient is ill, to try and think of extra things to do. The best way to study medical first aid is to take the body system by system, to refresh our memories first on the anatomy and physiology of the various organs, and then to descri be the ailments which may occur for which the first-aider's advice may be sought. It is convenient to begin with the respiratory or breathing system. THE RESPIRATORY SYSTEM. Respiration is the process by which oxygen is drawn into the blood stre3.m through the lungs and carbon dioxide, a gas formed by the tissues, is removed from the blood and expelled from the body together with excess heat and water vapou r. The actual exchange of gases takes place in the lungs, which are therefore the essential organs of breathing. The remaining organs, the nose, the throat or pharynx, the voice box or larynx, the windpipe or trachea, and the bronchi-function by guiding air from the outside to and from the lungs. There are also the muscles of respirationthe diaphragm and the intercostals between the ribs, which cause the lungs to expand and deflate; finally, there is the pleura, which is a double layer of thin material c0vering each lung and the inner wall of the chest, making a closed cavity, the pleural cavity, which also assists inspiration and expiration. . The nose consists of two triangular-shaped passages which lead from the nostrils to the throat. They are separated from each other by a partition, called the septum, made partly of cartilage and partly of bone. Each cavity is lined by a red covering, called mucous membrane because it secrets mucus or slime; within it are three delicate scroll-like bones.

FIRST The pharynx is the space at the back of the nose and mouth. It is made of muscle and lined by mucous membrane. It has two openings leading from it-oesophagus and the glottis, which carries air into the larynx. The larynx is the organ of voice and contains the vocal cords. It is contained in the large ring of cartilage called the thyroid cartilage or "Adams apple. " The trachea or windpipe is about 4 in. long. It passes down the neck and enters the chest where it divides into two large bronchi, one for each lung. The bronchi on entering the lungs divide up li ke a tree into numerous branches, the smallest of which are called bronchioles, and are made largelyof muscular tissue. The lungs are two spongy organs divided into lobes by deep grooves called fissures. Each lung is made up of innumerable air sacs or alveoli, which a re arranged in clusters round the ends of the bronchioles. The alveoli are filled with air and through their thin walls the exchange of gases takes place. AILMENTS OF THE RESPIRATORY SYSTEM. Epistaxis. This is the technical term applied to bleeding from the nose, the only condition in th is article which comes into both categoriesmedical and surgical first aid. Epistaxis may be due to many causes, which may be classified;as local if they occur in ~he organ itself or general if they are due to some Illness or condition which affects the body as a whole. The local causes include injury either to the nose itself or the base of the skull, picking the oraan or the insertion of a foreign body. Someb . times it is due to the rupture of a small varIcose vein; first-aiders who work in factories should remem ber that epistaxis is often the first sign of the nose being affected by chrome. The general causes are not always clue to disease. Thus epistaxis may occur in people who go and live at a high altitude or undertake mountaineering; in children it is commo.n at pub~rty. Many diseases may caus~ no.se-bl:edlng,.especlally high blood pressure, whde In ch.tldren. It IS. often the first sign of sickening for an InfectlOus disease such as measles. FIRST AID (1) Cloth£ng. Tight clothing round the neck, chest and waist should be undone. (2) Pos£tz"on. Remembering that one of the general principles for the tr~atment of haem?rrhage is to elevate the bleed1l1g part, the patient should be comfortably seated, preferably in an easy chair with his head thrown slightly backwards and su pported so that his nose is eleva ted. (3) Instructions. The patient must be told to keep his mouth open and not breathe through

AID the nose or blow it, since it is very important not to disturb the blood clots which are forming and aiding the natural arrest of the haemorrhage. (4) Cold compresses. These should be apt:lied to the bridge of the nose and the back of the neck j they should be renewed frequently. (5) Warmth. The patient's body should be kept warm by wrapping with blankets or rugs and applying hot water bottles to the feet. (6) 1I1easures for severe cases. If the bleeding does not stop by the sim pie methods above described, a doctor's services will be required. In the meantime, the feet and ankles may be placed in a bath of hot water and the patient's arms held above his head, although it is doubtful if these procedures do much good in arresting the haemorrhage. If the bleeding is suspected to arise from a burst varicose vein, it can sometimes be controlled by compressing the nostrils with the thumb or forefinger against the septum of the nose; this, however, will only succeed if the vessel which is bleed in g is in the lower part of the nose. (7) Med£cal a£d Serious cases alwa ys require medical aid. Death from nose bleeding is rare, but certainly does occu r, and in an y event if the patient is allowed to lose too much blood, he may become so ancemic that a blood transfusion will be required. Surgical methods include cauterising the bleeding point, or making direct pressure by packing the affected nostril tightly with gauze, a procedure which should never be undertaken by a first-aider since, without a thorough knowledge of anatomy, it is very easy to damage the delicate scroll-like bones within the nose. In any event the patient should always be told to go to a doctor so that the cause can be investigated. Coughs. Patients often apply. at .the. ambulance rooms in factories and other 111stitutlOnS for a dose of medicine to relieve a cough, and mixtures or linctuses are often supplied to first aid departments by the lay executive for thi~ purpos:. The administration of drugs, except 111 certaIn rare and specified cases, is quite beyond the sc.o pe of first aid-medical or surgical, and the first-alder should always urge his patient to g? to. a doctor, who, by hearing the cough, by examl.natl.on, or by X-rays, will soon be able to ~e~ermlne Its ca~se. A cough is only a symptom-It IS th.e u.nd.erlyIng cause which requires treatment; t~IS, ~t IS true, may only be a minor one such as a httle Infl~~ma tion of the pharynx or trachea (phary ngitis. or trancheitis), but it may also be sign. of somethIng much more serious, e.g" tuberculOSIS. Haemoptys-is. This term is derived from the two Greek words meaning the' C spitting of blood." It is applied to any case in which blood is coughed

126

FIRST

up from the respiratory organs, usually the lungs. bleeding from the nose, mouth or pharynx is not regarded as haemoptysis. The commonest cause of haemoptysis is tuberculosis of the lungs; other causes include diseases such as pneumonia and a certain form of heart disease. It may also result from injury to the lungs caused through broken ribs. Diagnosis. It is generally easy to distinguish between blood that has been coughed up and blood that has been vomited. In haemoptysis the blood is frothy and bright red in colour because it is mixed with air. If the blood has been vomited (haematemesis), it is dark red in colour and often mixed with food; sometimes it looks like coffee grounds. Moreover, the opinion of the patient is normally reliable, for he can generally tell that he has coughed up the blood; in addition, if the case is tuberculosis, there will often be a history of a troublesome cough for some time past. FIRST AID. (1) Reassurance. Loss of blood from any part of the body always alarms a patient, and haemoptysis is a particularly terrifying experience. Fright increases the rate of the heart beat and thus may aggravate the bleeding. For this reason every endeavour should be made to calm the patient 'by tactful reassurance, and this the first-aider can do quite honestly, since most cases of haemoptysis respond q uickl y to treatmen t given by a medical man. (2) Posz'tion. The patient should be kept lying down with his head and shoulders slightly raised. If he happens to know, as do many tuberculosis patients, which of his lungs is affected, he should be advised to lie on the affected side, since this will prevent the blood from en tering the opposite lung. (3) Rest. This is most important. The patient should be told not to talk and to avoid coughing as far as possible. He must not move without assistance, and if given drinks should receive them from a feeding cup. r -'~ (4) General PrinczjJles. These include undoing tight clothing, ensuring an adequate amount of fresh air, and supplying warmth, which, however, should not be excessive. Sips of non-stimulating fluids can be given warm, but not hot, a valuable drink consisting of salt and water-hali a teaspoonful to the pint. Medical aid should be obtained as soon as possible. (5) Masterly Inactivity. Apart from the measures above described, the less that is done for the patient the better. All stimulants such as sal volatile, or strong coffee are contra-indicated. Ice to suck is of no value-in fact, some authorities t~ink it may cause further harm to the patient -whIle the oft recommended ice bag has very little if any effect. .( Dr. Bel.il ios will deal with first aid for asthma, pneumonta, pleunsy, laryngeal spasm in the next issue.)

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AMBULANCE NEWS FROM ALL QUARTERS.

London: His Majesty's Stationery

A new booklet published by the Ministry of Health, consisting of a series of broadcast talks given by Dr. Doris Oldum on the "psychological" side of bringing up children. Many publications have appeared during recent years on feeding and the physical care of children-particularly babies, but this book is produced with the idea of giving advice to parents whose children are at the "interesting" and sometimes rather "difficult" age. It contains many useful hints, appropriate sketches by " Props", and is very interesting to read. The Houselwld Docto.,.. London: The English Universities Press Ltd. Pn'ce lS, 6d. net. The aim of this book, which has been written by a family doctor and is based on an extensive experience, is to teach people to be healthy and, at the same time, to offer some advice if accident or sickness should befall. For these reasons the author concentrates on health first, thus reflecting the attitude of all healthy people and seeking to avoid the pitfalJ of gloom inseparable from the unrelieved study of The second half of the book deals with many of sic1mess. the common ailments and conditions, which are arranged in alphabetical order for convenience in reference thereto, and supplies useful information about each, and some rules for home treatment.

S.J.A.B. No. I (Prince of Wales's) District No. 37 (G. W. R. AND PADDINGTON BORO). The Officers, N.C.O.'s and members of the above Division held their re·union dinner and social at the Sutherland Hotel, Padding-ton, on February 22nd. Members, wives and fri ends totalled 94 and among the guests was the President, Sir H. V. Kenyon, M.B.E., J.P. After a very enjoyable dinner, entertainment was provided by Leslie and Leslie and the Chas. King Sextet, who also provided the music for the dancing which followed.

County of Bedford. W ARDOWN. The Nursing Division celebrated its fourth birthday recently, when husbands an~ fr~ends,. a.nd m.embers of the Ambulance Division and their Wives, lomed 10 games and dances at the Nursing Division headquarters. Div. Supts. Mr. and Mrs. Stevens presented 13 Royal ce rtificates to Ambulance and Nursing Divisions and eight third-year efficiency stripes to the Nursing Division.

County of Birmingham.

" Septonal" Antiseptic. PROMPT and efficient service has always been a watchword of I.D.L. Industrials Ltd., Newcastle-upon-Tyne, and the new management who have recently taken over intend to keep up the high standard already attained. 'I Septonal" is one of the more widely known products of the concern. This antiseptic has now been made for weII over thirty years and used regularly in first aid rooms and am bulance departments of industrial undertakings. A speciality is made of selling "Septonal" Antiseptic in concentrated form for use in factories, etc. Full instructions for dilution accompany every package. The antiseptic, we are informed, is entirely non-poisonous and harmless even in the most severe cases. It combines antiseptic and styptic qualities with complete success as a local anaesthetic. It is available in ointment form for minor injuries and skin troubles. 1. D.L. Industrials Ltd. also stock complete equipment for first aid outfits and have many items ready for immediate delivery. First aid attendents, ambulance secretaries and others interested, are invited to write direct to the firm stating their requirements. A full price list will be supplied upon demand.

Notice to Ambulance Secretaries. Will Ambulance Secretaries please forward reports of local activities as soon alte?' the actual event as possz'ble. We regret that owing to the shortage of paper we are not able to include all reports submitted. Preference is given to those of general interest.

H ARBORNE. It was a sad little company of alJ ranks of the Division which attended the service and cremation of Mrs. Emily Ada W ard, wife of the President of the Division, at Lodge Hill on Saturday, February 15th. . Mrs. Ward who had suffered for many months, retained her keen interest in other people and of the Division. ~he patient, brave manner in which she endured her suffenng was an inspiration to all who knew her. Whilst not personally a member of the Brigade, she did much to help the work of St. John through her interest and encouragement to Mr. Ward, and attended all the Divisional functions.

County of Hampshire. ANDOVER. A very full and successful year was recor~ed by th5s Nursing- Division at their annual general meettng held 10 Gale's School on Thursday, February 13th. Mrs. A. J enkins (President) was in the chair. . The total duties for the year numbered 1,133 and dnlls 4- 7. A considerable amount was added to the funds through the medium of dances, etc. The bed for the Town Ambulance was purchased, and £35 was contributed to the Ambulance Fund. During the year the cadets had stud~ed hou:ecr~ft and sio-nalling and all entrants had passed their examtnatlOn. t> During the evening Mrs. Mackenzie, County Officer, presented awards to members.

County of Lancashire. ATHERTON. The annual party of the Atherton Ambulance and Nurs-

ing Divisions was held in the Church House on l\larch 1st. After tea, Councillor C. Fletcher, J. P., President, introduced the new Commissioner of No.4 District, Major E. S. Burt Hamilton, M.C., and District Officer Miss K. Lamb to the party. Mrs. F. Wardley, J. P., Nursing Vice-President was presented with a fountain pen and pencil as a mark of appreciation of her service to the Divisions. A concert and dancing concluded the evening.

MERSEY DOCKS AND HARBOUR BOARD. To promote interest in first aid and to encourage recruitment to the Brigade, the above Ambulance Divisiop from their own funds have purchased a handsome silver cup, mounted on an oak plinth, for competition annually by members of the Division. The cup which has been named the " A. G. Curry Cup" to perpetuate the memory of one of the members of the Division who was lost at sea during the war, is awarded on a points basis for public duties performed, drill and first aid tests. On this occasion the cup was won by Francis G. Doran, Engineer-in-Chief's Dept., with 15 years service in the Brigade to his credit, and was presented at a formal dress parade of members at the head office of the Board by Mr. R. J. Hodges, the ~eneral manager and secreta:y, w~o is ~he Division's President. f r. L. Leighton, engineer-in-chief, Mr. J. D. J. Saner, one of his assistants, who are VicePresidents of the Division, Mr. C. Ree, assistant general manager, and Mr. T. E. Williams, the Board's supervisor of labour matters, were also present. Great credit is due to Private Doran in winning the cup which was keenly contested. The presentation was followed by an infor.m.a~ interchange of views between the m~mbers of the Olvl~lOn and the Board's officials on first aid and the Board s work generally, during which refreshments were sen'C'd .

LIVERPOOL. The following are some statistical details of the above Corps for the year ending December 1946.. .. . The Brio-ade in the Liverpool Area is dIVided Into ~ve Corps cromp~ising 30 Ambulance Divisions and 15 ~u.r~ing Divisions. There are also 11 Cadet Ambulance DIVISions and 5 Cadet Nursing Divisions. Total number of Presidents is 68, Surgeons 52, Officers 143, N.C.O.'s 156, and Privates 1,212. Total duties attended 17,219, total cases treated 4,084, removals by ambulance 220, mileage 3,626.

County of Leicester. MELTON MOWBRAY. A special 'bus took the Melton section ~f the Nursing Division out to Waltham where, for the 6rst time, the annual meeting was held, preceded by an excellent supper prepared by the Waltham section. . It was stated that during the year there had been 30 drills with an average attendance of 12 ; 42 cases h~d been treated and 112 duties performed. At Walth~m 21 drills had ta k en p Iace WI'th an average attendance of S!X and 15 cases

FIRST had been treated. Both the Melton section and Waltham section reported satisfactory bank balances. Aftertbe meeting games and competitions were arranged, followed by dancing.

County of Nottingham. NOTTINGHAM.

On March 5th in spite of the worst blizzard of the winter in Nottingham, a large gathering assembled at the Scout Hall, to witness 17 boys from various Divisions of the Corps being enrolled as cadet members of the Brigade. Corps Officer J. E. Potts who officiated, stressed the importance of the Code of Chivalry which would help cadets to become good citizens as Crusaders of old Faithful in small things and Master of many. The Chairman, County Officer G. Lodge, speaking on "Character Building" said, "The St. John organisation has a real contribution to make; boys are given a background which will help them individually and which collectively, will help the country." ' The programme was organised by Senior Cadet Officer E. A. Holton, who has the confidence and respect of his collea~ues. Some ~~r?, yet interesting work is being done, to bUlld up the D1v1s10ns which were started during the war.

FIRRT

AID Orchestra. A Cabaret was presented by Miss Chater's School of Dancing. STOURBRIDGE.

Mr. C. Davies has relinquished the position of Supt. of this Division and has bee~ ~ransferred to the Brigade Reserve. He has an assoc1atIOn of over 32 years with the Brigade. Mr. O. F. Sawtell has been nominated to succeed Mr Davies as Div. Supt. He has been a member of the Divisio~ for 17 years, and has seen service in the R.A. F.

West Riding of Yorkshire.

------.--.------

RAILWAYS. County of Oxford. WOODSTOCK.

The Woodstock Division members mourn the loss of their oldest member, Sergeant Thomas William Hine who died on February 25th, in his 57th year. He had been a member of the ~ivision for 41 years, and was employed by the G. W. R., be1l1g also a keen ambulance worker in their Division. He took his first aid certificate on June 12th 1906. He held the post of Divisional Secretary for a time ~nd received the long service medal in 1937. ' ' He was very popular with all, and his loss will be felt by many who live in the locality to whose aid he always gave h1s expert knowledge of first aid in their sufferings no matter how small. '

County of Somerset.

London, Midland and Scottish. ENGLAND AND WALES.

The 21st annual report on the work of the Ambulance Movement for the twelve months ended June 30th, 1946, states that there has been a small increase in the numbers passing examinations. Four Meritorious First Aid Certificates were awarded. The number of Long Service Medals awarded in England and Wales since the formation of the Centre is 4,956 i ,!3ars, 20 years, 2,421; 25 years, 1,158 i 30 years, 536; 3~ years, 202 ; 40 years, 51 ; 4S years, 7. Two members had the honour of Officer (Brother) conferred upon them and 13 the honour of Serving Brother. The Final Ambulance C?mpetition, 1946, was won by Uttoxeter, and the International Ambulance Competition 1946, by Crewe Works Machine Shop" B." The Women'~ Ambulance Competition, 1946, resulted in a win for Horwich.

BATH CITY.

Mr. E.r~est Tovey, a member of the well-known Bath firm of 0l?t1clans, recently gave an interesting lecture, illustrated .by sltdes and charts, on "Health and the Eyes," to an aud1ence of members at their ~eadquarters in Pulteney Mews. Mr. Tovey commenced h1s talk by giving a brief outline of the struc.ture of the eye, in order to assist his audience in understanding some of the eye ailments to which he subseq.uenlly ref~~red, and then passed on to explain some of the senous condItIOns that could jeopardise the sight such as cataract, trachoma, scotoma, etc. ' At the con~lusion of the lecture, many questions were ?-ske.d, upon .Wh1Ch Mr. Tovey gave a great deal of interestmg 1I1formatIOn.

County of Worcester. MALVERN.

A Ball organized .by the. j?i.nt committee of the Malvern Ambulance and Nurs1l1g Dlv1sIOns was held at the Winter Gardens, Malvern. The bad weather prevented alar e attendance but there were about one hundred dance rs preg t M ' . sen. USIC was prOVIded by Billy Gammon and his

Southern. BASINGSTOKE.

A most successful class individual competition was held recently at the Great Western Hotel, Basinastoke for the " F rancts . " an d" Who1te "C ups and prizes. :The :., tests consisted of 1 practical and 2 questions. Practical.-The ~rst aider returning home late on a foggy December even1l1g, finds a man lying in the road near the grass verge, immediately outside an isolated house in the country. The patient was suffering from severe degree of secondary shock and fractured base of skull, lacerated wound of the nght forearm. Equipment in house as normally would be available. Questions.-1. To what use may bystanders be put? 2. What are the necessary qualifications of a good first aidor? The prize winners were announced as follows :-1st ;nd " Francis" Cup-Mr. P. Hocking (Barometer)' 2nd and "~Who1te "C up- M r. A. Garrett (set of carvers) ;' 3rd-Mr. W. Owen .(cut glas.s dish) ; 4th-Mr. A. Gorier (fountain pen). B~g1l1ners Pnze- Mr. A. Hobgen (bread knife). Th~ Judges for the competition were Drs. McLean and Romanles, and arrangements were made by Class Secretary Mr. A. Francis, Driver, Basingstoke.

12 9

Practical Nursing in the Home. By AGNES E. PA. VEY, S. R. N., Diploma in Nursing (University of London).

THE PATIENT'S TEMPERATURE AND ITS SIGNIFICANCE.

CASTLEFORD.

The annual general meeting of the above Division was held recently, and the reports of the Div. Treasurer and Div. Secretary indicated a very satisfactory year in finance and work done. During the past year, 582 duties were performed, 1,269 reported cases treated, 525 drills and practices put in by a membership of 55. Effort is being made to reform the Division Silver Band.

AID

To be healthy, the human body must maintain a constant temperature whatever the temperature of the surroundings. It must not rise on a hot summer day or fall during a freezing day in winter. Moreover, it must remain at the same degree when one goes out of a warm room into a biting wind or a snowstorm. So that, in order to have some reserve of heat, the body must always produce more than is actually required, and it must be able to lose the excess. To obtain this balance under changing conditions, the body needs a heat-regulating centre in the brain. Heat P1~oductz"on.-- We produce heat in two ways--(1) by the burning up of food, particularly carbohydrates and fats, in our muscles, and (2) by chemical processes in our glands, particularly in the liver, which is the largest gland in the body. The blood in the vessels passing through muscles and glands takes up heat in the same way as water passing through a boiler of a furnace would do, and the heat is distributed to all the tissues that are supplied with blood in the same way as a large building can be heated by hot water pipes and radiators. Heat production is greater in strong, healthy, energetic people than in weak, undernourished lethargic people; but during sleep, when the muscles are not acting and glandular activity is reduced, heat production is at its lowest; so we need warm coverings to conserve the heat of the body. Excitement, worry, nervousness and anger tend to increase heat production, and any factor which depresses the nervous system, such as shock, will lessen the production of heat. Heat Loss.--We lose heat to a slight extent through the excretions of the body, and . continually through the expired air. We give off a certain amount by radiation and by conduction from the body, but the main source of heat loss is by a process of slow evaporation of moisture (sweat) from the skin. The skin is continually exuding moisture. This moisture, however, does not become obvious so long as the amount is not excessive and the atmosphere is not too humid for evaporation to take place. It is estimated that at least one pint of water is lost by the skin each clay by what is known as "insensible perspiration, II the skin not becoming obviously damp, although

this amount might be multiplied several times during profuse sweating. Heat Regulation.-- The mechanism in our bodies by which heat production and heat loss is balanced, so that the tern perature of the body remains constant, is controlled by a centre in the medulla oblongata of the brain. \Vhen the heat loss from the body needs to be checked, all the small blood vessels in the skin, which have muscular tissue in their walls, contract so that they hold less blood. These vessels supply the sweat glands, and when they are contracted the sweat glands cannot secrete much water from the blood in them. \iVhen, on the other hand, the body needs to be cooled, the blood vessels in the skin dilate and the sweat glands become more active. The sweat exudes on to the surface of the skin and heat is taken from the body in order to evaporate it. In health, the balance between heat production and heat loss is constantly adjusted so that the temperature of the body remains at approximate1y 98'4 degs. F. whatever changes occur in atmospheric conditions. This level is therefore regarded as the normal human temperature. People differ a little in this respect. Some, although perfectly healthy, never have a temperature much above 97 degs. F., but it is seldom that a normal tern perature exceeds 98'4 degs. F. In most people there is a slight daily swing, the temperature being lower in the morning before much muscular activity has taken place, and higher in the evening, but the fluctuation does not involve more than one degree. Fluctuations z"n Dz"sease.--In disease, when abnormal activity is going on in the body, alterations in the heat-balancing mechanism occur and the patient's temperature may rise or fall. The degree to which this alteration occurs is often an important indication of the patient's condition and of the effect of treatment. It follows, therefore, that the taking and recording of a patien t's tern· perature is an important nursing duty. A high temperature is sometimes part of the body's defence against invading bacteria or germs, which are weakened by the heat. So that it is not always advisable to reduce a high temperature, but if it is continued for too long the patient may become delirious and dissipate his remaining strength by his restlessness, and in any case a prolonged

FIRST

13 0

high tern perature has serious resul ts, for the fuel reserves of the body are used up, and even the tissues themselves may be com busted. TAKI~G

THE TE~IPERATURE. A clinical thermometer is used. This differs from any other type of thermometer in that it is graded only within the comparatively narrow limits of 95-110 degs. F., and it is self-registering. The temperature can be taken in the mouth, the axilla, the groin or the rectum. The Mouth.-Having ascertained that the mercury in the thermometer is shaken down to below 95 degs. F., the bulb is placed under the tongue and the patient is asked to close his lips upon the stern and to hold it in position for one to three minutes, according to the time stated on the tbermometer as being necessary for it to register a temperature correctly. It is then removed, the height of the mercury is read and recorded and, after shaking it down, the thermometer is washed in cold water and is placed in an antiseptic solution, or is wiped on a piece of clean rag or cotton wool and returned to its case. In order Iha: the temperature shall be correctly recorded, the patient should not take a hot or a cold drink or have been smokilJg immediately before the temperature is taken in the mouth. The mouth is the most accessible and convenient situation for taking the temperature in most cases, but it is unsuitable for children and for patients wit~ difficult breathing, or who are coughIng or sneezing frequently. If the nasal cavities are "packed" or the patient is hysterical, delirious, mentally unbalanced or unconscious, the temperature must not be taken in the mouth. If the patient inadvertently breaks the thermometer whilst it is in his mouth, no harm is done unless he swa.llows glass-which is unlikely considering the thickness of the stem, but he should be given a mouth wash, and if it is feared that he may have swallo\~ed some of the mercury he should be given the white of an egg, for albumen combines with mercury to form a harmless compound. . ~/~e AxZ"lla.-Jt must be seen that the armpit IS qUite dry or the thermometer will not register proper!y, and there must be good contact between ~he skin and the bulb of the thermometer, which IS placed well into the armpit. The arrr. is folded a~ross the chest with the fingers towards the opposite. shoulder. This method is not suitable for patients who are perspiring freely or for very thin people. The Groz"n.- This is the most suitable method for small children. The skin area is dried the thermometer is placed in posi tion and is held st~ad y by crossing the legs.

. The Rectum.-The bulb of the thermometer is slIghtly lubricated with vaseline and is inserted

FIRST

AID into the rectum for a distance of one to two inches, the nurse holding it whilst it registers. This is the only situation in which an infant's temperature can be taken. The legs are usually held vertically to the body in the same position as when changing an infant's square, the nurse then having complete control of the baby's movements. For patients with pulmonary tuberculosis who have distressing coughs, are very thin and are perspir!n~ freely, it gives the only accurate reading, and It IS a useful method for extremely ill patients when the other methods are unsatisfactory. Rectal thermometers have a short thick bulb, but the ordinary clinical thermometer can be used provided that it is kept separate from any other thermometer and is disinfected satisfactorily. Unless an adult patient is extremely ill, he can be taught to insert and hold a rectal thermometer for himself, the nurse standing by whilst it registers. "\iVhichever method is used, it should be adopted throughout the illness, for there is a variation in the temperature as .taken in the different parts of the body. The skIn temperature, as taken in the axilla or groin, is! to 1 deg. lower than the mouth temperature, and 1 to 1 t degs. lower than the rectal tern perature.

Injuries in Coal Mines. By J. W. SCOTT. (Concluded jrom page I 2S.)

FACIAL INJURIES.- \Vounds of the face are often dreadful in appearance and, if very severe, are usually fatal. Shock, haemorrhage and obstruction of breathing are the principal dangers, and some advice on these is not out of place. SHOCK.-This is treated in the ordinary way, but special attention might be given to encourage the patient, remembering that the mental effect on the person of such an injury tends 'to produce shock out of proportion to its severitv. Such remarks as " These face wounds do very~ well "-" It is in a good place for healing "-" I think it can he fixed all right" made in the hearing of the patient, do much good. Hot drinks like warm sweetened tea are very useful. and should be giv~n if procurable, but a small piece of rubber tubIng or even the spout of a small teapot may be necessary to administer the fluids In the more severe facial injuries. ~.tEMORRHAGE. - Bleeding is usually profuse, b~t In general responds well to dressing applied directly to the wounds. Occasionally, if branches of larger arteries are involved, digital pressure by the thumbs on one or both facial arteries may be needed if the wound is below the level of the eye-

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AID

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S.J.A. HAT for Officers and Ambulance Sisters. 18/ .. Box and postage 2 I. Badges obtainable only from H.Q. Hats stocked in sizes :6f, 6 ~ , 6 ~ , 6*, 7, 7 ~ , 7t, 7~. Storm Cap 17/ 11. Box and postage 1/ 4. S.J.A. CAP for Ambulance Sisters. 27 x 18 ins. or 28 x 19 ins. 33. Embroidered cross on front.

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13 2

FIRST

brows. Serious bleeding from the tongue is often troublesome, but can be checked practically always by grasping the tongue, or what remains of i~, an? drawing it forward into the mouth and keeping It there. OBSTRl'CTION OF BREATHING. - Immediate attention to breathing may be needed because the air-way has become blocked by blood clot, broken dentures or fragments of bone which have become lodged in the back of the throat. When the lower jaw is badly fractured, the patient's tongue tends to fall back into the throat and choke hIm. It must be pulled forward by the fingers at once and held forward, a piece of gauze or a handkerchief being used to prevent it slipping from the grasp. THE TRANSPORT OF FACIAL INJURIES.Death from suffocation caused by the falling back of the tongue has been common when the patient has been placed on the stretcher, and to prevent this, directions have been given that he is to be carried face down, with his head hanging over the end of the stretcher. A much better position now recommended is known as the semi-prone position. The patient is placed lying on the side of the facial injury, the lower arm is pulled out stretched above the head which is rested on this arm, the uppermost knee is bent up level with the pelvis, and the patient then turned sufficiently to cause this knee to rest on the stretcher. The patient's other leg is stretched out. The patient's free hand supports his injured face or, if necessary, holds out his tongue, and if, as is often the case, the patient is very restless, a loop of bandage is used to secure the bent knee. This method is now recommended by the surgeons who specialise in treatment of facial injuries. CHEST \VOUNDS. - Large ragged open wounds of the chest wall, with great splintering of ribs and a grave danger to the underlying lung, are unfortunately not infrequent. Dangerous shock and dreadful distress from difficulty in breathing result in a very high death rate. The patient's unhappy state is made worse by the awful fear produced by the horrid sucking sound of the air passing in and out of his wound. Immediate first aid and rapid transport give him his only chance. At once the wound should be sealed by covering it with the best dressing available. Vaseline spread thickly on lint is particularly suitable for preventing air leakage. He should then be well propped up so that the chest is raised and inclined to the inj ured side. The best shock treatment that is possible in the cicumstances is urgent. It has been pointed out by several surgical specialiBts that the patient will travel more safely propped up in the corner of the back seat of an ordinary car than by ambulance, and the difficulty of getting him into the car is more than balanced by the ease with which he travels. The sur-

FIRST

AID

J33

AID geons who have to deal with him later are of this opinion. ABDOMINAL WOUNDS. - Extensive torn wounds of the abdomen with a mass of bowel prbjecting are to be expected, although occasionally this type of wound is at once fatal, the person's chances of recovery are often better than might be expected from the appearance. As soon as possible the head and shoulders should be raised and the knees well bent, and the patient supported in an almost sitting-up position with the knees bent well up. Shock treatment is, of course, essential, but nothing is allowed by mouth; the lips may be moistened from time to time by a wet handkerchief to alleviate thirst. The v,round is covered with. the best available dressing laid over it, but not bandaged owing to the danger of crnshing the projecting bowel. The advantage of hot normal saline dressi ngs is considerable, if such can be obtained. PELVIC INJURIEs.-Crushing of the body in the region of the hips may result in grave perforation of the pelvic organs, especially to the bladder and lower end of the large bowel. Treatment for shock and a firm, but not too tight, binder round the patient are required. The customary warning not to attempt to pass urine is given. The patient may be transported in whatever position affords him the greater comfort. From a surgical view point, flat on the back has some advantages, but too ri gid adherence to this position may cause unnecessary suffering. SPINAL INJURIEs.-Large wounds to the back often accompanied by fractures to the spine are sometimes met with. The bone damage is not of itself serious; it is the injury done to the spinal cord by possible fractures of bone that are most disastrous. Intensive bruising or tearing of the spinal cord will be indicated by paralysis of the limbs below the injury. The utmost care is required in lifting these casualties. Help from others must be obtained to lift the patient in order to prevent the body from sagging. The instructions for the transport of spinal fractures have recently been radically altered. It is now advised that the patient be placed lying on his back on a hard flat stretcher, with his legs and thighs secured together, irrespective of the level at which the fracture may have occurred. The natural hollows at the small of the back and beneath the neck should be carefully padded up with folded garments so that the natural curves of the back bone are as far as possible preserved. HYSTERICAL PARALYSIs.-In the stress of severe accidents, cases of hysterical paralysis· of limbs, associated with some minor injury to the back, are not uncommon. In these cases the muscles tend to be held rigid rather than to lie relaxed and flabby, · but first aiders cannot be ex

(Contz"nued on page 136)

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Mr. Boyce-Mears advises most ~01:npetently on the building of the team, on tr~1I11llg for cc:>mpetition work, what to expe~t ill the test, diagnosis and examination routrne an~ comple.tes the booklet with a very useful and rnformatlve specimen of an average judge's mark sheet.

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134

FIRST

AID

Queries and Answers to Correspondents. Queries will be dealt with under the following rules : i.-Letters containing Queries must be marked on the top left-hand corner of the envelope" Query," and addressed to FIRST AID, 46, Cannon-street, London, E.C.4. 2. -All Queries must be written on one side of paper only. 3.-All Queries must be accompanied by a " Query Coupon" cut from the current issue of the Journal, or, in case of Queries from abroad, from a recent issue. 4.-The Textbook to which reference may be made in this column is the 39th (1937) Edition of the S.J.A.A. Manual of First Aid to the Tnjuf"('d.

Alkalies with Crush Injuries. T. P. (Hayle).-At a recent Divisional Practice the question was raised concerning the use of sodium bicarbonate in the treatment of patients suffering from crush injuries (see Supplement to Textbook p. 25). Presumably this would react with the hydrochloric acid in the stomach. If so I take it that it would be absorbed as sodium chloride and ask why we should not administer it as common salt. In our difficulty we turn again to you for help. One of the effects of a crush injury with its attendant shock is dilatation of the blood vessels and especially of those near the surface of the body. This has the effect of lowering the blood pressure. The treatment, therefore, consists of the administration of alkaline liquids for the dual purpose of raising the blood pressure and of counteracting the poisons which arise from the crushed tissues and have an acid reaction. Further, the administration of sodium chloride might cause vomiting which would be injurious to the patient and which will not arise from the use of bicarbonate of soda.N. CORBET FLETCHER. Examination Howler. L . R. (Charlton Park}.-In a recent examination the doctor asked one candidate to define a rupture and was much amused when he replied-" A rupture is the prostitution of bowel through tJze walls oj the abdomen!" Good! Next, please! !-N.C. F. 'treatment of Frost Bite. W.P. (Burnley).-In the answer to Question 5 of Fi1'st Aid Quiz which was published in the January issue of FIRST AID and which deals with the treatment of frost bite we are told to "bathe the affected part with a weak antiseptic lotion and to "avoid rubbing." The Textbook, 'however, on p. 182 tells us to use" mild friction and the application of dry gentle warmth." Please explain these apparent contradictions and accept our best thanks for your answer to this query and for your very interesting and enlightening replies in the past. As the result of frost bite the skin hardens and may crack. Consequently the suggested application of a mild an~iseptic lotio~ seems to anticipate the possibility of some leslOn of the sktn and to be of the nature of precautionary treatment. Personally I am of opinion that you should stand by the instructions of the Textbook. -N. C. F. Burst Varicose Veins. A. M. (Stratford).-Amongst the members of our First Aid Class we have two teams practising for competitions' and there is a difference of opinion with regard to inter~

pretation of the Supplement to the Textbook. So I have been requested to ask for your valued opinion on the three questions set out below. First, in the treatment of a burst varicose vein, is it correct to suppose that the old standard treatment as laid down in the Textbook has been superseded and that the bandage above and below the wound is now ruled out? The treatment of a burst varicose vein as set out in the Textbook has been modified in the Supplement (Rule 9, p. 26) to the extent that the bandage below the burst vein is abolished and also that the bandage above the vein is only to be applied when bleeding is uncontrollabl('. The reason for this change is the result of experience which proves that direct pressure will control the vast majority of bleeding wounds.-N.C.F.

FIRST

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What a gratifying experience it is to find that the skin no longer irritates, and has become clear and healthy again. Germolene has helped many a skin sufferer to get rid of his, or her, complaint ... and it is interesting to know why this should be so.

Petrol for Wounds. M. T. {Hoxton).-Recently I was told that in an emergency, petrol can be used for the treatment of wounds; and that in factories where petrol had been introduced for this purpose, the number of re-dressings had been considerably reduced. We welcome and thank you for your comments on this point. Petrol is certainly an antiseptic and is used by some surgeons for the preparation of the skin previous to operation. Further, to some extent it will control bleeding. The chief drawback to its use as an antiseptic is that it may prove an irritant; but this is negligible if, as has been claimed, petrol can be relied upon to ward off tetanus in accidents in which wounds are contaminated by soil from the road.-N.C.F.

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There are three reasons why in the treatment of fractured clavicle the coat should be removed at an early moment ; (1) To alleviate pain caused by the weight of the coat on the fractured clavicle; (2) To ensure the placing of the large pad well within the armpit; and (3) To assist subsequent treatment because the coat must be removed before the patient can receive medical aid, -N.C.F.

135

ADAM, ROUILLY Be CO.,

Foreign Body in Wound. A. M. (Stratford).-Secondly, is direct digital pressure to be applied over a foreign body in wound or subjacent fracture, or should the dressings be applied round the wound in the manner of a ring pad and without direct digital pressure? While I agree with you that the Supplement is not as definite as it might be on this point, yet I note that Rule 8 on p. 25 insinuates that in cases in which a foreign body is present in, or a fracture subjacent to the wound, direct digital pressure should be avoided.-N. C. F. Treatment of Venous Baemorrhago. A. M. (Stratford).-Thirdly, if haemorrhage is not controlled by the direct method in the case of venous haemorrhage and it is considered advisable to apply a rubber bandage, should this be applied on the heart side of the wound? Yes.-N.C.F.

Treatment of Fractured Clavicle. M·l. (Boston).-Please tell me why the Textbook tells us to remove the coat of a man suffering from fracture of the clavicle.

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FIRST Stretcher Exercises. R. Y. (Melbourn e, ' Australia). - :'day I a s k, Sir, for your ruling on th e position of the hands of Bearers No.1 and 3 in usin g the alternative method for that laid down in Rule 6 of S tretcher E xercises, on pag e 31 of the Supplement to t he T ext book, as shown in th e footnote. T o u se this alternative, does No.1, having linked his left hand with the left hand of No.4, maintain support of th e t hig hs by linking his right hand with the rig ht hand of No. 3? If so, wha t su pport does No. 3 rend er wi t h his left hand ? Or does Bearer No.1 alter the position of his right hand from thigh s to hi ps, linking there with the right hand of N.o. 3, lea ving th e left haud of No.3 free to s upport th e thi g hs ? In practice, our observa ti ons ha ve been that in the fo rmer, No. 3 is in con venienced by the uncomfortable position of his ri g ht hand, but Bearers 1, 2, + and the pat ient m ost comfortable. In the latter, the patient was not as comfortable, while No. 3 had unequal purchase in liftin g, hav ing his right hand midway under th e hips and h is left hand embracing both thig hs. Also sli g ht di sturba nce of t he pa tient was noticed in two pair of hand s being worked in to position from the natural holl ow of th e loins. We eagerl y awa it your reply, and Sir, your comm ents will be g reatl y appreciated. Th e exac t posi tion of the hands of the Bearers must be m odi fied in accorda nce w ith the len g th and wei g h t of the patient so th at, as fa r as is poss ible, all four Bearers take an equ a l s hare of th e burd en. In my opinion the linking of ha nds by Bearers Nos. 1 and 3 is the more effective method. -E.T. M.

( Continued fro m p age I.J2.)

pected to distin g uish this type of casualty from the real spinal injury , and s hould always treat as for a fractured spi ne. ASP HYXIA.-Cases of asphyxia may occur in accidents from either drowning in flooded areas, g as and / or rarel y from electric shocks. Because of its many advantag es, the Schafer method of artificial respiration should be used unless it is physically impossible to turn the patient over into the fa ce-do wn position. When for some reason the patient cannot be turned, the Silvester method will have to be employed. The other methods of artificial res piration are hardly worth considering from the first aid ' point of view. When instruction is given in the Silvester method, much importance is attached to the pulling forward of the tongue by an assistant, but it is proved in actual practice that if a really firm support is placed beneath tbe patient's shoulder blades so that his head is weIl tilted back and turned to one side, that obstruction of the air way from his tongue falling back will not occur. A person's chances of recovery from asphyxia are immeasurably improved if a mixture of carbon dioxide and air is administered while artificial res pi.ration is. being carried on. A very simple and Ine:cp~nSlve .apparatus is all that is required, and thIS IS avaIlable at the majority of Fire Stations, or at stations the addresses of which can be obtained from Local Authorities.

AID

FIRST

To conclude this paper, I will say something of the signs of approaching death. In more than half the cases a period of insensibility precedes death. The face is pale and grey, the nose pinched and cold, the eyes glazed and sunken, with the lids half closing over them. The breathing is deep and noisy, except in death from haemorrhage, when it tends to be shallow and sighing in type. Finally the head is drawn back and the chin jerks up with each indrawn breath. The lower jaw drops, the eyes become fixed, slight convulsive movements of the body take place, and the death rattle of mucus in the wind pi pe is heard and the end comes. Comfort the dying. Your duty is to the living, but if you ca:1 be spared from other work, lend your aid to tho~e about to die; your patient knows that he is dying and he feels very lonely; your touch will comfort him. Support him in your arms so that he rests against you, and grasp him firmly by the hand. If possible, let him face a light, even if it only be the light of your torch, as he greatly fears the approaching darkness. After sight and sense of touch have gone, he will still hear your voice, so perhaps you may speak close to his ear some words of comfort.

Miscellaneous Advertisements. Ad vertisements with remittance should be sent to First Aid, 46, Cannon Street, London, E.C.4. Rate 3d. per word, min imum 45. 6d. Trade advts . 4d. per word , minimum 65. Box numbers Is. extra.

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RUPTURED ? FORGE T IT! Use Brooks Rupture Appliance- the new dis covery. Wonderful! No lumpy pads, no springs, durable, cheap. Binds and draws parts together quickly. Sent on trial. Catalogue free. Address: Brooks Appliance Co., Ltd. (718) 80, Chancery Lane, London, W.C.2. (718) Hilton Chambers, Hilton SLreet, Stevenson Square, Manchester, 1. FIRST AID Cq mpetition and Practice Tests. 3 series each of 6 Team, 6 Individual, 6 Oral. Including supplement revisions. Excellent testimonials. Each price 2/ -, postage 1d. From: Robinson, BCM / Superb, London, W. C.1. FOR SALE. B.R.C.S. Officer's Uniform. As New. No Coupons. Height 5 ft. 10. in., Chest, 39, inside leg 32. 98, King Street, Knutsford.

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OPHTHALMO-ANTIPEOL con tains in a se m i-flu id base. the sterile vaccine filtrates of STAPH YLOCOCCI, ST REPTOC O CCI. B.PYOCYANEUS, PNEUMOCOCCI FRAENKEL and GO NOCOCCI. IN DICATION sn : Conjunct ivitis. blepharitis, keratitis. dacriocystitis>-and all inflammatory conditions and letions Of the eye.

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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.

Subscriptions, Advertisements and other business Communications connected with FIRST AID should be forwarded to the Publishers. & Co., LTD., 46, CANNON STREET, LONDON, E.C.4.

DALE, REYNOLDS

Full catalogue of Ambulance fqull>ment No. 7A wiJI be sent on reQuest.

'----------- GREAT PORTLAND ST., LONDON, W.1 . .

Telttraphic Address-" Twent"l-/our, London." Telephone-City 37 ro. KARVAL/D. WESDO. LONDON

Editorial.

S~l't0nal

News from New Zealand.

ANTISEPTIC &OINTMENT For Works, Factories and Ambulance Outfits.

Septonal cleanses and heals wounds with amazing rapidity. Prevents and arrest~ inflammation . A safeguard against blood-po:soning. Possesses extraordinary styptic properties. In liquid form Septonal is supplied in 16 oz. bottles at 3/-, quart 6/ ·. ~ gallon 9/6 and 1 gallon bottles at 17/ - per bottle, cnd in concentrated form in 2 oz. bottles, for making up 1 gallon, at 14/- per bottle. Septonal AntiseptiC Ointment This ointment is most useful for boils, minor inj.uries and skin troubles. Available in i lb. jars at 2/3. ~ lb. 4/- and 1 lb . 7/6 per jar. Make sure you include Septonal in your ambulance outfits. We hold stocks of Surgical Bandaoes Dressings, Lint, Cotton Wool ~nd all First-Aid requisites.

. and equally important are the facts that a Pre-heated

engine means instant and effiCient lubrication -thereby saving cylinder bore and piston wear -an aI/-round saving of time and money-and what's more-your battery charges and stays , up,' for instant, easy;starting ! " No ENGINE Complete Wit h 0 U t Pre·h eat. Write to-day (or (ully illustrated brochure and instructions (or fitting to Dept. F.A.S.

Be on the "safe" side-Septonal will meet every First-Aid need.

THE I. D. L. INDUSTRIALS LTD. 1, ST. NICHOLAS BUILDINGS, NEWCASTLE-ON-TYNE, 1.

The

Its aim and object being the advancement of Ambulance Work

C. Illustrate. the same Gear WIth the top stretcher frame !tinged down for use when only one stretcher case is carried.

-: .Phone.' ' Langharri'. I049.

READERS.

m all its branches, the Editor invites Readers to send Articles and

for loading.

FI1{5T AID is published on the :loth of each month. Annual Subscription is 58. post free; single copies 4d.

Shows the two stretchers in position.

B. Shows the top stretcher lowered ready

Te/ellra9hlc Addresl:-

APRIL, 1947.

No. 634.-VOL . .LIII.

The Gear Illustrated (A.B.C.D.) carries two stretchers on one side of Ambulance. leaving other side clear for sitting patients.

CALDWELL HEATERS,

448, Barking Road, London, E.6 SALES & SERVICE: Phone Grangewood 5020. WORKS Grangewood 1236

1T is always a pleasure to hear from friends overseas, and we read with more than usual interest the annual report of the Canterbury and West Coast Centre and District, Order of St. John, which has been sent to us from New Zealand. This is the 61st annual report, and it is good to see that in a busy year the high standard of efficiency as set over a long period of time has been sustained. New Zealand, of course, was the pioneer in the whole of the Empire as far as St. John's work was concerned. The Dominion holds the highest record for cadet training, not only in any Dominion, but on population, in the whole of the British Empire, whIch is definitely something to be proud of. The figures and details given in the report show that much hard work and effort have been put in during the year, especially in the transport of the sick and injured. The invalid transport of the Centre, for exam pIe, shows that there was a total of 10,245 calls, and a total mileage of 96,861 ; and 10,226 cases were transported during the year. These are only figures and may convey very little except to those who have knowledge of such matters, but, as the Chairman, Mr. B. J. Mckenna, J.P., justly remarks) the united

efforts. of . the Association and Brigade in this human1tafl~n work have gained a better public understandtng and appreciation of the service which is given voluntarily by the Order to them. Glancing through the reports of the Sub-Centres which .are included, one senses a grand spirit of enthustasm and keenness which augurs well for the future. Their problems and difficulties are just as ours, and this , of course, is to be expected, because ambulance work the world over is an int~rnational .affair working for one end, despite dtfferences in locality and climate. But there is more to it than that, for there is a comradeship amongst those who are bound together in the service of others which knows no national boundaries. This spirit was admirably described by Lady Louis Mountbatten, when she spoke to the workers of St. John in Christchurch during the year-II I know you are intending to extend your work to cover service wherever it is needed," she told them, "and I do feel that this great family of of ours, this great team spirit I find throughout the Empire wherever I go, and which is so very typical of our very much loved Order and Brigade, I feel that it is a big potential force for improving the world, and for ensuring the future peace of the world." That is a sentiment with which all ambulance workers will agree. To our friends in New Zealand we offer our congratulations on the fine results of a hard-working year, a nd our best wishes to them in the grand work they are doing.

IN THIS ISSUE. NEWS F ROM NEW ZEALAND A

139

COURSE IN ADVANCED FIR ST AID

By A. D. Belilios, M.B., B.S.(Lond.), D.P.H. Eng.) LETTERS TO THE EDITOR

140 142

FIRST AID QUIZ

142

AMBULANCE NEWS FROM ALL QUARTERS...

143

PRACTICAL NURSING IN THE HOME.

By Agnes E. Pavey, S. R. N.

146

REVIEWS

148

QUERIES AND ANSWERS TO CORRESPONDENTS

150

FIRST

AID

A Course in Advanced First Aid. By A. D. BELILIOS, M. B., B. S. (Lond.), D. P. H. (Eng.).

AILMENTS OF THE RESPIRATORY SYSTEM.-( Con-

Nnued.} No article on first aid emergencies of the respiratory system would be considered complete unless it contained some mention of asphyxia. This complaint is already dealt with in the standard textbooks; a full description would occupy several articles, and would be unnecessary. It is worth while, however, to discuss briefly a few aspects of the subject. The first point to realise about asphyxia is that there are two degrees of severity-partz'al and complete. Partial asphyxia occurs when the obstruction to breathing is incomplete and the patient can still succeed in obtaining small supplies of oxygen just sufficient to support life. The patient experiences considerable difficulty in his breathing, which becomes jerky, irregular and accompanied by coughing, spluttering and fighting for breath. Sometimes bloodvessels burst in the eye, producing large red patches in the white of the organ, called subconjunctional ht:emorrhages. Unconsciousness follows, quickly or slowly, according to the severity of the case. A characteristic feature is the change of colour of the patient, which affects particularly the lips, cheeks, ears and finger-nails j these develop an ugly bluish hue, which is called cyanosz's. An important exception to cyanosis is found in carbon monoxide poisoning, when the lips, etc., become much pinker than normal. This exception must never be forgotten. First-aiders who think that every case of asphyxia is cyanosed fall into a serious trap if they assume that the lovely pink colour of a pati~nt rescue.d from coal gas, etc., is a sign t~~t h~ IS not serIously affected j usually his condItIOn IS more serious than one that is cyanosed. Complete asphyxia occurs when the victim is unable t~ obtain sufficient oxygen to support life. The patIent loses consciousness and breathing ceases. Soon afterwards the heart stops beating and death takes place. . Caus~s of Asplryxia.-Many students have dlfiiculty In remembering the numerous causes of asphy~ia. This I?roblem, however, is easily overc?me If the first-alder has in his mind's eye a good dIagram of the respiratory system. He can then classify the causes as follows :_ A.

Causes acting w£thz'n the air passaaes(1) Water, i.e., drowning. b

(2) Breathing irrespirable gases, e.g., carbon monoxide fumes, etc'. (3) Foreign bodies, including food, false teeth, bl'ood and vomit. (4) Tongue "slipping backwards, e.g., in unconscious patients. B. Causes affecting the walls of the air passages(1) Swelling of the tissues of the throat, e.g., scalds and stings. (2) Diseases of the aIr. passages, e.g., growths. C. Causes acting from outside the air passages(1) H~nging, strangling, throttling, smothering, garotting, etc. (2) Pressure on the chest or neck. D. Miscellaneous causes.-Paralysis of the respiratory muscles caused by (a) electrocution, (b) pOisons such as strychnine, (c) spinal injuries, (d) diseases such as epilepsy. FIRST AID. (1) Removal of Cause.- This is obviously the first step in treatment. In many cases of partial asphyxia, e.g., choking, and in some cases of the complete variety, removal of the cause is in itself sufficient to re-establish breathing. When it is necessary to remove the patient fro~ the cause,' e.g., in coal gas poisoning or electrocution, the first-aider must never forget the possibility of danger to himself. (2) ArtzjicialResjJirat£on.-This mustbe begun immediately and continued unceasingly until the patient recovers or life is pronounced extinct by a doctor. (.3) General Principles.- These include undoing tight clothing, arranging for the transport of the patient to shelter, and the treatment for shock so far as applicable. Under no circumstances, however, should ancillary treatments be allowed to interfere with artificial respiration; they should be undertaken by other first-aiders or intelligent bystanders. (4) Oxygen and Carbon Dz'oxz'de.-If available, an extra supply of oxygen can be aiven to the patien t. . b Inhalations of carbon dioxide stimulate breathing by acting on the brain, and a few breaths given to a patient when breathing is shallow cause respiration to become much deeper and stronger. • Carbon dioxide should always be given cautiously,

PI R S T however, and only for short periods at a time. Six breaths or so should be followed by an interval of normal or artificial breathing. Many factories and ambulances are equipped with a special piece of apparatus, the N ovox apparatus, by which a mixture of 97 per cent. oxygen and 7 per cent. carbon dioxide can be administered. Affect£ons oj the Larynx.- Two diseases of the larynx are of interest to the home first-aiderlaryngitis stridulosa and laryn gismus stridulus. Both these conditions affect young children up to the age of five. They occur at night and cause considerable alarm to parents as well as to the patient. Each complaint consists of a spasm of the larynx. The. word "spasm" may be a new term to many first-aiders. It is applied to any condition in which there is excessive muscular contraction. Its effect on the larynx is to cause partial closure of the aperture through which air is conveyed from the throat to the lungs, and this, of course, produces great difficulty in breathing. It results, therefore, in temporary partial asphyxia. Laryngitis Stndulosa.- This usually occurs in children between the ages of two and five. The child develops a slight cold accompanied by a cough, or which the parents take but little notice. The child goes to bed quite normally and falls to sleep, but within a few hours wakes up in a state of terror with a severe attack of shortness of breath. Its breathing is accompanied by a peculiar" crovring," a brassy cough, and there is often marked cyanosis. The attack may last for several hours and is liable to recur for several nights. FIRST AID. (1) Reassurance. - Although the symptoms of laryngitis stridulosa are very alarming, the attacks are never fatal. Hence the the first-aider should at once reassure the parents that the child is in no danger and the attack will soon be over. (2) Posd£on.-The child can be left in bed, well propped up with pillows so that it can breathe more easily or, what is probably better, can be wrapped in a blanket and nursed by the fireside on its mother's lap with its head supported on her shoulder. (.3) Hot FO'lnentat£ons.- These applied to the larynx and renewed at frequent intervals may reI ieve the pain. (4) Steam Inlzalatz'ons.-A bronchitis kettle can be placed on the fire and its spout directed towards the child so that it will inhale the steam. The addition of friars balsam to the water in the kettle, although an advantage, may be omitted in order to save time. The doctor may order a steam tent. (5) Medz'cal Aid.-It is always necessary to communicate with a doctor. Since the attack

AID usually occurs at night, it is generally better to telephone and describe the symptoms as fully as possible, together with the treatment that has been given . . From this description, the doctor may be able to make further suggestions for immediate treatment to be carried out before his arrival. Laryngismus Strz'dulus.- This affects children who are about eighteen months old, and consists of attacks of partial asphyxia. Without previous warning, the child stops breathing and begins to struggle for its breath. Its face becomes congested and often cyanosed. After a few seconds, the seizure ends by a prolonged crowing inspiration. The attacks, which are liable to recur, generally occur at night or in the early morning; they are often precipitated by excitement or annoyance. FIRST AID. - This consists of relieving the spasm by dashing cold water on the face or tickling the back of the throat; hot compresses may be applied to the larynx. If the attacks recur, the child may be placed in a hot .bath and its head sponged with cold water. Professional advice is essential to investigate the cause of the condition and to prescribe treatment that will prevent future attacks. Pleurz"sy.- This is quite a common complaint and consists of inflammation of the pleura, the delicate membrane which covers the lungs and also lines the inside wall of the chest. The disease occurs in two chief forms, dry pleurisy and pleurisy with effusion. In dry pleurisy, the membrane becomes reddened, swollen, and covered with a slimy secretion, called exudate, which looks rather like a thin layer of butter; in pleurisy with effusion, however, a varying quantity of fluid collects between the two layers of pleura. Patients suffering from dry pleurisy frequently make an attempt to carryon their work, at any rate in the early stages of the disease, before they realise the complaint from which they are suffering, which they often mistake for a strain. Hence it is not at all uncommon for them to apply at an ambulance room for treatment. Pleurisy with effusion is, however a much more serious condition, causing the pati~nt to stay at home and call in a d~ctor; hence it need not be discussed further in this :trticle. The chief sym ptoms of dry pleurisy is severe pain in the side of the chest, ~hich is describe.d b'y the patient as stabbing in character. The paIn IS made worse by coughing or by deep breathll1g. It will be noticed that the patient breathes cautiously and avoids as far as possible taking a deep breath, which would increase the pain. Other symptoms include a dry cough and a slight rise in temperature, which, however, are not by any means always present. FIRST AID. (1) Tight Bandages.-Two broad

FIRST bandages may be applied tightly round the patient's body in such a man ner that .the affec:ed side of the chest can only move sltghtly wIth breathing. The treatment, therefore, is ver.y similar to that recommended for broken ribs. The bandages should overlap each other to ~ppro:,i mately half their width, and can be appl!ed with advantage over the vest, so that unnecessaryexposure of the patient is avoided. The bandage should be tied as tightly as possible, and, to ensure this, the patient should be instructed to deflate his chest and then avoid taking a breath while each knot is being tied. (~) General Prz'nc£ples.-A r ran Rem e n t s should be made for the patient to go home immediately and call in his own doctor. Transport by motor car or ambulance is desirable. While awaiting medical advice, he should rest quietly in bed j lying on the affected side sometimes relieves the pain. Fluids may be given liberally, and light diet if the temperature does not exceed 100 degs. F. (To be con hnued.)

Lerters to the Editor. We are in no way responsible for the opinions expressed, or the statements made, by Correspondents. -EDITOR. FIRST AID FOR ANIMALS. DEAR SIR,-As a member of the S.]. A. B. and fervent reader of FIRST AID I was very interested to read your correspondent's appeal for information regarding the necessary treatment in respect of animal injury. We are all capable of dealing with an injured person, especially when that person is able to give us some valuable information as to the history, pain, etc., but the animal is something different, and if we are able to relieve them of undue suffering by virtue of our ability to deal effectively with their injury, we are doing something worth while. May I take this opportunity of thanking you for a very valuable journa1.-Yours truly, York, Feb. 16th. W. JAMES. DEAR SIR,-I was interested to read in this month's Journal about first aid to animals. I should welcome some lectures on the subject. I have often been asked to help, especially when out in uniform. I have been a reader of FIRST AID for the past eleven years, and find the talks most helpful in my work-especially "our dear N.C.F."-Yours faithfully, Worthing, Feb. 6th.

L. WEST (Amb. Sister S.J.A. B.)

DEAR SIR,-I would much appreciate articles on first aid for animals and a rough idea of how best to bandage them. They would ,:dd to the enjovment of the magazine one looks forward to each month.-Yours etc., Birmingham, Jan. 30th. E. H. VIGURS. DEAR SIR,-I shall look forward eagerly to the articles " First Aid for Animals," as I too, have often been at loss in trying to relieve a cat or dog in distress. .

•

FIRST

AID May I take this opportunity of thanking you for the series just commencing" A Course in Advanced First Aid," this, I feel certain, will nil a long felt want. If, in your opinion, it would be worth while, would YOll again put before readers the suggestion I made some while ago, that some window sign be exhibited by qualified first aiders showing their wilIingness to be called upon in emergencies. -Yours faithfully, London, E.5, March 28th. L. COLE, F.r.C.A.P. DEAR SrR,-In your January issue you mention first aid for animals. I think it would be a splendid idea to have some articles on the subject. Both my wife and self are in the Ambulance Brigade, and people often ask us to help them with their pets, and seem surprised when we carmot assist. Please keep up the quiz, we think it grand. Wishing your book every success. -Yours truly, Ley ton, Essex, Feb. 5th. G. STUDZ. DEAR SIR,-As a regular reader of FIRST AID I would be interested to learn about firs( aid for animals, as also, I think, would other B. R.C.S. members · in Doncaster.Yours etc., Doncaster, Feb. 5th. F. SURRELL. DEAR SIR,-I for one, would be very interested to read some articles on the above subject. It is often needed, and little generally known about it.-Yours faithfully, Dorking, Surrey, Eeb. 18th. H. COLLINS. [The above are extracts from some of the letters we have received following J. Brinkley's request for some information on " First Aid for Animals. " We are pleased to advise readers that the P. D. S. A. have kindly consented to co-operate in this matter and that the subject will be dealt with in these pages in the near future. -EDITOR.]

---._.--First Aid Quiz. Questions. uncommon, but how

(3) Gentian violet is (a) · A poisonous flower, (b) Type of electric-ray, (c) A disenfectant. (4) In shock what is the cause of asphyxia? (5) What is a " narcotic" ? (6) Why do we apply witch hazel to bruises? Answers are on page 148.

Practical Poi nts. THE EDITOR invites readers to send in notes on actual cases attended or witnessed, making special reference to good and bad points in first aid treatment. All correspondence should be brief and to the point and addressed to "The Editor, 'First Aid'" (Practical Points), 46, Cannon Street, London, E.C.4. 2/6 will be paid for each item published.

143

AMBULANCE NEWS FROM ALL QUARTERS. St. John Ambulance Brigade. No. I (Prince of Wales's) District No. 135 (HARLESDEN). The above Division recently lost the services of a very capable Officer when O/Supt. S. J. Green was promoted to the rank of Corps Officer on H. Q. staff, and to mark the occasion, an informal dinner was held at the Silver Horseshoe Restaurant, Neasden, at which the Div. Surg. (Dr. H. M. Setna) presented to Mr. Green on behalf of all Officers and members, a handsome chromium and glass tray as a token of their esteem and appreciation of his services to the Division during the past twenty years. He also handed to Mr. Green, as a personal gift, a beautiful cigarette case, with his best wishes. Replying, Corps Officer Green said the gift had taken him completely by surprise and he wished to 1 hank all who had subscribed. Amb. Officer C. A. Lifford is Mr. Green's successor.

No. 119 (EpSOM AND EWELL). The annual general meetin~ of the above Division was held at their Headquarters on March 13tb. Mr. H. Leaney, hon. auditor, in opening the meeting said the Division was on a very sound financial footing. The Officer-in-charge. Supt. W. W. Lucas, in giving his report thanked all members for their help and co-operation during the past year, and he congratulated Pte. H. Canfield in heading the list both for public duties and for attendances at drills. This was the first time in the history of the Division that one member had carried this out.

(1) What is the common name for the thyroid cartilage? (2) Fracture of the sternum is would you treat?

AID

Nos. 30 AND 76 (E. LONDON). The annual general meeting of the Division was held at the Free School, Amb. Officer J. Spanjer, the President, occupying the Chair. The Superintendent stated that they now had only 52 members, as a number of non-efficient men had been struck off. He also stated that all returned ex-service-men would be equipped immediately with new uniforms, together with those members whose uniforms now needed replacement. Cadet Officer Webber made his report on C.23 Cadet Division j he stated that the call up of young men was depleting his strength iust at the crucial time, but that he hoped that they would return to the fold when their service was completed.

Nos. 93 AND 133 (FrNCHLEY). The above Ambulance and Nursing Divisions have been desirous for some time of obtainin~ new Headquarters, so that when the opportunity of taking over a large A. R. P. shelter in the Borough arose, they accepted. Eventually, the shelter was taken over and Supt. "Vood commenced to mobilise the craftsmen members of his Division to carry out the necessary alterations to the building. The shelter measures 40 ft. by 22 ft., and is divided by a blast wall length wise, thus making two departments, one

being used for stores and an office, and the other as the lecture and practice hall. Although there is still much to do, both Divisions are now meeting under very comfortable conditions. Parties of Brigade personnel desiring to visit these headquarters should telephone for appointment to Supt. Wopd, Colindale 8646 or Supe. Miss Harman, Enterprise 3691.

County of Berkshire. Major General Sir John Duncan, K.c.B., C.M.G., C.V.O., D.S.O., Knight of the Order has been appointed County President vice The Marchioness of Milford Haven.

During the recent floods in the County of Berkshire, the County Commissioner, Mr. C. A. Poole, placed the buildings, personnel and vehicles at the disposal of the County and Borough Authorities who made full use of them. At an enrolment ceremony for cadets held in Reading, a collection was made for the Mayor of Reading's Distress Fund and £7 6s. 1d. realised. READING. The number of boys and girls enrolled as cadets by the Vice-President Cadets. Buckinghamshire, Major P. M. Beachcroft, O.B. E., K.St.J., at Palmer Hall, West Street, Readin~, was 130. After an interesting speech by ~lajor Beachcroft, the County Commissioner then presented numerous "Var Service Certificates to Officers and members, and Nursing Cadet K. Clarke received the Badge of the Grand Prior.

County of Derby. DERBY AND DISTRICT CORPS. We are pleased to state that the Rolls-Royce Cadet Nursin~ Division is to be known, as from March 12th, as the " Rolls-Royce Student Nursing Division." This is the first Cadet Division in the Derby and District Corps to assume Student status.

County of Hampshire. ANDOVER. Mr. W. J . Armstead, President, Andover Division, was in the chair at the first annual meeting of the Cadet Division of which he is treasurer. The large attendance included parents and friends of the cadets. After Mr. Armstead had made a satisfactory financial statement, Cadet Secretary Hon. Sgt. 1\1. Hannon, said that 12 new boys had been received but five left the Town and the avera~e attendance was 13 and 1 ~ boys per week. . Supt. Harris stated that dnlls totalled 50 and publIC duties with Senior Divisions 17. The present strength was 27 cadets and 2 probationers. The meeting concluded with the presentation of awards

County of Kent. AYLESHAl\l. Amhulance work in the Kent Coalfield was further stimulated by the annual competition for the Snowdown

FIRST

144

Colliery" Welfare Challengp- Cup," held at the Snowdown Colliery Restaurant on Saturday, April 5th. . Five teams competed, and the judge was Div. Surgeon I. B. McCrae, Snowdown Colliery Division. The winners were No.5 Team-Div. Supt. H. Braithwaite (Capt.), L. Sullivan, P. Wilson, S. Causer and H. Brown, who gained 89 per cent. of the possible marks. The trophy was presented to the winners by ViceAdmiral Woodhouse, Chairman of the National Coal Board, South Eastern Division, who complimented the teams on their fine work, and also presented other awards to members. Mr. A. McKnight, President of the Snowdown Lodge, National Union of Mineworkers, moving a Vote of Thanks said that as a miner it was really encouraging to know that there were so many efficient first aiders to deal with the numerous injuries received in the mines.

County of Leicester. LEICESTER CORPS.

On March 26th the City Division held a reunion dinner for the returned members, at the Hotel Victory, Gt. Central Street. It was also the 65th year of the Division (Nov. 14th, 1882). Corps Supt. Dexter presented Long Service Medals to Amb. Officer l\Iartin and Corporal F. Lockton. Supt. H. W. Martin, father of Amb. Officer Martin, has served the Division for 45 years. An enjoyable evening was spent.

County of Lancashire. FARNWORTH.

A very interesting display took place recently, in connection with the Safety First Campaign. It was staged by the cadets of the Farnworth Division, under the command of Cadet Officer H. Kirk. The incident staged was : A boy had been knocked down by a cyclist and was found to be suffering from a fracture of the left arm and also a bruised knee, and the cyclist himself was under the cycle and found to have a fracture of the right thigh and a slight head wound. They were both ably attended to by the team of cadets. Several bandages were demonstrated later to a very interested audience. The boys were provided with light refreshments by the police. LIVERPOOL CORPS.

District Officer W. E. Searl, O.St.]., was invited by the Cadet Officers to attend their meeting on Friday, March 14th, to give a talk on the Cadet Movement. Mr. Searl gave a direct, clarifying talk on the relationship and position of the Cadet Movement. within the Liverpool Corps which was thoroughly appreciated by the Cadet Officers who attended, both Ambulance and Nursing. During the course of his remarks Mr. Searl said some Divisions lacked members because their leaders did not get ~own to the f~ct that they must, by their keenness, sympathy, Interest, vaned occupations, successfully compete with leaders in other Youth Movements, even with the call to youth of the. cinema, etc.. A Senoior Officer had an easy job compared With the manY-Sided demand which a Cadet Officer must recognise and accept.

LIVERPOOL

"A" CORPS.

The "Grace Cup" competition for Divisional teams within Liverpool "A" Corps was held recently at the Exchange Divisional Headquarters. Four teams competed and Exchange" B "team retained

AID the trophy which they have held since the inception of the competition. They were closely followed by Central "A" team who were only 1 mark behind.

County of Stafford. WEST BROMWICH.

The annual general meeting of West Bromwich Headquarters Division was held at Headquarters on Monday, March 31st, when Div. Supt. R. Sorrell was in the Chair. After the accounts had been presented and approved, a vote of thanks was accorded to the Treasurer, Amb. Officer C. Hudson, and to the Hon. Auditors, Messrs. Fisher Batty & Co. The main point in the Chairman's Report was that pUblicity efforts recently had so far failed to attract any recruits. In conclusion, it was announced that the Secretary, Hon. Sgt. F. Heckett was retiring and his conscientious services in the past were duly appreciated.

County of Warwick. COVENTRY MORRIS ENGINr::~.

The annual presentation dinner and social evening of the above Division was held in the Works Canteen on Friday, March 14th, and was attended by members of the Division and their friends. The Hctnorary President Mr. ]. Shaw (Managing Director) who presided, made the following presentations :_ The Coventry Central Corps Practical Test Trophy, and Quiz Competition Trophy, won by the Morris Engines Division, the Marvill Team Trophy (competed for annually by members of the Morris Engines Division) won by" C" team, the Hammond Individual Merit Trophy won by Pte. Lomas, and the Trophy awarded by the Coventry Central Corps Quiz Competition for the highest number of marks gained in that competition by any individual competitor, won by Cpl. Biddle of the Morris Engines Division. Also awarded were 19 bronze labels, 1 medallion and 3 vouchers. The presentation was followed by a very enjoyable programme of entertainment.

STOCKINGFORD AND DISTRICT.

On \Vednesday, March 26th, it was announced that Sgt. Stensfield of this Division had been promoted to the rank of Amb. Officer. The new Am b. Officer is very popular in the district, and he is also a member of the Rescue Team of the Haunchwood Collieries who were successful in gaining the Miners' Association Trophy at Wilnecote recently.

County of Worcester. HILL AND CAKEMORE.

The annu<l.l meeting of the Nursing Division was held in the Clinic Room, Hill Top Schools. During the year a Medical Comforts Depot had been started and also a Cadet Division. The Secretary reported 3 cases of first aid attended, 122 attendances at homes for nursing aid duty, 2 welfare cases were attended to by Miss Dye, 10 members attended annual inspection, 33 drills held during the year, with average attendance· of 9, and 4 members put in 72 attendances in connection with the training of the cadet recruits. Corps Supt. Miss F. M. Fearnside congratulated the Division on the work done during the year, in spite of the smallness of numbers.

FIRST

AID

OLDBURY.

Members of this Nursing Division competed for the Mildred E. Dyson Cup recently. The winner was Corporal K. Callagher, with Corporal N. D. Poole a close second. Mrs. S. Gould, Vice President, made the presentation.

Railways. Southern. GILLINGHAM.

Miss E. Ollis, who was Divisional Supt. of the Dudley Nursing Division for a number of years, has received the Insignia of Officer (Sister) awarded her for her great services to the S.J.A.B.

An ambulance" Quiz" was held recently at Gillingham, in which Gillingham and Chalham Town Nursing and Ambulance Divisions and Chatham Southern Railway Ambulance Class took part. Chatham S. R. team were the winners, and the Judge was Dr. Hoby. The winning team was presented with the" Gunn " Shield.

West Riding of Yorkshire. POOLE. ASKERN MAIN.

On Saturday, March 22nd, the members of the Askern Main Corps held their annual social for the presentation of awards, etc. About 120 members and friends had tea in the Colliery Canteen after which the company assembled at the Miners' Welfare Institute to be entertained. During the evening, Mrs. Jones presented the members of the Nursing and Nursing Cadets Divisions with their Certificates and Labels, etc., and the Corps President made the presentations to the Ambulance and Ambulance Cadet members of their Certificates, Labels, and .Service Awards. Addresses were given by the Corps President, Corps Surgeon and the Corps Supt. The entertainment was followed by a dance to the music of the Dominoes Dance Band.

A very enjoyable evening was spent recently by . the members of the above Ambulance Class and their wives on the occasion of the 21st anniversary dinner held at Lintlaw Lodge, Poole. Mr. S. L. Furnivall, Central Divisional Engineer, praised the men for their devotion to the first aid cause and said it was pleasing to note that Poole Class had still 5 original members who joined at the commencement of the Class in 1926. He also expre~sed the wish that many of the younger membets of the staff would join the Class and so help to keep up its fine record. Mrs. Furnivall, wife of Central Divisional Er.gineer, who, during the eyening, presented numerous first aid awards, offered to present a silver cup to be competed for annually by the Engineer's Department. Entertainment was provided by local artistes.

Priory for Wales. ROYAL

NATIONAL

EISTEDDFOD

"VALES

AMBULANCE

COMPETITIONS.

The Royal National Eisteddfod of Wales Ambulance Competitions will be held at Colwyn Bay from August 4th to 9th this year. The competition officials include The Hon. John H. Bruce, Principal Secretary and Commissioner for Wales, Mr. "V. Mabon Abraham, Drs. ·G. Pari Huws and T. C. Oliver, and Mr. Gwilym Williams. Full particulars of the Competitions, conditions of entry and entry form may be obtained from Mr. Elwyn Roberts, Eisteddfod Office, Abergele Road, Colwyn Bay. All entn'es 1Jmst be submitted by May I5th.

RYDE,

I.O.W.

Several members of the Ryde Ambulance Class recently held a competition in which they competed ' for the " Pioneer Cup." . The competition (a practical test) was Judged by Dr. Audrey MacLean of Basingstoke: . . The winner of the competItIon was Mr. A. TImms, Permanent Way Dept., Yarmou th, and he was presented with the trophy by Mr. Nicholson. The runner-up was Mr. Venables, Traffic Dept., Ning Wood. Dr. MacLean congratulated the Centre and put forward many useful suggestions for future competition work.

1.0. W. A competition to Brigade teams fro~ Hampsh!re and Isle of WiO'ht was won by a team representmg Eastlelgh St. John Amb~lance Brigade under the captaincy of Supt. E. S. Guppy. Four out of the five men in the team were members of the Southern Railway Staff. The winning team was presented with the Col. Triss Challenge Shield by Brig. F. B. Hurdall, l\1.C., Cou.nty Commissioner for Hampshire, who congratulated Eastlelgh on their success. The competition included uniform inspection, individual questions and practical work as well as a t~am .test. Eastleigh were the winners of the shield 10 1932, 19~8 and 1946 on each occasion Supt. E. S. Guppy was theIr captain. 'This team will now compete later on for the · District Final. HAMPSHIRE AND

CAERNARVON.

The Headquarters of the Caernarvon Division at 33, Pool Hill was opened by the County Commissioner, Sir Michael Duff, Bart., on Saturday, March 15th. During his remarks, Sir Michael Duff co?gratulated the members of the Division on the work done 10 the preparation of the premises, and hoped the acquisition of Headquarters would lead to an increase in the strength of both the adult and Cadet Divisions. After the opening ceremony was conc.luded a tablet erected to the memory of the late Trooper ClIfford. Lambert, R.A.C. (a former member of the Division) who died on Active Service was unveiled by the Commissioner. The Rev. E. T. Evans led the prayer, and in his address referred to the excellent and religious qualities of the late Trooper Lambert who was a member of his Church. The dedication ceremony was performed by the Rev. Canon D. Thomas] ones, Vicar of Caernarvon. Mr. E. S. Parry sounded the Last Post and Reveille. Those present were afterwards invited to inspect the Medical Comforts Depot which was recently started. A number of articles have fllready been loaned to members of the public.

The first number of The Institute of Certified Ambulance Personnel Ltd. Quarterly Re.\'iew has just been issued. Edited by Dr. Bedford-Turner, M.R:C.S., L.R.C.P., future issues will contain matters of first Importance to members and will prove a splendid medium for the exchange of views.

FIR S T

AID

• the Home. Practical Nursing In

FIRST

AID

ADAM, ROUILLY & CO., Duman Osteology, Anatomy, Etc.,

Even a splinter can bring trouble !

IB, FITZROY STREET. FITZROY SQUARE. LONDON. W.I Telephone: MUSEUM 2703.

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

TYPES AND DEGREES OF PYREXIA.

THE technical term for high temperature is pY1'exia. \Vhen 3. temperature remains high with little variation during the twenty-four hours it is known as constant or contznuous pyrexia. When there is a variation of several degrees between the morning and the eve ,1ing temperature although at no time during the twenty-four hours does it drop to normal, it is called remz"ttentpyrexia / whilst if the temperature is high at one part of the day but at another it falls to normal or below, it is said to be z·ntermz"ttent pyrexia. \Vith a fluctuating temperature the highest point is usually reached in the evening. A temperature which is high in the morning but low in the evening is known as inverse pyrexia. Special terms are applied to differer.t degrees of temperature, the following being the most frequently used : Collapsed temperature Subnormal temperature Normal temperature Subfebrile temperature :.Y1oderate pyrexia ... Severe pyrexia Hyperpyrexia

95- 97 degs. F. 97- 98degs . F. 98- 98·8 degs . F. 99-100 degs. F. 100-102·8degs. F. 103-104·8 degs. F. 105 degs. F. or over

Methods pi Reducz'ng a High Tempe1'ature.From the explanation that has already been given it will be seen that if a patient can be made to perspire 'freely his temperature will come down. Drugs such as aspirin and quinine have this effect, but they also have their dangers and they should not be given unless ordered by the doctor. It must also be remembered that a patient who is perspiring may develop a chill unless he is intelligently nursed. There is, however, much that can be done without recourse to drugs. The room must be kept cool and well ventilated, the bedclothes and the patient's garments must be light, cold drinks can be given . and a thin cloth, such as a small handkerchief, can be wrung out of cold. water and placed on the patient's forehead, it being renewed every few minutes. The patient can also be sponged with tepid water. Tepz'd Sponging.- This is a very useful method of reducing temperature, but it needs to be done with great care. Seyeral sponges and a bowl of

tepid water are required also an empty bowl, a jug of tepid or cold water, a cold compress for the forehead with a second one for changing, a large towel, a bath blanket and a fresh nightdress or suit of pyjamas. It is well to have a little sal volatile or other stimulant at hand in case of neeci, and the patient will require a cold drink. The object of tepid sponging is to induce sleep a.,s well as to bring down the temperature, so the nurse must be especially quiet and unhurried in all her movements, and no talking is allowed during the procedure. The top of the bed is stripped, leavirJg only a thin covering blanket. The bath blanket is rolled under the patient and the gown is removed. The face and neck are sponged and then, with the towel placed under each arm in turn, the limb is sponged with long, slow, even strokes which commence at the shoulders and end at the finger tips. A wet sponge may be placed in each axilla and groin. The sponges are used very wet and in rotation. After use, the surpl us water from each sponge is squeezed out into the empty bowl, tor it is now warm; the sponge is put into the sponging water until it is again required, fresh cold water being added as the treatment proceeds. After the arms, the trunk is sponged, using circular movements; and then the sponging proceeds with long, slow strokes from the neck to the ankle on each side in turn. It is seldom necessary to dry the limbs, but if excess water must be removed, the skin should not be rubbed, for this would again raise its tern perature. The feet are never included in the sponging. From ten to twenty minutes should be taken in giving the treatment, but if the patient begins to shiver, looks blue or his' pulse becomes unsatisfactory the sponging must be stopped and the patient be given a warm drink and be covered up warmly. At the end of the sponging, he is gently rolled on to his side for the bath blanket to be removed, and his back is sponged, dried and powdered. A fresh gown is put on and the top of the bed is made up with only a sheet and a thin blanket or counterpane. It is a mistake to put warm coverings on a patient who is generating mare heat than he can lose, but the nurse must keep a very careful watch that the temperature does not fall too rapidly or too much. It is taken when the sponging is completed and again an hour later

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FIRST unless the patient is asleep. It should not have been reduced more than two or three degrees by the sponging, but this is sufficient to give relief from severe fever and to induce a feeling of comfort. A RIGOR AND ITS TREATMENT. Some diseases commence with what is called a " rigor." This is a sudden and rapid rise of temperature preceded and accompanied by intense shivering. The patient complains of feeling cold even though the. temperature is rising-and it may rise from subnormal to 104 degs. F. in less than half an hour. The feeling of cold is followed by one of burning heat, after which the patient begins to perspire freely and the temperature falIs 'although the patient continues to feel hot. Rigors occur at the onset of severe infections such as pneumonia, in some sub-tropical diseases such as malaria, and in severe kidney or bladder diseases. When they occur during the course of an illness they usually denote the onset of septic complications. In any case, if a patient has a rigor the doctor should be notified immediately. Meanwhile, nursing treatment must be given. This consists of hot blankets, hot water bottles and a hot drink during the shivering stage, but the extra blankets and bottles should be gradually removed when the patient begins to feel hot. The temperature should be taken at this stage, and towels and fresh night attire should be put to warm. When sweating occurs the patient should be rubbed down with the warm towels and be put into dry clothing, care being taken to avoid chill. The temperature is taken again. and although it will be found to have fallen, the patient continues to feel hot. He will, however, be much more comfortable and may sleep. S£gnijicance of Low Temperatures.-A very l~w temperature may be quite as serious as a very hIgh one, and may indicate a condition of shock or collapse. Low temperatures may also be due to profuse sweating, vomiting, diarrhrea, starvation or severe h~morrhage. When due to depletion of body fluids it is often accompanied by muscle cramps. The application of warmth to the body is most essential and, unless hcemorrhage is taking place, copious hot, sweetened drinks should be given. Bilious attacks and jaundice are associated with l~w temperature, but not so low as to give rise to anXIety.

Notice to Ambulance Secretaries. Will Ambulance Secretaries please forward reports of local activities as soon after the actual event as possible, We regret that owing to the shortage of paper we are not able to include all reports submitted. Preference is given to those of general interest.

F1RST

AID

Reviews. Whatever Does the Almoner Do? By Dorothy Manchee, Almoner, St. Mary's Hospital. London: BaiIIiere, Tindall and Cox. P1ice 6s. net. Most almoners are acquainted with the expression "\Vhatever does the Almoner do?" voiced in tones of mystified incredi.tlity, genuine enquiry or pained surprise. This book, therefore, has been written in order to provide an answer to this question and to indicate to those who have never needed, ami so know little of, the services that may be rendered by an almoner. Further, it should encourage working ~lmoners who are striving to put into daily practice their ideals of social service; and,. lastly, it should attract to the profession the finest of our young women.

Answers to First Aid Quiz. (1) Adam's apple. (2) (a) Keep the patient in a lying position with a Ilrm pillow between shoulders. (b) Undo all tight clothing around chest. (c) Transport the patient on a stretcher to shelter. (3) (c). (4) Paralysis of cells of the respiratory centre of the brain. (5) Any drug which acts on the nervous system and produces tendency to sleep, e.g., paregoric, cholorodyne, luminal, alcohol, choloroform, etc. (6) To act on the effused blood and promote clotting. BOOKS OF REFERENCE.- ' • Aids to First Aid." N. Corbet Fletcher. " Why and Wherefore in First Aid." N. Corbet Fletcher. I I Handbook of First Aid and Bandaging. " Belilios, Mulvany and Armstrong.

Miscellaneous Advertisements.

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149

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blood transfusion . Later, surgeons discovered its special qualities made it an ideal pre-operative surgical barrier. Today it is superseding bandages and plasters as a dressing for cuts, abrasions and small burns. Not only is it neat, flexible, waterproof, transparent and selfsealing, but because of its high phenol content it also greatly acceler~tes healing. " Portex " Plastic Skin is now available through all chemIsts. In tubes, price I/8d. including tax, and in larger size bottles. In case of difficulty, write direct to the proprietors, giving the name of your pharmaceutical suppliers.

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-THE TRAINING OF FIRST AID COMPETITION TEAMS 2nd 2nd By

EDITION

Advertisements with remittance should be sent to First Aid, 46, Cannon Street, London, E.C.4. Rate 3d. per word, minimum 45. 6d. Trade advts. 4d. per word, minimum 6s. Box numbers Is. extra.

AiD

(( Gives clear and constructive advice on selecting and training .teams for fi~st aid competitions, and prOVides us~ful ups.on individual and team behavlOur durlllg competitions . . . . . should find a ready public."-Fire Protection.

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LONDON: H. K. LEWIS & Co. Ltd. 136, Gower Street, London, W. C. I. Telephone: EUSton 4282 (5 lines)

FIRST

AID

Queries and Answers to Corresp9ndents.

RESUSCITATION APPARATUS

------.--.------

(OXYGEN & OXYGEN + CO 2)

Queries wil1 be dealt with under the following rules ; 1. -Letters containing Queries must be markt:d on the top left-hand corner of the envelope" Query," and addressed to FIRST AID, 46, Cannon-street, London, E. C. 4. 2. -All Queries must be written on one side of papt:r only. 3.-All Quede; must be accompanied by a " Query Coupon ., cut from the current issue of the Journal, or, in case of Queries from abroad, from a recent issue. 4. -The Textbook to which reference may be made in this column is the 39th (1937) Edition of the S.J.A.A. Manual of First Aid to the Injured.

Cigarette Smoking. M.G. (Willesden}.-Will you please tell me the correct treat~ent for illness due to cig-arette poisoning- and accept In advance my thanks? Alas! Your query is beyond the scope of first aid because it does not refer to sudden illness or accident. -N. CORBET FLETCHER.

Examination Howler. M K. (Victoria, Australia).-In a recent examination one ca?did.ate was asked how he would treat a case of lysol pOlsontng-. The surgeon examiner was stagRered and almost collapsed when the candidate replied-" Iwould ne 1dralisr! the poison with a corrosive and wOllld follow this up witlt K,ellol['s All Bran which w()uld g-ather up the potson and zn due course ",xpel it jrom the body! " Good!

AID

Next, please! !-N.e.F.

Foreign Bodies and Palmar Bleeding. A.e. (Selby).-The Supplement to Textbook apparently cancels the pressure points radial, ulna and brachial, but tells us on paRe 26, clause 12-" When it is impossible to al?ply direct pressure successfully for the arrest of artenal haemorrhage as in the case of wounds high up in the arm, it" is necessary to apply indirect pressure to the subclavian." Under this new rule where should indirect pressure be applied for arterial hapmorrhag-e from the palm of the hand with foreig-n bodies in the wound, in order to facilitate examination, etc., of the wound? Your reply will oblige. The answer to your query is to be found in Rule 8. p. 25 of the Supplement to Textbook where you are told (1) to builc the dr.essings. round the wound so that they may serve somewhat lIke a nng pad and (2) to bandage lightly. In other ~ords, the n~w m~thod of. treatment aims at gettingthe patient to medical aid as qUickly as possible; and consequently, the first aider should not waste time in hunting for foreign bodies in the wound.-N.e. F.

Brigade Uniform. H. H. (Hull}.-Can you please tell me if it is in ord~r for a ful!y paid S .J.A. B. amhulance driver to wear his Brigade uOlform when on duty? Briga~e uniform can be worn only on the instructions of th~ S~penntendent of Division of which the ambulance dnver 1S a member.-EDIToR.

Control of Arterial Haemorrhage. W. P. (Barrow).-Re the new methods of stopping arterial haemorrhage in a case of compound fracture of femur by means of rubber bandage. We have found in practice that (1) When attempting to release the rubber bandage after 20 minutes, it adheres to itself and will not uncoil and (2) When re-applying the rubber bandage we have to remove the splint controlling fracture to secure the rubber bandage. . Would you advise controlling fracture same as when splints are unavailable? Your remarks on this subject would be appreciated.

for asphyxia in electric shock, etc.

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(1) It would appear from your letter that you have been using a rubber bandage which has partly perished and of which the surface has become sticky. A rubber bandage which is in good condition does not become adherent; and the remedy is a new rubber band. (2) Personally I agree with you that the splint must be removed before the rubber band can be relaxed; but, as this would be done whilst the patient was 'not being moved, no harm would result. Further, the splint should, of course, be reapplied before further transport is undertaken. Incidentally, I do not recommend that you should discard the splint just because extra work is involved in relax~:1g the rubber band . Further, in the middle of p. 8 o~ the Supplement to the Textbook, you are told that s~lints, when available, should be used in such cases and on p. 9 that transport must be particularly careful when no splints ale used.-N.e.F.

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Transport of Patient Down Hill. P. B. (Margate).-lf we had to carry a patient on a stretcher down hill and if the patient was suffering from fracture of skull with signs and symptoms of compression of brain together with a simple fracture of right femur and a compound fracture of right leg-, should we carry such patient "head first" or should we regard the head injury as the more serious and carry him "feet first"? Your kind ruling wilI be appreciatad. The compression of brain, being the.more serious con?ition in its immediate risks, seems to me to require priority In treatment and transport. Consequently, I would anange that such a patient should be carried down hill" feet first." -N.C.F.

Simple Fractures of Both Legs. R.S. (Wellington, New Zealand).- We shall be grat~ful if yuu will kindly settle a little dispute for us with reference to the treatment of simple fractures of both legs. Some of us say that we should treat the fractures separately and uge four splints, while others say that we should treat as a sing-Ie injury and use two outer splints only. We await your ruling with interest. Btyond all doubt you should treat each fractured leg then bind limb to limb. By so doing you would facilItate your task as a first aider and also that of the doctor who subsequently takes charge of your patient and separatel~ ~nd

NOT

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DELAY.

Write for full particulars to Organising Secretary: 38. Argyle Squat'e. London, w.e.1.

The Royal National Eisteddfod of Wales, Colwyn Bay, August 4th-9th, 1947. Ambulance Competitions. The Lady Lewis Cup, open to teams of four men and the Lady Bute Cup open to teams of four women are open competitions. Entries from ambulance and nursing teams in England are invited. Booklet and entry form from the National Eisteddfod Office, Colwyn Bay, on application.

THIS COURSE WILL QUALIFY YOU IN THESE PROFESSIONS.

MASSAGE . MEDICAL ELECTRICITY. Anatomy and Physiology Static & Current Massage Movements Electricity General Massage Galvanism Facial Massage Far~dism Scalp Massage Ionic Medication Treatment of Sinusoidal Neuritis, Paralysis, Current Corpulence, Constipa- High Frequency tion, Electrolysis Stiff Joints. Rheuma- Rad otherapy tism, Diathermy Mechanotherapy ColourTherapy, Hydrotherapy, etc., etc. etc., etc.

This Book will make m oney for you . Don't lose time but send in this • 1 The Coupon wltdh 2~d. ~tamp for v\~;'·"·' Secretary, postage an you will get '}\\\S....... ··· Central Training the book promptly ~G....•..···.... College, 19, Wei beck !'-vS...··· Street, London W.I. by return. co:......····· Sir.-Please send me your valuable ............ book by return. I have not had a copy. ...... ··············.. ............

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FIR S T who would then be able more readily to deal with eacb fractured leg.-N.C.F.

Artificial Respiration with Burned Back. ~. O. (Felixstowe).-In our ambulance class recently, we had a difference of opinion as to the correct method of artificial respiration which should be applied if such were indicated for a patient who in addition was suffering from severe burns on the back. Some of us suggested Laborde's method, but as this no longer figures in the Textbook, others considered that we should forthwith commence Schafer's method. We agreed to submit the point for your decision, and we thank you for past help. The restoration of breathing being much more important lhan the risk of aggravating the burns on the back, it follows that in all such cases you should at once commence Schafer's method j and that, as far as possible, you should protect the burned parts so that a minimum of aggravation shall result. Consequently the question of the presence or absence of Laborde's method in the Textbook is immaterial to the solution of your problem.-N.C.F.

Treatment of Burns and Scalds. ].L. (Li\·erpool).-Would you oblige by clarifying the wording in the Supplement to Textbook with reference to the treatment of burns and scalds. It emphasises that we should not remove clothing. Does this mean that we do not even expose the injured area so that we can apply the sterile dre~sing as instructed? If the patient was wearing soiled clothing (greasy overalls, etc.), and the sterile dressing applied over, it would not achieve its object. Also, if the skin was broken, and the area saturated with warm alkaline solution, it is probable that the solution would carry dirt and so increase the danger of sepsis. Or do we use common sense and refer to the principles of first aid, viz. : Removal of Clothing. In short should we uncover the patient as little as possible so that a dressing can be applied direct to the skin bearing in mind that exposure increases shock and 'shock and sepsis are the chief dangers of burns and scalds. We thank you in anticipation of your reply, and we also thank you for your valuable advice in the past.

To me the instruction (( not to remove clothinO' " in Rule 1 on p. 29 of the Supplement is less clear than i~ the Textb.ook. Doubtless the Revision Committee wished to emphaSIse the danger of wholesale removal of clothing from the burned or scalded area; and you emphasise my difficulty when yo~ imagine a burn or scald beneath greasy overalls. Had the lOstruction read-" Do not remove adherent clothing" I could have understood better the intentions of the Revision Committee. Some few weeks ago I discussed the point with one of the member~ of the Revision .Committee. He strongly supported ~he Vlew that all doth!O~ should be left in position on the pabent but he had no effectIve answer when I asked him what beneficial action lint soaked in alkaline solution would have on t.he burned or scalded area if it was applied on top of the clothlOg.-N. C. F.

AID

FIRST

statement, because I maintain that the Black Book would have stressed the change of dressing. In the Supplement to Textbook on p. 8, it states: C< A general method for dealing with any jracture of the upper limb is carefully to remove the coat if possible, straighten the limb by gentle and steady extension, etc." Does this appertain to the position of the fracture, or to the variety of fracture and so answer the above query? If the fracture was described as you state, there was no indication that the broken end was protruding. Consequently the use of the small arm sling was strictly correct. If, however, there was protrusion of bone, then theoretically it might be good treatment to substitute the large for the small arm sling. Practically, however, I COI1~ider it unlikely that the use of the small arm sling would, 10 fact, cause any marked extension. Such being the case you would be justified in using the small arm sling.N.C.F. -

The answer to your query is to be found on the last page of Chapter VII of the Textbook. Incidentally, massage applied by a first aider to a ruptured mu~cle would be a waste of time, would delay removal of patient to medical aid and might do further damage !-N.C.F. '

Treatment of Concussion of Brain. W. S. (Abertillery).-l\fany thanks for your efficient reply to my query on Treatment of Crush Injury which was published in the] anuary issue of FIRST Am. I now submit a further problem with reference to the treatment of slight concussion of brain caused by a blow on top of head of a player on the football field. . I was. in char¥e of the First Aid Squad on duty on thIS ~ccaslOn, ana the player was very wet and dirty. So I IOstructed two of my Bearers to remove him to the Dressing Room and to give him a warm shower but to avoid heat on head. When the match was over: I proceeded to the Dressing Room, only to find out that contrary to my order, the patient had been given a cold shower. I contend that the treatment given was detrimental. to his condition and tbat my instructions were more beneficial. I await your reply eagerly. The treatment for this case is as laid down on p. 16-1- of the Textbo~k, where, among other suggestions, you are told that a patIe?t .suffering from concussion must be kept absolutely qUIet 10 a darkened room. In these circumstances the warm shower should have been postponed until patient was normal, more especially as the patient must stand on bis feet for the shower.-N.C.F.

Compnund Fracture of Humerus. ].L. (Liverpool).-At a recent competition one of the injuries was .a compound. fractured humerus. The judge pe?ahzed te~ms whIch applied the small arm sling. He saId that thIS created a natural extension (with which I agre.e) and that a large arm sling should have been apphed. Personally, I do not agree with the latter

A HINT TO HELP

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TROUBLE HEAL QUICKL'l

Treatment of Ruptured Muscle. T. B. (Larne, Northern Ireland).-l\lay I ask what is the best method of treatment for a ruptured muscle of the leg 'I Is it correct to massage it? If so, why, but if not, then why not? l\1eanwhile my best thanks in anticipation of your reply.

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CONTENTS

. and equalfy important are the facts that a Pre-heated engine means instant and efficient lubrication -thereby saving cylinder bore and piston wear -an all-round saving of time and money-and what's more-your battery charges and stays c up,' for instant, easy: starting! " No ENGINE Complete Wit h 0 U t Pre -h eat . Write to-day for fully illustrated brochure and instructions for fitting to Dep t. F.A .6.

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Steel body with composite doors' Hygienic mou/ded floor covering' Purdah g lass windows/or stretcher compartment • FilII and officially approved equipment Wideopening rear doors and extra nearside door • All door-handles recessed /01' safety • Forward control with integral body and cab • Soft semi-elliptic springs and hydraulic dampers . Large 9 x 16 R.H.S. ty res • D.H. V. 16 h.p. engine gil'ing high performance wizh low /uel alld oil consumption.

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Editorial-Accidents in the H ome

J 55

Practical Nursing in the I-lome

A Course in Advanced First Aid'

156

Practical P oints

First Aid to Animals

158

Queries and Answers to Correspondents

News from All Quarters

I59

First Aid in the Office

NOTICE TO READERS. FIRST AID is published on the 20th of each month. The Annual Subscription is 5S- post free; single copies 4d. Its aim and object being the advancement of Ambulance and First Aid Work in all branches, the Editor invites Readers to send Articles and Reports on subjects pertaining to the Movements and also welcomes suggestions for Practical Papers. All Reports, &c., should be addressed to the Editor at the address below, and should reach him before the 8th of each month, and must be accompanied (l1ot necessari(y for publication) by the name and address of the Correspondent. Subscriptions, Advertisements an d other business Communications connected with FIRST AID should be forwarded to the Publishers. DALE, REYNOLDS & Co., LTD., 46, CANNON STREET, LONDON, E.C+ Telegraphic Address-" Tu'enf)'-/otlr, London." Telepholle-CifJ' 3710.

Editorial Accidents in the Home LL concerned with the appall ing toll of road accidents

A will welcome the Government' s safety campaign,

and the many other method s of publicity and instl"uction which are being applied to the problem. But in the pre-occu pation with death on the road we must not neglect that other group of accidents which causes every year almost as many death s as road accidents, and in which the incidence of carelessness and neglect are much higher. That group is accidents in the home, a matter which is now being given increasing attention by the Royal Society for the Prevention of Accidents. This type of accident does not receive the same publicity as the road accident. Figures of casualties and deaths al"e not specially recorded as they are in the case of road accidents, and co.nsequently they have been overlooked by many in the past. But when we find that in 1942 (the last available figures) some 8,633 people in England and Wales were killed by accidents in their homes, and that of this total 2,147 were children under the age of 15 years, we realise how serious is the problem. Nearly half the total of 8,633 deaths were old people of over 65 who died chiefly as the I"esult of falls, and in this group we cannot hope to see much improvement having regard to the nature of the acc:ident and the age of the persons

concerned, but with children the case is different. A little thought and care would save many of those 2,000 doomed children, and the thousands of others who were disfigured and disabled as a result of accidents that could have been prevented. For example , in the same year, 539 children under 5 years of age were killed by suffocation, 230 others were killed by scalding, 267 children under 15 met their deaths by burns, and 488 were drowned while playing. Can it be doubted that many of these precious lives cou Id have been saved with the exercise of a more careful supervision on the part of the parent or guardian? The appalling total of 2,147 children killed in the home is more than were killed by motors in the same year, and much more than the figure of deaths from birth injuries. What can be done to reduce this grim total? First, instruction in the welfare and care of children, which can best be done through the welfare centres and through health visitors. Secondly, every housewife should have some knowledge offlrst aid, and particularly how to give prompt attention to small injuries. The R.S.P.A. have emphasised this latter point, and we entirely agree. We should like to see housewives I"eceiving first aid instruction, preferably in their homes from health visitors. In this way much of the need less sufferi ng and deaths of so many of au r young people can be avoided,

FIRS T

FIRST AID

A COURSE L~ ADVAL~CED FIRST AID by A. D . BELILIOS, M.B ., B.S. (Lond .) D .P.H . (Eng.) ASTHMA common disease takes the form of attacks of T H1Sshortness of breath (dyspnoea); these are due to spasm of the muscles of the bronchioles accompanied by over-secretion of mucus, Attacks usually occur at night, The onset is rapid, the patient experiencing great clifficultT in breathing; he complains that there is insufficient air in the room and asks for the windows and doors to be opened, Often he will stand up or sit on a chair, leaning forwards to grasp a support such as a table which will aid him in his breathing, Expiration is more prolonged than normal and is accompanied by obvious and often musical wheezing, The pulse is quick and feeble and the patient pale, cold and clammy, The attack may last for a variable time ranging from a few minutes to hours, or in severe ca es even days. It generally ends rapidly with a seyere fit of coughing in which quantities of phlegm are produced. -FIRST AID(r) Position. The patient should be placed in a position in which he can breathe as comfortably as possible. If there is a bed available in the ambulance room, it is better to have him in it; he should be propped up and encouraged to lean forwards, grasping a support such as an improvised bed-table.

(2) Clothing and IV-armth. All tight clothjng should be undone and the patient kept reasonably but not excessively warm. (3) Fresh Ai1', Plenty of fresh air is essential. Pure oxygen, if available, may prove valuable, but the patient should not be told to make an effort to inhale-in fact any effort on his part is undesirable since he is far too busy trying to get his breath. (4) Fluids. These should be given as desired by the patient. Hot, strong coffee sometimes cuts short an attack. (5) Medical Remedies. Apart from the above measures, the first-aider can do no more except to administer these remedies which may have been previously recommended by the patient's own doctor for use in an emergency. These may include special tablets, capsules or a drug

called" Riddobron " ,,;hich is gi,en 9") inhalation from a spray, Powders which can be burnt in a saucer and their fumes inhaled are not usually advised since they may aggravate the bronchitis which generally accompanies the disease. "Cnless the attack passes off quickly a doctor must be sent for; he will probably giYe an injection of a drug v,Thich will relieye the spasm of the bronchioles.

PNEUMONIA This is an acute disease affecting the lungs and caused by a special germ called the pneumococcus. Although there are se\-eral yarieties of this complaint, only lobar pneumonia will be referrf'd to in this article since it is the variety which the first-aider is likely to meet in its early stages , The effect of the pneumococcus upon the lung is to ca~se it to lose its normal sponger character and to become solid like a piece of liver. This process, as the term lobar implies, affects the lobes of the lung, picking out one or more according to the severity of the case, The illness begins suddenly with a se,Tere attack of shivering (rigor) during which the temperature rises rapidly to r03° or ro-t. The patient usually develops severe pain in the side which is sharp, like a knife digging into him, and worse on attempting to breathe quickly or to cough. This pain is due to pleurisy. There are the usual symptoms and signs of fev'er; the patient feels ill, his face is flushed and he may complain of headache and pains in his arms and legs. His breathing is short and rapid, and his pulse quick and bounding, Cough, if present in the early stages, is short, frequent and repressed. The sputum, generally produced within a few days, is thick and sticky, often tinged with blood or a rusty colour. --FIRST AID(r) Arrange Removal. Pneumonia is essentially a case for home or hospital treatment, hence the first-aider must make immediate provision for the removal of his patient preferably by ambulance ordered on the instructions of a doctor. If home is the destination, care shou Id be taken to warn the patient's relatives of his anticipated arrival so that adequate preparations can be made. It is obviously far better for him to remain for half-an-hour or so in a warm ambulance room than to be taken home to a cold bedroom in which the bed may not even have been made.

(2) Preparations for Reaption, The fir t -aider ,,-ill be well repaid by gi\ ing per onal attcntion to the in tructions which are sent to the relatives, The patient will ha\-e to be nursed in a warm cedroom, temperature between 60 and 65; the bed mu t be \yarmed by hot water bottles for his reception and be ,,-ill have to be nur ed in a sitting-up p osition obtained by d :e U. c of a bed rest or the" armchair" arrangement of pillo\ys. He \\ ill require a small boL ter or c: knee pillow" under his knees and a further support for his feet' if draw heets are a\-allable they should be put on while the bee. is being made. A plastic curtain makes quite a good improyi ed mackintosh draw sheet. (3) TelilpOraJ)' Treatment. During the interval before taking the patient home, the first-aider should carry out as far as possible the nur ing treatment de cribed, particularly as regards warmth and posHion both on the bed in the ambulance room and on the (fetcher. Tight clothing hould be undone and a liberal supply of fresh air pwyided, Inhalations of pure oxygen are yaluable if the patient has di,tressed breathing. Fluids should be aiven freeh- ' tea milk or lemonade are all suitable. D ." , C+) .l\Iedical ~ iid. The doctor' help should be enlisted as soon as pas ible; he may gi\Te morphia to relieve the pain, and the drugs commonly but incorrectl) known as M. & B., or pencillin to cure the di ease.

AID inv,-ard when a rib ~ broken, Occasionally a '-oreign body such a a pin which ha been inhaled, may make it way to the surface ot the lung and finally perforate into the pleural cayity. ~part from accidents, a pneumothor~"" can be caused by the. pontaneou. rupture of a \\-eakened portion of the lung into tbe pleural cavity. This is far more common than i u. ually :uppo_ed. It occur in a u -ceptible subject through a sudden train. uch a a neLze, laugh or severe fit of coughing. The Sj'lJIptOIilS and siglu are very \'ariable. In the milder case, particularly tho. e cau. ed b~- disease, the patient notices a sUuden pain in his che-t rather like that of pleurisy; thi i accompanied by breathle ne . The attack may pas off quickly and be attributed to rheumatism or indigestion. In mOre se,-ere ca es, however, the pain i excruciating and the shortness of breath extreme. There is a coniderable degree of shock accompanied by . e\Tere cyanosi. , The patient is terrified; he it up and leans forward in hi eHort to breathe.

-FIR T AID(r) U--01!llds. Any \,-ound of the chest which i ' uspeeted to ha\-e penetrated must be co\-ered immediately with a dre sing rhat will prevent air trom entering the pleural cavity. A uitable dressing consists of everal thicknes es of lint co\-ered with oiled ilk protecti,e or PNEUMOTHORAX other air proof material. As an alternative a \-a eline Entrance of air into the pleural cavity causes a complaint ~ and\Yich can be made by preading a thick layer of known as pneumothorax. This condition may be very vaseline between two pieces of lint. The dressing should serious since it interferes with the normal movemenL of be made larger than the \,ound and secured firmly o\-er inflation and deflation of the lung sometime ~ to such an it by adhe. ive plaster. extent that it cause partial or complete collapse of the (2) POJitiOIl, The patient uhould be placed in a position organ. , in which he can breathe most easily, l.'suallr thi will be Air can gain access to the pleural cavity by t\\-O ducf found to be . itting up and leaning forward, grasping a routes best described as follow : support as in asthma. _ (r) Elltrance of A;r From W-ithollt. AnT perforating (3) General Prilloplrs. If a\-ailable, inhalations ot "Tound of the che. t may permit air to enter. Thu: hould be ISaiven liberally. All clothing .hould be O-x,-aen b pneumothorax may be cau ed by stabs or, in war-tin1e, lo~sened and the patient kept warm by light coverings through the penetration of bullets, fragments of shells \\-hieh will not hamper breathing, There is no objection or bombs, to giving fluids, but usually the patien~ i i~ too great If the wound is small, its edges may act like a yah-e distre. . to be able to take them, .:\Iedical aId must be allowing air to be drawn into the pleural ca\Tity, with e~ch obtained as quickly as po.. ible since \Tery often the inspiration but pre,Tenting it from escaping With expIradoctor will be able to \\Tithdraw some of the air from the tion. The affected hmg gradually collapses as the pressure pleural cavity, (to be cOl/tilmed). of air within the pleural cavity rises. \'('hen the wound is larger, air pas es in and out of the pleural cayit)' '.vith each breath. The ~un? become Prompt fir t aid rendered by i-h, Harry ~ay,_ station fore man_ at deflated by inspiration and inflated by expIratIon. These e,en King" Station, probably ayed the lite at a \\,'oman "ho, tcll unusual mO\Tements of respiration greatly embarrass the in front of a train at the cation recently. \s the tram steamed Inco heart and circulatory ystem, . the Station a ,,-airing pas enger, :'Ill'S, Katherine. Palmer, _accident.aUy (2) Entrallce of Air Frolll rr"itbill. This occurs if .aIr fell from the pi3d-ofm on to the line, The engmc ~nd hrsr carnage of the train pa' sed O\"cr and amputated :'I1rs, Palmer s legs. escapes hom one of the lungs into the pleural caVIty. First aid" as gi\cn by :'I1r. Ray and the injured woman was ru ' hcd It may result from blows or falls on the chest, or through to hospital, where, we understand, she is making good progress. perforation of the hmg by a splinter ot bone forced

Prompt Action by Railway First-Aider

FIRST

FIRST AID

FIRST AID TO ANIMALS * N0 ~ of ~s, \\:c arc a nation of animal love.rs, likes to see an ammal m pam, and perhaps on some occaS10n when we have seen an accident in which a dog or cat was the unfortunate victim, we haye been deterred from helping, by the fact that in the process of rendering first aid, we ourselves might be the victims of tooth, claw OJ" nail. The scalded animal, the dog run over by a car, etc., all of them are frightened animals, likely to be savage even towards their o\\"ners, more likely indeed to yiew the approach of a stranger with misgi\·ing. Jungle law, and our domestic animals even to-day are not unaware of it, leayes the injured or sick animal to find its o\\-n remedy or perish, and approach by man, or other animal, means only further pain and peril. The objects of first aid to animals are practically the same as towards human beings, except that sometimes when an animal is beyond help, we put it out of its misery as soon as possible. That, ho\\"eyer, is the job of the expert and it would be rash not to apply first aid wheneyer possible, eyen if we only succeeded in making the animal more comfortable. Again, howeyer, let us remember that our personal safety must be the firSt consideration ,vhen tackling an animal. Cats and dogs are natural scavengers, and their teeth are capable of causing dangerous punctured wounds; their nails, too, are filthy. The fact that an animal cannot tell us of its feelings and ensations is no t such a handicap as many people imagine. We have some compensation in the fact that the injured animal has no particular whim or fancy about its injuries, docs not try to disguise or exaggerate its symptoms, or try to mislead us as to the cause. At the same time the animal cannot, and does not understand why it should co-operate with the first-aider, and except in cases where consciousness has been lost, shows its resentment in yarious ways-the drawing back of the li ps, the raising of the hair of back and neck, the furtive glanceall these are danger signals that we must appreciate. It is obvious, therefore, that we must deal with the restraint of the injured but still conscious animals. Once you have restrained the animal in such a way that it can no longer give fu'r ther injury to itself or injury to you, the help you may need from a bystander is usually forthcoming without delay.

Simple Methods of Restraint, Dogs and Cats. The approach to an injured animal should be quiet, talk to the animal in a soft yoice but without any suspicion of a hiss, using the animal's name if it is known. Keep your hands down by your side. \,,'atch the animal's eyes. The expression in an animal's eyes is usually indicative of its temperament, feelings and attitude towards you as the human expression. The nature of the animal's injury will help determine the speed of your approach, too. You can probably afford to spend a little while getting into the confidence of an animal with a simple fracture of a leg bone, for example, the urgency is not as great as if the animal was bleeding freely from a large artery. A Jog in convulsions or hysteria can be caught hold of with but little fear of aggressive action on the animal's part. Such an animal is usually quite oblivious to external impressions, and allows itself to be restrained without showing resentment. On the other hand, an animal crazy with pain should be approached with con-

* We are indebted to the People'.r DiJpenJary for Sick Anilllais for il1for/llatioll supplied- Editor.

fidence but also with care. One means by which either a dog or cat may be secured is by using a " dog catcher." This article can be quickly made ,yith a broom pole, two metal eyes and a length of sash cord or thin clothes line. One eye should be screwed into the end of the pole, the other eye crewed about three or four inches below the first eye. One end of the rope should be secured to the uppermost eye and the rest of the rope drawn through the second eye, leaying a loop of rope hanging between the metal eyes. It is usually quite easy to slip the noose over a dog's head and a pull on the free end of the rope preyents the animal withdrawing its head and getting free. 1f it is now intended to gag the animal to prevent it biting, the pole and rope should be handed to an assistant, with instructions not to loosen the noose until so instructed. The pole keeps the animal at a distance and there is no chance of the person holding the" dog catcher" being bitten. A muzzle is not usually available ,,-hen wanted, and it is far better to use a piece of string or tape to bind the animal's jaws together. The tape (about four feet long) should be held in the left hand. Slide the left hand down the pole and secure the loose skin at the scruff of the animal's neck, getting a good grip on the scnUf and retaining one end of the tape in the hand. With the right hand draw the tape underneath the jaws from left to right, and take several turns around the jaws. Finish the turns at the right hand side of the Jog's jaws and tie both ends of the tape at the back of the head. This method causes no pain and effectually secures the jaws. Do not make a noose in the string first and try to slip it oYer the jaws from the front. Such risk of being bitten is completely unnecessary. Once the arumal is thus safely muzzled, the" dog catcher" can be dispensed with, provided the animal is wearing a collar by which it can be held. Some dogs will l"nake desperate attempts to remo\'e the tape muzzle with their feet and claws. This is best prevented by the assistant holding the collar in the left hand, and placing the right arm over the dog's back and in front of the upper part of the fore limbs. 1n Some cases "w hen the fore legs are not injured, it is possible to use a simple hobble. The hobble consists of a piece of tape or string tied from one leg to the other immediately above the" stopper pads" of the front legs. The "stopper" or carpal pads are on the front legs and lie on the skin at the back of the carpal joint or wrist. The tape need be tied in a loop just large enough to prevent it slipping down over the pads, not as firmly as a bandage. The hind legs may be hobbled in a similar way, but in this case the hobbles should be tied above the " hocks," again just tight enough to prevent it slipping down over the point of the hock. Hobbles can be very useful, for instance, when an animal with a wound has to be left alone for a period. With careful adjustment of the hobble it is possible for a dog to move about quite freely, and yet be unable to use its feet to tear off a dressing . Never get under a bed or low piece of furniture to try and secure an animal. If the animal is capable of moving itself it should be enticed or forced out. If the animal is incapable of movement, shift the furniture to get at it. The crook of a walking stick, or umbrella, can sometimes be hooked under the dog's collar and the dog secured.

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NEWS FROM ALL QUARTERS St. John Ambulance Brigade. PRINCE OF WALES'S DISTRICT Watford Division.-A :M arch Hare's Ball held at Watford Town Hall resulted in the sum of £245 being contributed to the Division's Building Fund recently. About 500 were present at the entertainment which continued into the early hours. The March Hare was there selling " bricks" for the Fund, his cousin "St. John Hare", in full Brigade uniform, was doing a brisk trade selling his " equipment" for tbe cause. Roll-a-penny and darts, staffed by the Division, added to the festive atmosphere, and a magnificent raffle, nobly aided by the Nursing Division's sex appeal, completed the side shows. Dancing was to Tommy Hunt's Dance Orchestra whose rhythm was only interrupted for the auction of a beautiful silver tea sen' ice and nylon stockings. Special praise was heard for the yery fine refreshments and for the lay-out and the floral decoration of the hall. The Senior Divisional Surgeon Dr. A.. Sta\' eley Gough's yoice was to be heard at the microphone and Supt. White and A.lo.'s Toovey and Craft were present. The Division o"wes an inexpressible debt of gratitude to Mrs. Stayeley Gough for her efforts in organising so successful an eyent ; Mr. Philip Horton carried out the onerous duties of treasurer and illr. George Forbes was responsible for the raffle and prizes, for which grateful thanks are expressed to local traders and Others. Since 19.P Mrs. Gough has raised a grand total of £1,741 for the Diyision.

COUNTY OF BEDFORD Biseot Division (Luton Corps).-The Mayor and Mayoress of Luton, Councillor and Mrs. G. F. Seaward, took part in se\'eral games when they attended the Diyision's annual dinner at Redrup and Starking's Hall, High Town, on Saturday, "April 19 t h. _ In musical laps, the 1Iayor \,'as the nrst to take his chair, and was quickly partnered by Miss Jeanette Glasgow. This pair eventually won the game. The Mayor and Maymess partnered one another in the next ganle and tied with ilirs. Payne and Mr. Tester. Speaking at the dinner, the Mayor expressed pleasure at the presence of the ladies, and paid tribute to their selfself-sacrificing efforts in the home.

COUNTY OF BERKSHIRE A competition between the Ambulance Divisions of the Coumy was held at Malvern School, Reading, on Saturday, April 19th. Winners were Team o. I from Hungerford Ambulance Division with 114 marks out of 150, the runners-up being Team No. $ ~r?m Reading Great W/estern Ambulance Divis10n with 83!- marks. The Trophy \-vas the Didcot Shield given to the County in 19~4 by Sir FelLx Pole and last compe.ted for 111 1939 when it was won by Read111g Great Western Ambulance Division. The Shield was presented to the winning team by the County Commissioner (Mr. C. A. PooIc) and will be held for one year. The test was set and judged by COl.U1ty Surgeon A. Buchanan Barbour, assisted by Div. Surgeon

D. J. Turnbull of Maidenhead Nursing Division. Correctness of uniform was judged by the County Commissioner. Members of the Casualties Union under County Officer H . F. Skidmore took the part of patients and other characters in the tests, faking and acting the injuries according to their own special methods. Before making tbe presentation tbe Commissioner said he wished to express his gratitude for the work of the Union which made the atmosphere so interesting in every way. He said that this was the first County Competition to be held in Berkshire since the war, and he hoped next year to run it on a larger scale, when he would like to see every Division in the County send in a team. After presenting the Shield, l\1r. Poole handed a Cup to the team from Reading Great Western Ambulance Division who had won it in a recent Competition. Lastly, he thanked Dr Barbour and the Assistant County Commissioner (ilIt. F. A. C. Jarvis) for all the work they had done in arranging the Competition. Dr. Barbour said that during the war most equipment was there to hand, but he had arranged this Competition more on a le,el with ordinary peace-time events. Accidents, he said, happened where and when they were least expected, and so he had given the teams a chance to do their own improvisation, setting the incident against a background of floods with communications and transport services cut off and no extra first-aid equipment available. Dr. Barbour also thanked the members of the Casualties Cnion for their help in producing the test. Mr. Jaryis was ably assisted during the afternoon by County Cadet Officer W. G. Thomas and Officers of Reading Corps. Arrangements for tea were in the hands .of Sgt. Miss E. Clinch and Hon .. Sgt. 111ss F. W. Phillips, assisted by urS111g Cadets. Reading.-On March 26th at the Ambulance Hall, Chatham Street, teams from Ambulance Diyisions in Reading Corps held their Annual Competition. The winning team was from Reading Great \,\'estern Ambulance Diyision. The tests were set and judged by Div. Surgeon C. ~. Boucher of Town " B" Ambulance Div1sion. The Cup, which was given anonymously, was presented to the team by the County Commissioner ,,,:hen they to?k part in the County Compet.lt.lons on Apnl 19 t h. On March 29th at the Ambulance Hall, Chatham Street, Reading Nursing Corps held their Annual Competition for the Howitt Cup. The winning team was fr?m Reading South ursi.ng Division: The Erst Aid Test was set and Judged by D1v. Surgeon C. A. Boucher, and the Home ursing Test by Corps ursing Officer Mrs. Crofts. Correctness of uniform was judged by County Officer ( ) Miss D. K. Gib~i.ns. The patients for the tests were prOVided by the Casualties Union. The Couno/ Superintendent (The Hon. 1lrs. Leslie Critmage) welcome.d the gues~s, who include.d the County Pres1dent (Major-General S1r John Duncan, K.C.B,), the County Surgeon (Dr. A . Buchanan Barbour, O.B.E.), and Ir. WI . E. C. McIlroy, C.B.E. (pr~siden~ ~f \'(/oolhampton and Brimpton Nursmg D1VIsion). Mrs. Gamage also thanked Dr. Boucher and Mrs. Crofts for judging the tests. Sir John Duncan presented . the Cup to the winning team who had won It for the

second year in succession and will now hold it for another twelve months. Casualties Union-Reading Braneh.On Wednesday evening, 1\pril 23rd, at the G.\'{' .R. Canteen, Reading Station, 1u. E. C. Claxton, Han. Organiser and Senior Inst.luctor of the Casualties union, gave a most interesting talk and demonstration to members of St. John Ambulance Brigade and others. He explained that the object of the Union was to provide " wounded" people on whom others mig ht gain experience. He said this was not a new idea. Twentyfive years ago in Copenhagen a sculptor gave a demonstration of faked injuries. The only way to learn First Aid was todo it,anditwas not only the make-up that made the firstaider want to do something, but the way tbe casualties behaved. 1n this acting of injuries, he said, members were really trained. This training bad been extended to all groups of people interested in First .-\id work and not only to members of recognised First J\id Societies. Recognition was now commg gradually, and the Lruon had recently provided casualties for competitions run by the Metropolitan Police as well as St. John and Red Cross.

COUNTY OF HERTFORD Ware Division.-The Di, ision have lost a valuable help through the death of 1It W. G. Stewart, M.B.E., who held the position of Diyisional Surgeon since 19 2 . The deceased gentleman was yery keen on the work of the Brigade, and undertook the medical training of the first aid seryice during the war. He was also Co mmandant of the V.A.D. hospital at the \Yare Priory d,:ring the 19I4-18 war. He will be greatly lTIlssed by all members of the Division. At the funeral service a guard of honour was f01TIled by a number of the members.

COUNTY OF LANCASHIRE The big programme of ambulance comp~ titions which was scheduled to take place 111_ the popular Lancashire holiday town ot 1Iorecambe and He\Tsham during this month ha been cancelled. Reason given by enthusiastic compe~tions committee chairman, Dr. \,\'. ill. McLmney, is " Lack of entries but ~OT lack of interest. Conditions in the various industries in which most arr..bulance enthusiasts are employed are such that it is not possible for teams to secure leave of absence to travel and compete in our competitions. One collier,y team has written to say that for one day s absence from work they would lose two dar's pay. It is obvious that they cannot afford that, nor can the country, afford to lose their output. We have ~ut 111 a great deal of hard work and our senes of competitions promised to do big things, but we have had to bow to the inevitable." Considerable interest had been aroused in orthem ambulance circles by the syll~bus of competition, and many teams ~aye wntten in to say that they would have llked to compete, but for a yariety of reaso,ns were preyented from doing so. Entnes from ten anlbulance teams from as far away as ~elfast, Crewe and Liverpool had been rec~ived. The committee provisionally deCIded to hold the event in September, 19+8 .

COUNTY OF LEICESTER The Gipsy Lane \mbulance and Cadet Di,i~ions gaye the \nnual Treat ro old age penslOners of the Gip<;y Lane \\"orking ~rcn's Club on \'\ cdnesday, :"pril 9th. This consisted of a supper, at "'hich lO5 sat down, and an emenainmenr. At the conclusion tbe Presidem (~fr. L. ~Iiller) gaye a shorr talk saying that he hoped all had enjoyed the ~,-ening. upt. T. Harne said that all connected with the "-\mbulaoce ~loyemem were plea ed that rhey "ere able again this year ro giYe [he Trear aod was glad ro see the aood number prescm. H~e hoped in the ~ear futUre that something else would be giyen [hem. ~lr. \\"ilJiam responded on behalf of the ol? people, thanking the _\mbulance ,,:o:kers tor such a wood~rful eyening. ~\lr. Krught made a prcsem ot a IS. ro each of the old people presenr. COUNTY OF N ORTHU1'vlBERLAND Shiremo?r Division.-Past and present members ot the abm-e di, isinn held a Social Eycning in rhe Sr. John's Church Hall, Backwcnh, on _'pril 5th. .-\n engra, ed cigarette case and lighter ,,-ere presemed to Superintendent \\'. G. Gibson ?y County Officer J. \\'. Srobbs on behalf of the members. ~[r. Gibson has forty years' sen ice in fir t aid, haying obtained his cenificare in 1907. ~ ith othe'lmembers of Shiremoor Brigade, he sen-ed in the R.A.~r.e. from 191+-1. The Di,-ision was refonned in 1930 and he rejoined as Ambulance Officer. In 1936 he was promoted ro Superintendent, an office he has held until .A'?yember, 1946, ,,-hen, owing to the age hma, he retired and is now on rhe Reser,e list. ::-[rs. Gibson was presemed on behalf of rhe Diyisi( n, with a brooch by Corps Superintendent '\Irs. Srephenson. ..'.11'. and ::-Irs. Gibson receiyed the congratulations of rhose presenr, not only <?o the honour conferred on them, bur on the torty-fourth anni,ersarY of their wedding which they celebrated that day. 1.\Ir. Gibson's successor is ::-(1'. E. Sander:'00, of Shiremoor, \\ ho has been connected wirh the local Ambulance and Nursing Di,isicns for many veal's. He took ~ leading pan in ci, il defence first aid as ao l11structor during the 1939-45 war.

...

COUNTY OF WORCESTER .The inter-Corps competition bern-een the wmners of the onh \'{'orcestershire and Dudley and Districr Corps, eliminating rounds of the " Dewar" Shield ~-as held on Friday, .-1pril 5rh, in rhe ~anteen of Messrs. T. \\. Lench Ltd., Blackbeath. .The rwo competing teams were: 1\'orth \'\ orcestershire Corps represented by T. ,\\'. ~ench's Di,ision, and Dudley and ~D.istrict Corps represenred by Brierley Hill DiYi~on. In the t~am test the ~eams were called upon to deal \Yllh twO panents, one with a fractured lefr shoulder-blade, fractured femur and artenal bleeding from the head, whilst the other patient was suffering from ~poplex-y. The test proyed ro be Yery Inrerestlng to the spectators. The individmll tests ,\,ere conducred in pri\,ate. Asst. Commissioner T. e. Lench announc~d the results as follo~'s: T. \\i. Lench s, a total of 293 marks ' Brierley Hill a tot~l of 279~ marks. 11r. {ench said tha~ he :wlshed to congratulate the winners upon thelt s.uccess and also the losers for their splendid fight. He was ,ery grateful to Dr. Daly for undertaking the team test for them. They had had to call upon him twice

within a week. He also wished to thank Dr. Ribchester for setting and judging the team tesr. :;.\Ir. Lench also thanked the Official. . for their pan in making the compeutlon a succe . Dr. Dah- said that borh teams had shown a high stare of efficiency, and he "as yeIY pleased ,,-ith their \\-ork. It had been a real pleasure for him ro judge thar test and he would be pleased ro help them ar any rime. .-\ssr. Commissioner T. e. Lench amidst applause, then presented the Lench' Cup ro the leader of the \yinning team. In doing so, .:\11'. Lench Wished the team good fonune in future rounds. Halesowen.- The .Annual Ball of the Di, isioos (_-\m bulance, A'ur ing and Cader- ) was held recently in rhe Boro' Hall Haleso~-en. His \\orship rhe 1Iayor ~nd the 11ayoress were there, toaether \yith l_nspe~ror \\,illiams, ::-liss Fel~side (Corps Supetlntendenr), ::-lrs. Lamb (.-\rea Cader Officer), ~1~. Sh,akespeare ( uperinrendenr), _\. up£. ::-II5S Knowles, Cader Suprs. 1Iiss Bidmead, ::-US5 Green, Cadet Officers 1Irs. Pengelly, Miss Coley and 11rs. Griffin; many apologies \yere receiyed from fIiends because of the yery bad ,,-earher. A very enjoyable evening was spenr. Horace Sadle-r prm-ided the mu-ic, gt. Pengell,- acring as ~\LC.

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Worcester Nursing_-The \,'orcester ::\'ursing Division held a \'\ hist Dri,e in the Council Chamber, Shire Hall \'\ arcester on \\'ednesday, Al?ril IQrh. :;.\fr;. Griffin, p:esidenr of the DIY1S100,presenred the prizes and thanked the players for coming along. About £1 4 was raised. This was ro be pr.es.e~)[ed to the Field .House Cadet :t\;ursing DrnslOn :nd orhe,: Bngade acrivities. PRIORY OF WALES Ogm'ore Vale Division.-.-\ ::-lemorial Sen-ice for Cadets who died on ~-\cti,e Sen-ice was held in the Ambulance Hall on S~n?~y, April 27th. A tabler, erected by the D.rnslOn, was unveiled by Cadet SUpt. 1'. Richards. The Dedication Ceremony was pel-fonned by Father Rew. Among rh~ large company present "as rhe Surgeon-in-Chief for \\'ales.

RAILWAYS Great Western On April 24th the firSt competition ince 1939 was held in the Porchester Hall Paddington, eight Creat \X'estern Railway: ambulance teams selected from an original entry of 93 rendered firsr aid to yolunteer patients in tests set by Major 1\.. C. \X hite Knox and Dr. G. S. Phillips. The setting for the team test represenred a G.\x, .R. restauranr, the scenery for which was lent by the Pinewood Studi~s. The tesr was as under : " You are sitting haYing a cup of tea in the restaurant, when you hear a crash from the other end of the room, and on looking acros~ you see a waiter, who was carrying a tray of tea things, has tripped on a mat and fallen . The manageress, kno\\'ing you are all good first-aiders, calls you oyer to render assistance. She has first aid kit available but no stretcher. She has a restroom at one side of the restaurant." The work of the competitors was watched with keen interest by a large number of

pectator, including officer of the Company. The sub~equent presentarion of trophies and prizes was presided o,er by rhe Rt. Hon . Yiscoum Porral, P.e. D.S.O., ::-1.Y.O., Chairman of the Company, who was upporred by Sir Edward Cadogan (Director) and a large number of Chief Officers. The result of the contesr \yas as under:1\ larks Team Indh idual Total (~rax.

(~ Ia..".

(~Ia..", .

200)

100)

300)

I . Swindon Direcr01's Shield and Prizes ... 124 202 7S 2. Cardiff D ocks l.a1\'ell Cup and Prizes 61 188 ... 12 7 17 8 3· ]{eading-Prizes ... II9 59 Road f· Stafford Prizes 154 77 77 6'2.. I53~ 5· Kewpon High Street 9 1 6. TauntOn 83 qo~ ::1/"2 131~ 74 57t 7· \\'eymourh B. Old Oak Common Loco 72 5I~ 123~ The Swindon and Carcli£f Docks teams will represent the Great \\-estern Railway in the Inter-railway First Aid Competitio~ at the Borough PolYtechnic Borouah Road, London, on Jun~ 20th. ' b Preyious ro the presemation by Lord Portal of medals and certificates for exceptionally efficient first aid rendered by members of rhe staff durina the year 1946 Dr. H. H. Ca,endi h Fuller~ Chief ::-Iedical Officer, commented on the "ork of the recipients. .0\. Yote of Thanks to the adjudicators was proposed by the Rt. Hon. Sir Edward Cadogan, KB.E., e.B., which wa replied to by ~fajor \'\ hite Knox, who congratula~ ted the teams on the excellent standard attained, and Dr. Phillips. The proceedings ~-ere brought to a close by a Yote of Thanks ro the Chairrnan on th~ proposirion of Mr. G. S. Hodder, Diyisional J\.mbulance Secretary, Bristol. ~2

-~1

INDUSTRIAL Skinningrove Iron and Steel \Vorks, Sal~~urn.-The.Annual Departmental Comp~t1[lOn for the aboye works was held on \x ednesday, J\pril 23rd, when ambulance teams representing yal'ious departments competed for the" Debenharn " ambulance cup. .The E ngineers' team was placed 6rst 76 POl?ts, the Blast Furnace team second75 pOInts, the Staff team third-70 points. Dr. e. ~ ] ason, ?~ Sandsend, was the judge. After the. compet1tlOn the cup \\'as presented to the wmners by 11rs. Debcnham, wife of the works general manager. Ml'. Debenham said ho~- pleased he was to see the teams at work, and thanked all the ~mbulal1ce men for their lOterest and the ~~clenr ,,-ay they had always treated their 111Jured comrades. Mr. W. Brittain-Jones (Safety Officer) proposed a ,ote of thanks to D r . Mason for Judging the competition and to Irs. Debcnham for presenting the Clip.

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AGNES E. PAVEY, S.R.N. Diploma In Nursing (Uniyersity of London)

The Pulse and its Significance produced by the beating of the heart. T H EEachpulsetimeis the heart beats a e of blood i sent \'iTI

into the already filled artelies and tIllS wa,e distends them. The puLe is felt a an alternate distension and contraccion in any large artery which is near the kin and can be compressed against a bone. It L, therefore, an indication of the condicion of the heart and the way in which it i \yorking. ~ot only must the rate of the beat be ascertained, but also whether each beat is of th same strength as all the others, whether they are legular, or rhythmical and whether the blood pressure i~ high or not, as shown by the amount of pres~ ure needed under the upper finger to obliterate the pul e under the 10\,i'er finger. The most con,enient situation in which to take the pulse is oyer the radial artery as it passes down the thumb side of the wrist. The patient s arm should be resting comfortably on the bed with the elbow and wrist 100 ely flexed, and the nUl e .hould place three finger on the course of the artery whilst holding a watch with a .econds hand in her Other hand. he should not begin counting until she herself hac cecome accustomed to the throb under her fingers and any nenTou. ness her patient may haye been feeling has he should then count for a full minute . subsided . When the patient i asleep, or the \,rist are bandaged or otherwise inaccessible, the pulse can be counted oyer the temporal artery by placing three fingers in tront of, and abO\-e the ear. A baby's pul e can be counted at the fontanelle-the ~mall, throbbing area on the top of the head that is not ret hardened into bone. Tbe

Tormal Pulse. In adults, the a Terage pul e is 7 0

to 0 times a minute. It is slower when lying do\yn than when standing and. t is quickened by excitement and by exercise. It should not, therefore, be counted immediately aiter exertion or when a patient is agitated, and neither a pul e nor a respiration should be counted oon after a child has been crying. An infant's pulse rate i normally 120 to 13 0 , whilst a child of four to six u ually has a pulse rate of 100 a minute. P arents who do not knO\y this often become alarmed \"hen th y take the pulse of a small child. For both children and adults the beats should be regular and of equal strength. The Ptlise ill Illness. \Yhen the temperature is raised there is usua 11y an increase in pulse rate equal to ten extra bats for eyery degree rise in tel11p~rature; tllls should

not giYe am..i~ty . The q,(,dif)' of th~ pul e is often of greater significance than the rate. It is ~oft and compre ible in .hock and in haemorrhage, full and bounding in acme infections, and hard and incornpressible when the blood pressure is high. .A. continuou. ri e in puLe .rate \"dlilst the temperarure remain low or is falling i u~ ually a serious sign and should be reported to the doctor immediately. Following head injurie. the pulse ma,- become abnormally slow. TIll. is a danger ign, e-pecially if it is accompanied by deep, snoring breatlllng and a moi. r fluel1ing of the . kin, for this \\ould sugge:t compre-sicn of ci1e brain-a condition willch need medical aid most urgently. c

The Respiration and its Significance Respiration is the means by which the body gets rid of the carbon dioxide and water npour produced by the combustion of carbohydrates in the mu~cles and obtains a fresh supply of oxygen for further combu. cion. An increase in mu~cular energy \\lll therefore re.:ult in an increa.ed rate and depth of respiration. The rat~ \'aries al 0 with age and to a slight extent \\itll .ex. It i 16 to 1 tin1ec a minute in an adult, being slightly quicker in women than in men, whil t a baby breathes about 30 to 40 times a minute. It is normally slower during sle p because the muscles are then at re. t and carbohydrate combustion is lowed up, but it is quick ned by excitem nt as well as by exercise. The respiracion rate is normally one~quarter of the pulse rat ; 0 that in a child with a pulse rate of 100 one would expect a respiranon rate of 25 a minute. "Cnlike temperature and pulse rate, respiration can be yaried at will and directly one ie conscious that one's breathing is being obseryed one in,oluntarily exercise -orne control oyer it. 0 that it i_ best to count the respiration \dthout attracting the patient's attention to tbe process. TIu. is easily done if the nurse keeps ·her fingers on the pulse and, ha\"ing counted that, counts the rise and fall of the che, t wlulst the patient's attention is still focused on th ~ taking of IllS puIsC'. _\lternati\' ely, it can be counted whilst the patient is asleep, although, for the purpose of record keeping it is usually adyisable to take temperature, pulse and respiration at the same time. \\ ith infants and small children and \\'ith extrem ly ill patients it is \\ 1ser to place the hand lightly on the ch .st wall.

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Respiratiotl ill Illness. In accordance with rises in temperature and pulse rate the respiration rate is usually quickened but may keep its normal ratio. In nearly all diseases of the lungs or pleura the respiratory increase is dispropclttiona te to increases in pulse and temperature, being much more marked, whilst it is decreased in injuries or rumours of the brain and in all cases of deep unconsciousness whether this is produced by disease or by narcotlcs or anaesthe ia. One should note not only the rate of respiration but ",-hetber it is shallo\\- or deep, easy or distressed, noisy or quiet. Respiration is shallow In shock and in all conditions wherein mo\'ements of the 10\\Ter part of the chest cause pain, as in pleurisy and acute abdominal infections. It is deep in cerebral compression and in narcotic poisoning. It may be distressed in diseases of the lungs or the heart, it may be wheezing in bronchitis and asthma, whistlmg, or stridulous, \vhen there is some obstruction of the larynx or the trachea, such as occurs m diphtheria, croup, and tumours \\Thich press upon the laryn.",. It is stertorous, or snoring, in deep unconsciousne~s and in cerebral haemorrhage (apoplexy or stroke) although any nasal obstruction may cause snoring. \Then much blood has been lost, either as a result of an external wound or of severe internal haemorrhage, the breathing 1S sighing or gasping.

The Importance of Sleep Eyery injured tissue needs to be rested jf it is to recover speedily. In illness, \Tarious tis ues of the body are impaired, and sleep proyides general rest to all organs and structures. It is, therefore, a very important factor in the fight against disease and, as restlessness accompanies most illnesses, sleep is then more difficult to obtain than in health; but there is much that a good nurse carl do to belp her patient to sleep. If restlessness is due to discomfort from a wound, the bandage may be re-applied or the dressing may be changed. The bed may be re-

made, the face and hands may be sponged and a hot or cold drink mar be gi,Ten. Brushing the hair of a "'-oman patient is often I'ery soothing. The patient rna y not be warm enough for comfort, in which case an extra blanket or a hut ",'ater bottle may help him to become drowsy. He may be restless because he is too hot. The spong.ing of tne face and hands with changing of the night attire and the remo\'al of a blanker may correct this. A stuffy room may conduce to headache and restlessness, which are relie,'ed when \'enrilation is imprm'ed. Any irritating noise, such as a rattling window or a flapping blind, should be eliminated, and lights should be dimmed and be \vell shaded. Cool applications to the forehead often help considerably. A soft handkerchief \yrung out of cold water and renewed when necessary is suitable, ",-hilst a little eau de cologne sprinkled on the ,,-et handkerchief gi,res added comfort. Finally, it should be borne in mind that sick people are apt to be worried and an.'cious and this may interfere with sleep; so that if a nurse is able to find and allay the cause of arL'ciet~' her patient may become more restful. Only \\ hen all nursing remedies fail should there be reccurse to drugs, although the e are necessary when sleeplessness is due to seYere pain. The nurse should report the number of hours that the patient has slept and Il,'hether this has been quiet and restful or has been broken by periods of restlessness. It is sometimes clifficult to estimate the time that a patient has slept for he may be lying quite still "'Tith closed eyes in an endeavour to fall asleep and yet be awake for a bng period. On the other hand, the time that a patient is awa ke seems long, \''i'hilst he has no recollection of his hours of sleep, so that his impression of the amount of sleep he has had differs considerably from that of his nurse. His general condition and tbe absence of marked signs of tiredness may confir.rn..the fact that he ha passed a satisfactory night.

(t8 bt continued.)

FIRST AID TO ANIMALS (Continued from pal!.c 158.)

The cat is prubably the most difficult animal of all to handle. Besides teeth and claws they haye a suppleness of bod~', which allows them to perform incredible contortions, when attempting to escape their captor. Also, when a frantic cat is allowed to break free in a closed room, it performs somc queer antics, such as trying to climb walls, jumping on mantelpieces, etc., and often yanishing up the open chimney. Such things as a fracrured leg, or a dislocation, do not imrnobilise our four footed friends. They can get along quite well on three legs. When attempting to secure a cat, wear thick gloves. They may be inconvenient but they save most of the scratches you are likely to have come your way. The best places to grip a cat ate at the scruff of the neck with one hand, and the hind legs with the other, but it is sometimes difficult to transfer the cat to a helper, whilst you render the first aid. Probably the best method of controlling a cat is

AID

FIRST

AID

to use an old coat or jacket. PU 'h your arm through the sleeye from thc free cnd, so that the hand comes to the inside, of the coat. Grip the cat by the scruff of the neck, and pull the animal right inside the sleeye of the coar. .An assistant can take O\-er the grip on the neck from outside the slee,Te, and it is almost impossible for the animal to movc. If necessary, the slee\ e can bc cut to enable you to get at the injured part. Wrapping a cat in a piece of old blankct may bc sufficient control for somc cats but the sleeve method is the safest from thc point of view of the first-aider, provided it can be used \vithout causing further injury to thc animal. There is no effective way of muzzling a cat, but a small spongc bag ,,-ith a pursc string opcning placed O\'cr the eat's head and the string drawn not tOo tightly around the neck, may prove useful. . (Afore hints 011 Animal First Aid 1/1;/1 appear in fllltlre issues.)

P.-aetieai Points

by . Garrould

Tl9f Editor i/ll'itcs rt'oders to Jtlld ill 1I0tes 011 aclllal cases allflldtd or '·tl . S rfd makinG special I'f rerrll(f 10 good and bad poillts ill first aid trea/lI1mt. 1}/ .1 - , 6 j' . d dd . d I 4/1 correspondellce sbOliId bt' brief aJld 10 tbe pom! all a res.!" 0 "The Editor, 'First Aid'" (Pra(fical POilliS), 4(1.' Calilloll Streff, J L C "'s Gd lrill be paid j'for eo,b itt/II p"bl,s[,td. LollaOIl, ,L. ·4· -"

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Case. Patient, a lady, age about 40 wa placing fa~ly hcayy boxes

on a high shelf. She felt somet.hin? " giYe " in gram and reponed for treatment about 10 minute aherwards. . . . . . She complained of nausea and a -e\'ere pam .m the nght groll. shock. \.n inguinal herma '\"a suspected. P u 1 e \~-eak and .slight ~ warm swcet tea an d a11 0\\_ed to lie down Patient was gl\ cn . In a warm room. ~-\. donor "'as telephoned and suggested patient be

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taken to him in car. .' On examination doctor con.6rmed d1agno 1~. . . Pradical Points. ~Wd stimulating drink was gl\'en though pam and condition may ha\c been due [Q internal haemorrhage or qrangulatcd hernia. . . . In'the circum tances no examination \"as made, and dlagno 1S was arriyed at from hi_to r~ and general symptOms. Transport by ambulance on stretc h er may ha \C' becn preferable to

~~'lPL'T \.TIO.0. OF DIST -\'L PH.-\'L\KX OF FI~GER Case. )'Ian trapped finger betwecn belt of pulley. Distal phalanx

was compl tely torn off. . had been sc, ere, but had almost cea -cd \"hen paneor H aemOI'fhagc , f" . shock was brought to ambulance room, due ro on et 0 puma!) . f p 'imar"shock were . 1 f .\.11 signs and symptoms 0 a typlca case 0 1 J >

present. . hi" d Sterile gauze wool pad and bandage applied ug t)' t? lUJurc c finger and pati~nt laid dow'n W1th head low. ~\s shock 11l1prm' d ~ . aI 'eue An ambulance lighth' he ,,-a ' giyen warm sweet tca an d a C1g . . .

\\,;s c;lled. Blo~od began to soak t.h.rough dressing, but ra! 111g ann in a Sr. ] ohn sling appearcd ro be sufficient to re-conuol. Patient was detained in hospital for 3 days. Praclical Poinls. Yery definite cessation of haemorrhage ,,·hen shock \yas most seycre. St. John sling appeared to hold ann in suitable po -itio n "hcn slight haemorrhage recommenced. Yety detinite primary s h oc k- passed 0 f1:' panialh-_ as reassurance and treatment was giycn. I Bflndt')' for tbue " Practica 5S. bas been Mit 10 .\11'. 1[ 7'• -.rl . Pollt,. of ~ Poil/ts "-Editor.

Ex-Service Students> Successes All but ck\ en out of 163 candidates passed th preliminary . . f H ea1t h' s 1n te nsi'e Courses examination in the 1\1l111stry 0 \_. urslng h ' f for Ex-Sen-icc pcr-onnel: Onl y t\yO studems tallcd bot patts o. . f· Li"-crpool and nianche tet thc examinatlon, an d can d'd 1 ates rom h training centrcs achieved 100 per cem. succes es. This shortened course enables Ex,Sen-ice mc~ _an~ womcn "'.0 . ahty tor State" regl have had expericnce as nursmg ord er l'les to (1 u.: . , d ot' t hree,. an d t11e prehmllarv. exammatlon tration in one year lJ1stea 1 d bT at the end of thc first thr e months is the same. as that comp ete } d of her fust ycar. h the ordinary student nurse at teen . h S' . a tr'b The rernarkably high percentage of passes IS 1. u tc to t . e 1ster . detcrmmatlon .' Tutors and to the af th cseE 's- Scrvlce cand1dates to qualify as nurses in the shortest possible time. . d T'll h ' All are continuing their training and the few who fallc \\ 1 a, e another chance to take the examination. . personnel-3 6 4 111 en and 173 womenAltogcther 537 Ex-SerVice ' .' . . . courses . a t thc 10 tra1l11l1g centrcs. atc at present taking thcse 1l1tensnre

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Queries and Answers to Correspondents Queries 11.,ill be deall 11 ith ullder Ibe following mles ; I.-Letlers cOlltaining Queries must be 11Iark.ed all the top left-hand corner of the en/Jelope " Queo'," and addressed to " First Aid," 46, Canlionstreet, London, E.C+ 2.-All Queries must be JI'ritten 011 olle side of paper Oil!)'. 3·-AII Queries 1IImt be accompanied b), a " QlleO' COUPOII" wi frolll tbe ctlrrent issue of tbe JOtlmal, or, ill case of Queries frol7l abroad, from a recClit issue. 4.-The Tex/book to whicb reference 1I/a)' be made iJ/ this colulI/ll is the 39th (I937) Edilion of Ibe S.J.AA. j\[al1t1al of First Aid 10 the ltyured.

P ressure P oints C. S. (PadihaJ1/) .- I have recently been asked on several occasions by members of the Brigade why the more distal pressure points have been omitted from the Supplement to the Textbook. While I have been able to give several reasons, I should welcome an authoritative statement as to the reasons which the Reyision Committee must haye had for this alteration to our former teaching. As I read the new instructions in the Supplement to the Textbook, I assume that the Revision Committee have endeavoured to simplify the methods of treatment of wounds and haemorrhage and more especially to restrict the use of the tourniquet and the ligature on the part of first-aiders. In practice it has been found that in most instances haemorrhage is controlled by the simple application of evertheless, this pressure may be dressing and direct pressure. difficult of accomplishment in the cases of wounds in the upper ends of limbs and in the region of the neck. Consequently the Revision Committee have wisely retained the instructions with reference to the use of the pressure points of the femoral, subclavian and carotid arteries. When the new methods fail to arrest haemorrhage, the use of the rubber band is recommended but this is to be done only as a last resource.-N. Corbet Pletcher.

My explanation to the boys was that by stopping the arterial Elmv the venous flow is automatically weakened immediately and would, too, come to a dead stop and therefore the bandage above the wound would in effect achieve the same end by new means but the other boys in the D ivision cannot see my point at all. So we are still in the dark. \'V'ould you kindly give us your usual very clear and lucid information on this important point, which will be greatly appreciated?

Good!

Next pleasc.-N.C.P.

Bu rst Varicose Vein F. P. ('sou/bgate).-I notice in the Marcb issue on " First Aid" the answer which you baye given to the very important question concerning treatment of Venous Haemorrhage. Would' the trea[ment suggested therein and to which your answer was " Yes" be tbe same, for instance, for a burst varicose vein? I am afraid if that is so we, in my Di vision, do not quite understand the reason. We fully understand the reason why a rubber bandage should be applied w ~en necessary abo\ e tbe wound incases of arterial haemorrhage but why above the wound in cases of venous haemorrhage? Surely the venous blood would continue to flow towards the heart and if a bandage were applied above the wound and would continue to flow through the break in the continuity of the tissues.

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\Xi hat you fail to realise is that haemorrhage from a burst varicose vein can always be controlled by the application of a dressing and direct pressure. The instructions in the Supplement to the Textbook with reference to the use of the rubber band apply to any case of haemorrhage-arterial or venous-which cannot be controlled by the methods described in the Supplement. Such cases are very rare, very serious and call for exceptional treatment.-N.C.P.

Keep MILTON handy to kill the germs and help healing.

Fra ctures of Femur and Tibia

M. L. (Birlllillgham).-At a recent Divisional Practice a stretcher squad had to treat a patient who was suffering from compound fractures of left femur and right tibia without protrusion of bone in either injury. The wounds having been dressed, the fractures were treated separately. Then a broad bandage was passed round both knees but a separate figure-of-eight was then passed round each foot and ankle. The idea was to simplify examination on arrival at bospital. Would you please say if tbis treatment was correct? Both limbs having been tied together at the knees, I fail to see how you could separate the feet to apply the figure-of-eight bandages without causing unnecessary pain! In any case the surgeon can be relied upon to avoid u nnecessary movements during his examination and treatment.-N.C.P. T reatment of Poisoning

/vI. L. (Birmingham) .-Also, will you please tell me why certain Examination Howler M. R. (Cannon Street).-In a re-examination recently I asked one candidate what '.vas the first thing that she would do if she were called to a man who had just been knocked down by a fast-trayelling motor car. I was much amused when she replied promptly and confidently-" I 1vould whip out n~)I clinical thermometer and take his tempel-ature ! "

AID

poisons require special treatment as laid down in pp. 173 to 176 of the Textbook? When first-aiders have to deal with cases of poisoning the Textbook tells them to give either an antidote or an emetic, followed in each instance by the administration of some soothing substance. The last-named achieves its object by altering the nature of the poison or by minimising its effects; and experience has proven that the soothing substances named in the Textbook accomplish this object satisfactorily.-N.C.P. Methods of Loading Stretcher

II?'. S . (Gateshead).-Rule 12 on p. 12 of the Supplement to the Textbook tells us that all cases of spinal injury should be loaded feet first on to the stretcher. Yet in the same paragraph it tells us that in cases, in which the patient is carried to the stretcher, the foot of the stretcher should be placed as close to the feet of the patient as is convenient before proceeding to lift. Shou ld not the instruction read that the head of the stretcher should be placed as near to the patient's feet as is convenient? Meanwhile we thank you for your reply. It would certainly seem that a mistake has crept into the last three lines of p . 12 of the Supplement to the Textbook. In these circumstances the Revision Committee will doubtless consider this before the Revised Textbook is published.-N.C.P.

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Cause of Air-hunger M. Y. (PlaistoJt').-Please be good enough to tell me why it is that a patient suffering from haemorrhage from an internal organ may develop air-hunger--as we are told in Rule 5 on p. 136 of the Textbook. Another name for air-hunger is " oxygen stan-ation." It is not confined to cases of haemorrhage from internal organs; and it may occur when there is a serious loss of blood whether externally (and seen) or internally (and concealed). It results from loss of fluid from the body and especially of the red blood corpuscles consequent on which the latter cannot carryon their function of absorbing oxygen from the air cells of the lungs.- T.C.F. H ydrop hob ia A. H. (Norlhf!eel) .-~ ill you please tell me exactly how the ,irus travels in hydrophobia? Before I was called up I was a member of the Sr. John Ambulance Brigade and I was taught that the \ irus tra,els by the ncn'ous &ystem. Now I am training as a nursing orderly and have been told that it is carried by the blood circulating the body to the brain and then it trayels down by the nervous system. This point has me greatly perplexed and I would appreciate your help. If we submit the problem to another authority then Quain's Dictionaf]' oj Medicine reads as follows : " There is evidence tending to show that the virus inoculated by a bite reaches the central nervous system through the nerves; and it is perhaps fo r this reason that lacerated wounds involving nerves are more liable to be followed by hydrophobia. It is possible that the virus may be com-eyed from the peripheral nerves to the central nervous system through the lympatics." From all this it follows that the maj ority opinion is that the virus travel s along the nerves. At the same time I need hardly remind you that for your purposes it d oes not matter how the virus travels throug h the system.- 1.C.F. Foreign Bodies and P almar Bleeding R. H. (SwaJlsea).-I feel that the query and answer published under the above heading in your April issue of" First Aid" are both misleading. (1) Your correspondent seems to have misread Rule 12 on page 26 of the Supplement to the Textbook. This rule c nly gives as examples "v.-ounds in the throat, high up in the arm and high up in the thigh," when, of course, " it is necessary to apply indirect preSSure to the carotid, subclavian or fem'oraI points (as the case may be)." I do not consider that this mle in any way suggests that the radial, ulnar and brachial pressure points are cancelled. Indeed, such an idea is absurd 1 No one would go to the trouble of applying pressure on tbe subclavian point for a wound which is confined to the palm of the hand and ignore the ulnar and radial points (not to mention elbow flexion, brachial or axillary points, all of which are nearer the wound than the subclavian). The ulnar and radial pressure points are still there.

(3) With regard to your answer to the previous query I feel that you have been rather hasty in your statement- " the firstaider should not waste time in hunting for foreign bodies in the wound." While I agree wholeheartedly that there should be no " hunting" or probing for foreign bodies I feel it should be made clear that the removal of l l isible and loose foreign bodies, is permissible as stated in clause 4, page 25 of the Supplement, noting also that, " all others' are left severely alone,"

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EW PLASTI SU GICAL DRE SI G

j\,lay I say in conclusion how much I admire ~-our "open forum" in the form of your Queries and "\nswers column? (1) If you re-read the Supplement more carefully, you will realise that Rule 12 on page 26 does not giye examples of haemorrhage but states that its instructions only operate" wben it is impossible to apply direct pressure successfully . . . . " (2) Also you \vill find in the instructions to the section on "W'ounds and Haemorrhage" on page 19 the definite tatement that" W'ith the exception of the three pre sure points for carotid, subcla,ian and femoral arteries, pages II3 to 130 (ro end of Rule 10) in Textbook are superseded" and that all the remaining pressure points are no longer to be used by first-aiders in the treatment of haemorrhage. (3) Also if you re-read my pre,ious reply you will realise that I have not been hastr and that what I wrote nor only stressed the instructions of the Textbook, which you quo te, but also the need to obtain medical aid for such cases at the earliest po sible moment. Such being the facts, we will allow my preyious reply to remain unaltered 1- .c.F.

Ca lcium Ca rb ide P oison in g

F. B. O\,TorthaJllptoll).- Returnin g from a competition recently, I was asked by a bus conducto r ,,-hat I would do if 1 'was told that whilst a man was filling his acetylene lamp with carbide, a child had picked up and swallowed a small piece of carbide and then complained of burning pain in mouth and throat. As this gi>-es off a gas on coming into co ntact w ith moisture we would not be able to give an antidote as given on p. 171 o f Textbook. Testing of carbide with various liquids and o ils showed that medicinal paraffin was the only one which did not g i\-e off any gas. We presume that we should be correct if we treated this kind of casualty by withholding an antidote and applying Rule 4 on p. 172 of Textbook and leaving our the demulcent drinks. Your ruling would be greatly appreciated.

Replaces Bandages and Plasters ,~

Plastic Skin was originated fo r use as a dr~ssing ~f~er blood transfusion Later, .surgeon~ discov~red its specl~l .qual1t1es made it an ideal pre-operative surglcal barner, To~ay 1t 1S superse-ding bandages and plasters as a .dressing for cuts, abraslOns and small burns. Not only is it neat, flextble , waterpro?f, transparent and selfsealing, but because of its high phenol conte~t It also greatly acceler~tes · a " Portex" Plastic Skin is now ava1lable throug h all chemtsts h ea 1lOt:>' . ' b 1 I I n tu b es, Price 1/ 8d. including tax, and. In larger .. SlZe h ott es . fn case. of difficulty, write direct to the propnetors, glvrng t e name 0 your pharma ceutical suppliers.

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FORMULA : Phenyl Sahc),late, [0 per cent., Resorcinol, ·s per cent., Eugenol,

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EMERGENCY TREATMENT

OF SKIN INJURIES fje prepared for an eme~gency ~d keep Cuticur~ Br~ d O tnu;nenr . In "our First Aid Kit It b rings ill· ;tant soo hing relief to cutS, burn". skin lacerations - preveots 8pr~ad rf infectioo. quickly heals Obtatn· able at all C~emists and Stores.

REVIEW

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H andb ook of E lem enta ry Anatomy

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EX A R MY M ARQUEES

This atlas, which is nine by six inches in size, is chiefly intended for the instruction of studen t nurses and first aid students. It comprises sixteen plates, of \\'hich fifteen arc in colour, with descriptive matter. The system adopted of numbering on diagrams and in the corresponding text printed oppo ite pro, ide a simple and straightforward scheme which enables students quickly and easily to find out all they may require to know. Consequently, those for whom the atlas has been compiled \,' ill find it a most 11 eful ai d to their studies ,

m a base oj

pO~J'-7I1eth)'1 methacrylate and solvents.

You have e"idently fallen into the error of assuming that tbe gas for calcium carbide is co rrosive whereas in fact tbe poison falls within the group of irritant poisons. Little is known about the treatment of Calcium Carbide Poisoning (which may prove fatal in three or four hours) except that treatment must be immediate and pre,'ent the production of acetylene gas. The subject has been under discussion periodically in this column for many years, rhe last occas ion being .\ugust, 1943. The net result of these discussi ons is that glycerine (which absorbs water) is regarded as the ideal remedy for use by first-aiders who should administer it freely. This d one they should take steps to make the patient ,-omit by irritating the back of his throat and so empty the stomach. If, however, glycerine is not a,'ailable, then medid ru.1 paraffin might be used for the same purpose, although, of course, this remedy is insoluble in water and alcohol.- .c.F.

By JOHN J. TEKLE;-;;BURG London: H. K. Lewis & Co. Ltd. Price ss. 6d. net

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FIRST

168

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FIRST

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FIRST AID IN THE OFFICE By J. WI . SCOTT T O many of our readers, First Aid in an office may not amount to a great deal, owing perhaps to some offices being staffed with few personnel. This reaaing, however, refers to large public offices, local authority bpildings, Government offices, etc.; where staff figures reach the three or four figure numbers. In most of these instances, a Welfare Centre is in existence, who are responsible for the institution of Sick Bays, where First Aid treatment may be provided for casualties in the office. The size, and the amount of attendants in the sick bays varies of course on the number of staff in the building, also the size of the building, and the schedule of equipment depends on the staff figures for the building in question, and rderence to Factories and other Acts, will show the correct amounts that are required; but while we have these variations in equipment quantities, figures, and sizes, etc., Erst aid treatment does not differ in its manner of application (or shouldn't do), and if a close reference to the "Black Book," combined with a large amount of common sense is at all times maintained, quite a lot of good can be done, and so very little harm . The main object ot this article is to lay down a few simple and easily applied remedies for some of the ailments and injuries that appear in the average office sick bay, from day to day, and to discuss a tew of the unusual cases that sometimes appear at times when one least expects them.

Boils and carbuncles are a somewhat frequent cause of a visit to our sick bay. \Vhile I think of it, these must not be squeezed or pressed, in an endeavour to extract the matter that is within. The best initial treatment is a hot compress, repeated a few times, and then the patient advised to visit the doctor, and if he desires the treatment to be continued, then tbat is all that is required. Continued hot compresses, and no squeezing, as much harm can be done by doing so, especially in the regions around the ho.u:t of the face, i.e., in a circle a bove the eyes, cheeks and under the nose. The treatment as mentioned above may take a little longer to effect a cure, but it is much more effective and what is more important to many, is that there is less tear of an ugly scar.

In the building in which I am employed, we staff upwards of 1,200, and out of that number I should say,

Miscellaneous A dver tisem ents. Advertisements with remittance should be se nt to First Aid, 46, Cannon Street, London, E.C.4. Rate 6d . per word, minimum 4s. 6d. Trade advts. 4d . per wo rd, minimum 65. Box numbers 15. extra.

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HOW to Stop Smoking. Save Money. Safeguard health. Thousands cured. Send stamp for Booklet of World Famous Remedy. Stanley Institute Ltd., (Dept. 75) 265, Strand, London. R UPTURED? FORGET IT! Use Brooks Rupture Appliance- the new discovery. Wonderful! N o lumpy pads, no ::.prings, durable, cheap. Binds and draws parts together quickly. Sent on trial. Catalogue free. Address : Brooks Appliance Co ., Ltd. (718) 80, Chancery Lane, London, W.e2. (718) H ilton Chambers, Hilton Street, Stevenson Square, Manchester,!.

A HINT TO HELP

at a rough estimate, that 1, 1 99 use a razor blade to sharpen pencils, and such like . Some of them use the type that have a guard along one -side, but I do not see many of these. The three-hole type are the cause of mos t of the delightful incisions that I am faced with man y times, and they range from a quarter of an inch to maybe an incb long and vary in depth, but always a nice clean cut, with, as a rule, tree bleeding, that is soaking a handkerchief, and frock-never, or very seldom, trousers, owing to man being able to play with the blade in a 3ensible manner. A light dressing of lint, with a little eutlavine emulsion is ample treatment for these minor cnts, or even a clean dry dressing will suffice. .

(10 be contil/lled)

N0 COUPONS.

You can make 2 lovely pairs of Ladies or Gents Gloves. Send today for bes t Beige Chamois Skin with pattern (State Size) and directions, r 6/-. Cash returned if not delighted. Clayton Leathercrafts, Sutton in Ash, No tts . F IRST AID Competition and Practice Tests. Three revised series each containing 6 Team, 6 Individual, 6 Oral, for 2/-, postage rd . From: Robinson, BCM/ Superb, London, W.e. 1. E LECTROLYSISTS. Enrol free on National R egister. Farren, Hon. R egistration Sec., 15, Trebovir Road , Lonclon, S.W.5.

" FIRST AID "

QUE RIES and ANSW ERS COUPO N To be cut out and enclosed with all Queries. May. 1947.

SI(IN

TROUBLE

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HEAL QUICKL'l What a gratifying experience it is to find that the skin no longer irritates, and has become d e·ar and h ealthy ag ain. Germolen e ha s helped many a skin sufferer to get rid of his, or her, complaint . . . and it is interesting to know why thi s should be so.

PROTECTIVE First, let it be said that Germolene has proved to be a protection a!5ai.nst . delib e~ate or accidentalll'rltat lOn . Wl~ out the soothing, cooling touch of G ermolene some skin troubles provoke scratching which, of course, del ays healing.

PENETRATING It is the penetrating power of Germo1ene which enables it to sink right in through the top skin into the true, living skin below-and so to reach the tortured nerve endings-which brings such wonderful relief.

Th e futu re holds somethi ng good for us all.

If First Aid is a subject in wh ich you are inte rest ed , then yo u will readily understa nd th e va lue of SWEDISH MASSAGE and how it can assist in heal ing the suffe rer.

ANflSEPTIG The purifying effect o j Germolene penetrates doW? into the sweat pores, halI follicles and sebaceous glands, counteracts the activity of ~kin germs, reduces infiammauon . If you are suffering from skin trouble get a tin of G7rmol~ne today! 1/4 & 3/3 mcluding Purchase Tax.

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R INO·ANTI EOL

A nasallmmunising <:ream. contains Antipeol Liquid as well as the antivirus and autolysins of PNEUMOCOCCI. PNEUMO-BACILLI, ENTEROCOCCI, M.CATARRHALlS, a.PFEIFFER and calmative and decongestive ingredients . INDICATIONS: Coryza, rhinitis, hay fever, catarrh, influenza, colds and other nasopharyngeal infections.

ENTEROFAGOS polyvalent bacteriophages specific against 156 strains of mi~ro·organisms common to infections of the gastro-intestinal track, kidneys and bladder . RAPIDLY EFFECTIVE RESULTS in enteritis, dysentry. colitis , d iarrhceas, B.coli infections, typhoid and para-typhoid fevers, and other intestinal and para-intestinal infections. Oral administration. No reaction. No shock.

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CLINICAL SAMPLES AND LITERATURE FROM

MEDICO-BIOLOGICAL LABORATORIES, LTD., Cargreen Road, South Norwood, London, Printed by HOWARD, JONES, ROBERTS & LEETE, Ltd., 26-28, Bury Street, St. Mary Axe, the Proprietors, DALE, REYNOLDS & CO., Ltd., at 46, Cannon Street, London, E.C.4, to London, E.C.3, and published by be addressed. whom all communications should

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MALE

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ATLAS

An invaluable possession. Every Fi rst Aider shou Id possess these Atlases . The plates are coloured and very clear; the text is simple and complete. For Nurses, Students and all Medical workers, these Atlases have taken their places as two of the very best. Displays the anatomical relations of organs and structures so clearly that it is extremely easy to follow. The text gives a clear and accurate account of the anatomy and physiology of the female body .

EVERYTHING you want to know. A full Dictionary, explaining and defining medical words in common use. Numerous clear illustrations to help easy understand ing. Twenty-one excellent appendices, including such subjects as :-

I. 2. 3.

First Aid Treatment. Antiseptics and Disinfectants. Blood Transfusions. Treatment of Electric Shock . Average Weights and Heights.

Bandages and Bandaging. Poisoning . Common Drugs and Doses. Methods of Giving Drugs. Thermometers.

Over 500 Illustrations. Price 4/- Postage 3d.

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HOUSEHOLD PHYSICIAN Describes in simple language with helpful coloured plates and diagrams

The COMPLAINTS OF MEN, WOMEN AND CHILDREN.

FOR DIVISIONS OF THE

Their Cause, Treatment and Cure. A few of the Subjects treated: How to Keep Well, First Aid The Principles of Nursing What to Do in Emergen cies The Eye, the Ear Influenza, Colds, etc. The Throat, the Nose The Chest, the Heart Measles, Mumps, Catarrh Corns and Warts The Stomach, the Liver Phys ical Culture The Teeth, the Muscles Treatm ent for all Skin Diseases Infant Welfare The Lungs, Pleurisy Homoepathy, Neurasthenia Hygi ene, Anatomy, Pharmacy 375 Prescriptions, etc., etc. THE YOUNG WIFE will find just the information she requires. MOTHERS who wish their daughters to develop naturally will find exactly the teaching they need. WOMEN OVER 40 will find their difficulties regarding health frankly discussed. PRESCRIPTIONS- 375 proved remedies. Hundreds of subjects.

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By G. DOUGLAS DREVER, M.B., Ch.B.

DALE, REYNOLDS & CO. , LTD., 46, Cannon St., London, E.C.4.

~~" ~~~O~

and

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Meet this

Editor: DALE ROBINSON, F.R.S.A., F.S.E.

modern Ambulance by

AUSTIN

No. 636.-VOL. LIV.

JUNE, 1947.

Editorial-First Aid in the Mines

FOR

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First Aid to Animals

News from all Quarters

Practical Nursing in the Home

Articulated & Disarticulated

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(JONTENTS

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HALF SKELETONS, Etc. Etc.

Practical Points Care of the Hands in and out of the First Aid Room Queries and Answers to Correspondents Letters to the Editor First Aid in the Office

10 10 12 14 16

NOTICE TO READERS. FIR~T AID i~ publis~ed on the 20th of each month.

The Annual Subscription is 55. post free; single copies 4d. . Its aim and obJects being the advancement of Ambulance and First Aid Work in all branches, the Editor invites Readers t s d A . I d R 0 en rtlc es an eports on subJects pertalnlng to the Movements and also welcomes suggestions for Practical Papers. h th db' All Reports, &c., should be addressed to the Editor at the address below and should reach him before the 8th f (not necessaTily fOT publication) by the name and address of the Correspondent. ' 0 eac mon ,an must e accompamed Subscriptions, Advertisements and other business Communications connected with FIRST AID should be forwarded to the Publishers.

ADAM, ROUILL Y & CO , Human Osteology, Anatomy, etc., 18. FITZROY STREET. FITZROY SQUARE. LONDON, W.1. TELEPHONE : MUSEUM 2703 .

S~l't0Ral ANTISEPTIC &OINTMENT For Works, Factories and Ambulance Outfits.

Septonal cleanses and heals wounds with amazing rapidity. Prevents and arrests inflammation . A safeguard against blood-poisoning. Possesses extraordinary styptic properties . In liquid form Septonal is supplied in 16 oz. bottles at 3/-. quart 6/-. 1 gallon 9/6 and 1 gallon bottles at 17/ - per bottle, and in concentrated form in 2 oz. bottles, for making up 1 gallon, at 14 /- per bottle. Septonal Antiseptic Ointment This ointment is most useful for boils, minor injuries and skin troubles. Available in i lb. jars at 2/3, ~ lb. 4/- and 1 lb . 7/6 per jar. Make sure you include Septonal in your ambulance outfits. We hold stocks of Surgical Bandages, Dressings. Lint, Cotton , Wool and all First-Aid requisites. Be on the .. safe" side-Septonal will meet every First-Aid need.

THE I. D. L. INDUSTRIALS LTD. 1, ST. NICHOLAS BUILDINGS, NEWCASTLE-ON-TYNE, 1.

DALE, REYNOLDS & CO •• LTD., 46, CANNON STREET. LONDON, E.C.4.

The new AUSTIN' WELFARER' is of advanced design, yet embodies all the expert knowledge and practical experience gained by forty years of Austin ambulance building, including the famous K2 ambulance which served the armed forces in the war. The short wheelbase gives easy manreuvring; the specially hinged rear doors and folding step permit quick access to the interior, while an extra door on the nearside is very convenient for the attendant; soft semi-elliptic springs, hydraulic dampers and large 16/1 x 9/1 R.B.S. tyres impart excellent riding qualities. Many alternative arrangements of interior equipment allow accommodation ranging from 12 sitting patients to 3 stretcher cases. In the' Welfarer' interior, patients can relax in quiet, restful com/art. All equipment and fillings have been planned with a practical /wowledge 0/ modern hospital needs. Th e body has sound and thermal insulation and a hyg ienic moulded/foor covering. A heating and velltilating sys tem with thermostat control keeps the air fresh alld at an even temperature.

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Editorial FIRST AID IN THE MINES

~oard

to modernise and improve the mines, and to

Impro~e the lot of the miner working there. In the N0 industry calls for a more perfect organisation of execution of that excellent programme first aid activities

first aid activities than t hat of coal mining. The dangers of the miner's life need no elaboration here, suffice to say that in the mines the need for well-trained first aid personnel is well understood, and an excellent organisation has always been a feature in the various collieries. Our many friends in the industry have testified to the zeal and enthusiasm which the miners bring to first aid. and the help which the companies have given in the past have contri buted not a Iittle to the success of first aid activities. Now that the mines have been taken over by the nation thel"e has been some doubt expressed as to the future of the first aid organisations, but we are glad to be able to say that the National Coal Board are to appoint a Chief Medical Officer (by the time this appears in print the appointment will probably have been made) who will be in general charge of all first aid activities at the Board's collieries, and we hope that this will mean that first-aiders will be on a new and improved footing. Zeal and enthusiasm there is in plenty, as we have already mentioned, but generous and understanding help is always necessary in the equipment of the teams, and in the provision of training facilities and many other necessary items. The help that the companies gave in the past is no longer forthcoming, but the National Coal Board have shown that they well appreciate the problem, and they have a fine chance of establishing first aid in the mines as the well-organised and well-equipped service wh ich it deserves to be, It is the professed ai m of the

we feel sure, will not be overlooked. As for ourselves' we have been fortunate to have been of some serv ice i~ the past to coli iery first-aiders from time to t ime, and in . the ~utur~ we look forward to continuing that pleasant relationship. In that particular field of first aid, as in all other branches, our services are always available.

NURSES ARE BETTER PAID. Many nurses are now receiving salaries twice as great as those paid before the Rushcliffe Committee began its work five years ago. During 1946 alone, as a result of the Committee's recommendations the salaries of nurses and midwives of every grade from students and pupils to matrons were raised. The publication of the consolidated recommendations of the Committee is a reminder of the great advance in nurses' conditions of service during recent years. New recommendations are included in this consolidated report. These include some further increases in salaries. The Minister of Health, Mr. Aneurin Bevan, has accepted these further recommendations, and has commended them to employing authorities for adoption with effect from Ist April 1947, as proposed by the Committee.

FIRS T

FIRST AID

A COURSE IN ADVANCED FmST AID by A. D . BELILIOS, M.B., B.S. (Lond.) D.P.H. (Eng.)

EMERGENCIES SYSTEM

THE

CIRCULATORY

the first article of this s~ries, a di~tincti~n ~a~ m~de I N between medical and SurglCal first ald. This distrnctlOn will be carefully preserved in this article, for, strictly speaking, a description of the emergencies of the circulatory system should include bleeding. and the vari~us met~ods of arresting haemorrhage. Bleeding, however, IS essentially a surgical condition and is carefully studied in elementary first aid hence it will be omitted here. It is desirable to begin with a few words on the elementary anatomy and physiology of the circulatory system. It consists of the heart, the bloodvessels and the blood contained therein. Each time the heart contracts (beats), blood is forced along the vessels of the body and is thus kept in continuous motion. There are approximately I I pints of blood in the human body and its chief functions are to carry oxygen, food and water to the tissues and to remove from the tissues carbon dioxide and other waste products. The impure blood is finally carried to the lungs where the carbon dioxide is excreted and fresh supplies of oxygen are absorbed.

The heart consists of three coats, the pericardium, the myocardium and the endocardium as follows : The pericardium is the outer covering of the organ and consists of two thin layers like the pleura. It secretes a watery fluid which acts as a lubricant preventing friction when the heart beats. The myocardium is the muscular coat and is made of a special variety of involuntary muscles which maintains the regular beating of the heart throughout life. The endocardium lines the inside of the organ and provides a smooth surface over which flows the blood. Like any other organ of the body, the heart must have an efficient blood supply. This is provided by the coronary cimlation. Two arteries, the right and left coronary arteries arise from the beginning of the aorta and run back into the wall of the heart where they divide up into capillaries and supply the organ with pure blood. Impure blood is collected up by the coronary vein which returns it to the right ventricle.

DISEASE OF THE H E ART. No organ in the body is responsible for more worry caused to the average layman than the heart. With such an important function and such a complicated structure, it is The heart is a hollow muscular organ situated in the not surprising that the heart can be liable to a number of centre of the chest but extending also to the leit side. It diseases .. But disease of the heart is not nearly so common is shaped rather like a pyramid with its base upwards and as is usually supposed. Many young people who worry its apex directed downwards and to the lett. . about their hearts have no organic disease at all; very often The apex ot the heart can usually be felt beating against they are suffering from a nervous ailment which they do not the chest wall in the space between the fifth and sixth recognise as such but which they erroneously assume to be ribs just below and internal to the nipple. This beat, due to the heart. The same remarks apply to "heart called the apex beat or cardiac impulse, is ot considerable attacks." Every doctor is familiar with the urgent message importance in medical work, since it can be felt even "come at once, he has got a 'heart attack'," and the when the pulse has become imperceptible. Moreover, in doctor goes at once, knowing however, full well, that it heart disease, a nurse will often be instructed to count the is extremely unlikely that the provisional diagnosis is apex beat and compare its rate with that of the pulse at correct. the wrist; normally the two rates should be equal, but in There is another fallacy about heart diseases which some ailments of the heart, the rate of the apex beat will should be exploded at this stage. Many laymen assume be found to be quicker than the pulse. Failure to feel the that almost every form of disease of the heart is bound apex beat does not necessarily mean that the heart has to be fatal. This assumption fortunately is far from correct. stopped beating for sometimes its beat may be behind one There are, however, two varieties of heart attacks which of the ribs. are of great importance and which will be described, coronary throm15osis and angina pectoris. The heart is wvided from base to apex into two distinct halves, the right and left sides respectively. Each side is CORONARY THROMBOSIS. again divided into two chambers, the auricle at the base This is a form of heart attack which is becoming and the ventricle extending to the apex. There are openings increasingly common in modern life. It generally occurs between the auricle and ventricle of the same side of the in elderly patients but may affect younger subjects from heart but none between opposite sides. the age of 35 upwards.

The disease is due to the formation of a clot of blood (thrombosis) in one of the coronary arteries. This clot blocks the bloodvessel and thus deprives part of the heart of its blood supply. . The attack usually occurs when the patient is resting, i.e., during the night or in the early morning; it may, however, take place at any time during the daytime. The patient develops a dull aching pain at the front of his chest and over his heart which may be at first ascribed to indigestion. Soon, however, the pain becomes intense and agonising, often radiating upwards towards the left shoulder and down the arm. lIore rarely the pain shoots upwards towards the right shoulder an~ then ~own the right arm or up the neck to the gums. It IS most lIDportant to notice the direction in which the pain radiates or put into technical language, the part of the body to which the pain is referred. Accompanying the pain are many of the typical sympto~ns and signs of shock. The face is pale or ashen grey WIth cyanosis of the lips. The skin is cold and clammy while the temperature is subnormal. The pulse is quick and feeble; shortness of breath and vomiting may occur. A characteristic feature is restlessness. FIRST AID. (r) Aledical Aid. A doctor must be obtained at the earliest possible moment. He will give an injection of morphia which will relieve the pain and reduce shock. nless there is likely to be considerable delay in obtaining medical aid, the patient should not be moved pending his arriyal. (2 ) Treatment for Shock. A bs.olute rest from the ve~y beginning is essential. The patIent should be tol~ to lie as still as possible and reassured that the doctor will soon arrive and relieve his symptoms. \\'armth should be supplied by blankets and hot water bottl~s which la.tter must be covered in order to prevent burns srnce the patient himself will not be able to call attention to the fact that they may be too hot. Fluids may be given in small quantities at a time. Glucose is an advantage. (3) jHaster(y Inactivity. Apart from the ab<?ve meas:rres and applying general principles suc~ as undolng. clothing, etc., the first-aider should do as little as pOSSIble. Salvolatile, alcohol, smelling salts, massage over the heart, etc., are all contra-indicated and will do more harm than good.

Many cases of coronary thrombosis. make. an excelle-?-t recovery although they have to spend SlX to eIght weeks rn bed following the attack.

ANGINA PECTORI S . This is a common variety of heart attack and usually ot fifty. Generally they are occurs in men over the aae b suffering trom high blood pressure and hardening of the arteries (arteriosclerosis). The actual attack is caused by a spasm of the coronary arteries which results in the myocardium temporarily receiving insufficient blood for its needs. The attack usually occurs during t~e . day time while. the patient is at work; it may be preCIp itated bJ: hurrYlng, especially after eating a heavy meal, or by emot10n such as anger or excitement.

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The pain is very similar to that of coronary thrombosis and is usually referred to the left shoulder and down the lett arm. At the same tin1e, the patient feels that there is something tight, like a constriction or an iron band, placed round the chest, this prevents him from breathing properly and causes a fear of impending death. The patient stops still when the attack comes on and leans forwards with his hand pressed over his heart. He resents proferred assistance. This attitude of rigid immobility is an important distinguishing feature from coronary thrombosis in which restlessness is characteristic. The expression is anxious and the face pale or ashen grey, the skin is cold and clammy. The attack usually passes off in the course of a few minutes with the belching up of wind, the patient sometimes attributing the whole disturbance to indigestion. Sudden death, howeyer, mar occur, although it is amazing how many patients live for many years in spite of recurrent attacks. FIRST AID. (r) Work with ;:"latllre. This is an important principle of all medical treatment, yet it is often forgotten. In angina pectoris, it has been noticed how the patient immediately stands still and remains immobile until the attack is over. This instinct to keep still is one of nature's life saving measures because so long as the patient does not move, the curtailed supply of blood may be just sufficient to enable the heart to carryon. Any extra exertion, however, might just turn the scales against the alreadr embarrassed heart. It follows from this that the first-aider should avoid taking any action which might disturb his patient physically or mentally. The patient must not be moved; he should be allowed to remain in whatever position that gives him most comfort. Sudden movement or excitement may cause a fatal ending. .

(2) Render Assistance if Reqllired. Sufierers from angina pectoris usually carry special tablets prescribed by their doctors to be taken when an attack comes on. One tablet should be munched in the mouth at the first sign of pain ; the tablet should not be swallowed since the drug is absorbed into the blood stream more quickly from the mouth than the stomach. As an alternative to tablets, glass capsules containing a drug called amyl nitrite may have been recommended. One capsule should be crushed in a handkerchief and held to the nose and mouth. \\"'hen the patient inhales, the fumes of the remedy enter the blood stream through the lungs and ease the pain immediately. ~o~h the tablets and the amyl nitrite stop the attack by relievrn~ the spasm of the coronary arteries, causing them to dilate and thus supply more blood to the heart. It will be appreciated trom the above, 0at the c.hi~f duty of a first-aider during an attack of ang:rna pe~tot1s IS to assist the patient to take those remedies w~ch the doctor has previously prescribed. \~11e? the. attack 1S o,~er, he should provide tor the co~ort of his patient, supplyrng rest, a warm drink and arrangIng for the transport home. (To be continued).

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News From All Quarters

FIRST AID TO ANIMALS IT is not usually possible for the owner to assess the amount or nature of all injuries that may be inflicted on a dog in an accident. Expert attention and advice should be sought as soon as possible, in practically evety case and these btief notes are only meant to bridge the time between the accident and the anival of expert help. R eJlrail/l. An injured or frightened dog is an unreliable quality 'when it comes to handling. Therefore, take steps to secure the restraint of the animal, without risk of injury to yourself. Approach slowly, speak quietly, and keep the hands down. Once the dog's collar is in your hand, or a loop of rope around the dog's neck, the dog's jaws should be bound together with a piece of tape or string, Hold collar and one end of the tape in the left hand, take several turns of tape around the dog's jaws and tie the loose ends of tapes at the back of the head.

Occasionally an animal involved in a street accident or fall, breaks or dislocates a jaw bone. Symptoms of such an injury ate distortion of the jaw, and often inability to close the mouth. Such cases, of course, should not be gagged in the manner described and in any case the first-aider can do nothing to help the animal, until expert assistance is obtained. Bleeding, Haemorrhage. Bleeding is classified according to the vessel 01' vessels from which it escapes. AI·terial bleeding issues in Sputts and is of a bright red colour. Severance of a main artery such as the carotid artery in the throat, 01' the femoral artery of the thigh, results in rapid loss of large quantities of blood, and usually proves fatal. It is not, howevet, difficult to stop bleeding from smaller arteries by temporary measures. VenouJ bleeding issues in a steady stream, welling up from the inside of a wound. Venous blood is of a darker colour than arterial blood. Capillary bleeding oozes out from the tiny blood vessels, and tends to stop of its own accord.

Arterial bleeding from limbs or tail is best controlled by finger pressure, or by the use of a tournequet. Venous bleeding may be controlled in a similar way, but the tournequet should be placed on the side of the wound farthest from the heart. Capi~. bleeding from grazes, etc., can usually be rapidly stopped by application of cold water swabs, or painting the injured surface with Friars Balsaam.

Internal bleeding is most often the result of an accident internal bleeding caused by internal vessels being ruptured. The s~mptoms shown. are: the lining membrane of the mouth and eyes become pale; the arumal breathes faster at first, but breathing becomes slower as the rate and volume of the pulse decrease, and the temperature rapidly dr?ps to. sub-nor~al. The heart beat becomes very weak, and the ammal dIes, sometimes after a few convulsions.

~ittle. can be. done in cases of severe internal bleeding, but if the arumal IS conSCiOUS, it should be offered cold water with a little salt in it, to drink, and also covered with a light war~ coat or flannel. The head should be kept lower than the rest of the body. No spirits should be given. Note.-:-Wounds iD parts of the body to which a tournequet cannot be applied to control t~e bleeding, are best tightly plugged with cotton wool, the latter bemg kept in position by bandages or adhesive tape.

. ~~unds. A wound may he described as: incised wound when it is mfhcted by a sharp instrument such as broken glass, razor blades, etc.

Lacerated Wounds. When the skin and underlying flesh is torn and crushed in an irregular manner. Such wounds often occur when an animal is involved in a mishap with barbed wire, motor car, etc., owing to the tearing and crushing of blood vessels these do not usually bleed much, but owing to the destruction of tissue, and large area involved, they take longer to heal, and leave a well-defined irregular shaped scar. Punctured IPoulJdJ. When the flesh is penetrated by a sharp pointed instrument such as a nail, fang tooth, prong of a pitch fork, etc. These are dangerous, especially if but little blood is shed from them. Dirt and germs enter with the instrument inflicting the injury, and may produce dangerous complications, contusions and bruises, unless covering large areas of the body usually heal well with a little attention. InciJed WoundJ. Incline to bleed freely, but if kept clean tend to heal well. Treatment. Avert bleeding. Cut the hair away from the edges of the wound. Irrigate the surface of the wound with a solution of antiseptic such as salt water, botacic lotion, or Dettol, to remove any debris. Apply a clean dressing and bandage into position. Punctured wounds should, if it is possible, be syringed out with weak antiseptic solutions. Fractures. Fractures of the bone occur as a result of violence and the most common types met with are simple, compound and green~tick. . The first aid treatment of fractures should be on the lines of that rendeted to human beings. Useful splints may be improvised from a ruler, corrugated paper or newspaper. Do remember to call expert aid at the earliest possible moment. A dose of asprin or potassium bromide may be given to relieve pain. Dosage,s to IS grains, according to the size of dog.

Burn s. Burns may be caused by dry heat, such as flame, strong acids or alkalis, contact with electric cables or rails. Scalds are caused by hot liquids and steam. Very severe burning or scalding causes great shock, and blood poisoning, and often ends fatally. T1·eatment. As for human beings according to the type of burn. Anti-Shock Treatment. Mix a teaspoonful of whisky, or brandy, a teaspoonful of sugar or glucose, in a small quantity of water and give the dog a teaspoonful of the mixture at intervals of IS to 30 minutes. Poison a n d Antidote. The dog is very susceptible to the action of arsenic, whether taken internally or externally. Arsenic is often a constituent of wall-paper, sheep dip and rat poison, and dogs sometimes will eat such material, and show rapidly the symptoms of acute arsenical poisoning. SymptomJ. Great abdominal pain, sickness and the passage of dark watery diarrhoea. Death is often preceded by convulsions. The above and laJt month'J article have been reproduced in reJponJe to many requCJtJ in co-operation with the People/ DiJpensary for Sick Animals 14, Clifford Street, W.I. Readers requiring advice on any Jpecial points i~ connection with a particular caJe Jhould get into touch with the Society at the above addreJJ or any of their branches.

----. _. - - - E . & S. LIVINGSTONE The new edition of the catalogue of Medical Books published by the old-established house of Livingstone, Edinburgh, is now available. The publication consists of seventy-two pages giving details of books covering all branches of the Medical Profession including nursing and first aid. The publishers will be glad to send a copy, post free, to any interested readers.

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ST. JOHN AMBULANCE BRIGADE. PRINCE OF WALES'S DISTRICT EAST LONDON DIVISION.-The recently elected Social Committee of the Division lost no time in getting down to business and still fired with the enthusiasm of the General Meeting started on their first venture in the form of the Social held at the Beaumont Hall recently. Judging by the number of members anel friends who attended the function and expressed satisfaction of the arrangements made, the Social Committee may well be proud of their achieve:ner:t. The presence amongst others, of Dlstnct Officer and Mrs. Dunford and Dr. and Mrs. Oster, helped to make the function the Social success it proved to be. HARLESDEN DIVISION.-An excellent demonstration of the effect of various poisons on human beings was recently staged by Staff Sgt. Gibbons and Cpl. Treadwell at Leopold Road School, H.Q. of the Division. Staff Sgt. Gibbons' face was made up to g ive the impression of his having taken a poisonous substance and he then ena~ted with startling realism the resultant suffermgs of the presumed patient, while a Bri~ade member had to diagnose exactly what pOlson had been taken and then give the appropriate treatment, choosing the correct antidote, emetic, etc., from among the array of bottles and jars displayed. The demonstration was of great benefit to the members and it is hoped to repeat it on a future occasion, probably with members of other Divisions present. LEWISHAM NURSING DIVISION.-A very successful evening was held on Wednesday, May 28th, when the above Division held their Annual First Aid Team Competition at their Headquarters . Six teams entered, and thanks to the co-operation of the Judges and Officers acting as Stewards and well organised programme, a most interesting and instructive evening took place. The team test staged and acted was a stra~ght forward yet a likely everyday accIdent with plenty to do in IS minutes. Separate tests were held in the Individual room. Corps Supt. A. J. Green judged the team test and Corps Officer G. Buder the individual.

C O UNTY OF BER KSHIRE On Saturday, April 26th, the Annual Regional Competitions took place at Malvern House School, Reading, under the dlreCti?n of the County Commissioner, Berkshlre (Mr. C. A. Poole). Six ambul~ce an? five nursing teams entered . The W111ners 111 the Ambulance Section were Team No.6 from Wolverton Division, representing Buckinghamshire. The runners-up were Team No. 2 from Eastleigh Division, representing Hampshire. 'The winners in the Nursing Section were Team No. I from Weymouth Division, representing Dorset, the runnersup being Team No. 2 from Southampton

No. I Division, representing Hampshire. The trophies were presented to the winners by the County Commissioner (Berks) who congratulated them on their performance and wished them the best of luck in the forthcoming National Competition. The tests were set anel judged under the direction of County Su rgeon A . Buchanan Batbour who was assisted by D r. Munro Ashman, Dr. T. F. Briggs, Lieut.-Col. S. Hunt and Dr. Brodie Moore for the Ambulance Section, and D r. J. W. Maycock, Dr. H. S. Samuel and Dr. D. J. Turnbull for the Nursing Section. Correctness of uniform was judged by the County Commissioner and County Superintendent (Berks.) Casualties and staging were supplied by Reading Branch Casualties Union. Members of the County of Berks. and Reading Corps Staffs assisted with all other arrangements. Those present included the C:)Unty Commissioner, Bucks. (Major P. G. DarvilSmith) and Mrs. Dar vil-Smith, Counry Superintendent Mrs. Cooper (D otset), County Superintendent the Hon. ..\Irs. Cubitt (Hants.), Mrs. C. A. Poole and County Surgeon Gordon Wallace (Dotset). MAIDENHEAD DIVISIO .-During the month of May, the activities of the Social Club included a Social Evening held at the Ambulance Hall, Holmanleaze, and a very successful dance at the l'vlasonic Hall. It is hoped to hold one or two more dances and another Social in June. The Club IS run jointly by the Maidenhead Ambulance and Nursing Divisions . READING DIVISION .-In connection with the Living Communities Exhibition held in the Reading Art Gallery, Divisions of Reading Nursing Corps held an open evening at the Abbey Gateway, Abbot's Walk, when visitors from the general public were welcomed by members. Demonstrations were given in bed-making and first aid, and diffetent types of bandaging were shown and explained. Those present included County Officer Miss D. K. Gibbins and Corps Supt. Miss E. C. Sudul. READING CADETs.-On May 5th, at the Ambulance Hall, Chatham Street, Reading, teams from Reading Ambulance Cadet Divisions competed for the Frank Webb Cup and the Dr. Hastings Cup which latter was awarded for an individual test. The winning team was from Reading Great Western Ambulance Cadet Division Section " B " (St. Andrews). The runners-up were the team from Section " A" of the same Division. The individual test was won by Cadet John Wise who also won it las t year. The team test was set and judged by Corps Superintendent F. ash a~d the individual test by Divisional Supcrintendent O. J. Cripps of Reading Great Western Ambulance Division. The trophies were pres~nt.ed to the winners by the County CommiSSIOner, Mr. C. A . Poole.

COUNTY O F LANCASHIRE IRLAM AND CADIS HEAD URSING DIV1SIONs .- Members of these Divisions have once again been entertained by their President, District Officer J. Sinclair Kerr.

Among the guests present were Mrs. Janet Ireland Kerr (President of the ursing Division), Councillor Arnold Briggs (Chairman, Irlam G. D .C.) and t\Irs. Briggs, Mr. Edwin Jones (Vice-President) and Mts. Jones, 1\lr. and Mrs. H. Nurse, Miss Ryan, Mr. and :'\frs. P. L. P. Smith, Mr. F. Clarke, Superintendent, H. Weston (S.B.St.].) and Mrs. Weston, Superintendent 1\1iss L. Shepherd, Superintendent Mrs. Jackson and Cadet-Superintendent H. J. Lehrie. After tea, Mr. Kerr presented to the ursing Division a completely fitted nurs~'s duty haversack and other items of. e.q~l1p ment, that previously owned by the D1VlSJOnS having been lost during the war. ~\lr. Kerr remarked upon the urgent need for headquarters for the Brigade in Irlam and Cadishead. Recently he had had a cheque for £136 placed at his disposal for St. John work. He felt the good work done by the Briaade in the district entitled it to full suppor~, and he was certain the business people and the public generally would respond literally to the appeal he hoped to launch shortly. . . He trusted that the Irlam Urban Dlstnct COLll1cil and its officials would help in every possible way to further the project.. . Mrs. Kerr then presented re-exa:ntnauon awards for first aid and home nursillg. She said she was pleased to be once again in company of the nurses and cadets, and hoped to be able to come among them more often in the future. Councillor Briggs assured the President that he fully appreciated the value. of the work of St. John, and the self-sacrifice. of its members. He felt they did put serViCe before self, and he could promise them that he would be only too pleased to help them in any way possible.

COUNTY OF NORTHAMPTON DESBOROUGH DIVISION.-The annual examination was held on :.\lay 20th at the residence of Divisional Surgeon W. E. Lock, the practice work being ca!ried out on the lawns of Divisional Superilltendent A . L. Allan's home. The examining Surgeons were County Surgeon Dr. G. Gibbons, O.B.E., and Divisional Surgeon W. E . Lock .. After the examination, CounCillor Mrs. Lock provided refreshments .. Officers and members then spent an. enJoya?le hour together, their appreciatJ<;)l1 beillg ably voiced by Divisional Supenntendent Allan, who stressed the importancc he attached to the Social side of the Division's activities. He also thanked the Surgeons ~or the continual interest they showed 111 ~he Division and pains they took in instruct111g the members in first aid.

* * * ~ COUNTY OF SOMERSET BATH CITY DrvIsION.-This Division have recently concluded an interesting pr?gramme of lectures, which commence? 111 the ew Year, and included the ~0110Willg : "Recent Advance in Publtc Healrh l\1easutes "-Dr. Astley Weston (Medical Officer of Health), Bath.

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8 "Chemical Warfare Against Disease"Dr. Clara Cross, M.D., 1\1.R., C.P.(Lond.) "Health and the Eyes "-i'lIr. Ernest To\'ey. " Shock "-Mr. A. Leech-Wilkinson (Di\'isional Surgeon), F.R.C.S. " First Aid Treatment for Spinal Injuries" - ilft. J. Bastow, F.R.C.S. " History of the Order "-from a paper prepared by Assistant Commissioner F. ]. Sprawson. " Poisons "-nIr. A. H. Hale, M.P.S. " Roller Bandaging "-Miss D. Appleby (Divisional Superintendent, Nursing Division). A First Aid Quiz was also held between members of the various Divisions, with Assistant Commissioner Dr. Leslie Beath as Question illaster. The lectures were open to all members of the Bath Divisions, and well attended in spite of the abnormal weather conditions of [he first three months of the year.

COUNTY OF SURREY

BOROUGH OF GUILDFORD CORPS.-" This organisation, by its service over a period of 56 years, has built up a very honoured position in the life of the borough," the Mayor of Guildford (1\1r. A. W. Graham Brown) said recently when presiding at the Annual Meeting. He paid a tribute to those who had played their part in shaping the structure of the Brigade, whose service and inspiration, he said, had brought it to its present high standard of efficiency. The report of the officer-in-charge, District Officer C. E. Chaplin, showed that there were 260 members in the Corps, including the Cadet Divisions. During 1946 they had dealt with 4,596 transport cases and 347 accident cases (of which 103 'were road accidents), and the mileage travelled by ambulance was 47,913 miles. j\Iale members had given 1,008 day and night services, nurses were on duty 5,563 hours, and they attended 1,76+ cases.

COUNTY OF WORCEST~R

BRIERLEY HILL DIVISION.-This Division held an interesting function at the Horse Shoe Hotel, High Street, Brierley Hill, recently. It was the first Annual Dinner to be held since 1939, and it is the intention to hold this function annually in the future. Dr. N. V. Hepple (Divisional Surgeon) presided. He was supported by Mr. E. E. Marsh, J.P. (Divisional President), Rev. G. W. H. Alcock (Vicar of Brockmoor), County Surg~on G. C. Campbell, County Officer A. W111bow, Corps Superintendents J. A. Harris, F. G. Price, M.B.E., and]. H. Watk111s, Corps Officers W. Ollis and lvIrs. orthwood, Divisional Superintendent, K. . Northwood, Member - in - Charge J. 1'\ <;>rton,. :0,~~s. Yorke (Member-in-Charge, Nurslllg DrvlSlon), and members and friends of the A.mbulance and Nursing Divisions. Mr. Marsh, in proposing the toast of the :' St. John Ambulance Brigade," said that It was a long time since they had met at a function such as that one. Much had happened in the im.;rval and it was unnecessary for him to remind them of that. I~e did want to thank them for inviting him as he considered it a great honour to be their President. .Corps Superintendent Harris, in his reply, said that they had all listened with interest

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to Mr. Marsh. The St. John Ambulance Brigade was, of course, a voluntary organisation and all the members took real pleasure in their work. The Brigade was an old organisation and he hoped that when the hospitals were nationalised, that the functions and work of the Brigade would not be disturbed. County Surgeon G. C. Camp bell proposed the health of the D ivision and members suitably replied.

Corps Superintendent Miss Fearnside, in her remarks, thought the Division had progressed well and were very adequately financed . Regarding the Cadets taking fourth place in the Newton Cup, she considered this very satisfactory for their first entry in a competition. She promised her services any time the Division thought she could help.

HILL AND CAKEMORE NURSING D IVISION. -The annual inspection by Corps O fficers of the Division was held recently at County Modern Girls' School, Long Lane, Blackheath. The Inspecting O fficers were Corps Superintendent Miss Fearnside and Corps Ofricers .iYIrs. Northwood and Miss Wakefield. A good number of members were on parade under Divisional Superintendent Miss DXe. Mrs. Uglow, Divisional President, was also present. Mter uniforms had been inspected, the members gave home nursing and first aid demons trations. All the Inspecting O fficers expressed their satisfaction with what they had seen. Divisional Superintendent Miss Dye expressed thanks to the Inspecting O fficers after which light refreshments were served in the Clinic Room.

THE PERIHEL TWINRAY

LYE NURSING DIVISION.-The Annual General Meeting was held recently. The Secretary reported that the strength of the Brigade had been increased hy two members and that there had been one resignation. Twenty-one members had entered for and passed their annual examination. The pivisi<;>n had rendered public service, lllcluding dUDes for the stay-at-home holiday week, and also attended 20 cases of sickness . They attended the Civic Parade at Oldswinford Church, and an Annual Inspection on May 5th. The members had a course of lectures in home nursing, and a further course in first aid during the year. .T~e Treasurer's Report showed that the DlvlSlon was in a healthy financia l position. Cadet Superintendent Miss Green, in her R~port on the Cadet Nursing Division, srud that they had progressed well. The Cadets took their annual examination on July 12th when 12 Cadets were successful. A further examination was taken in Preliminary Home Nursing on the 28th August, when there was only one failure. They entered a team in the competition for the Newton Cup on the 28th September and gained fourth place . Cadet Superintendent Miss Green concluded with a report on their finance which was very satisfactory. Divisional Superintendent Mrs. Price thank~d President Mrs . Martin and Corps Superllltendent Miss Fearnside for their attendance, and also expressed her thanks to Dr. McCarthy and Nursing O fficer Mrs. Wall for their able assistance. She concluded her general survey by requesting the mer:nbers to keep up the good progress made to lllcrease the funds . T~e next item on the agenda was suggestions for methods of increasing the funds. Several suggestions were made and it was finally decided to hold a whist drive. each membe~ taking one friend or more.

T HE Perihel. Twinr~y has been s.cientifically deSigned 111 co-operatIOn with medical authorities. Its most important feature is the new Ultra Violet generator which has a high output intensity and long life. The envelope consists of a quartzoid tube transparent to all biologically useful rays which are blocked by O1'dinary glass. It operates at a comparatively low temperature and can be used for treatment where heat is undesirable. The Infra Red element is a dark emitter wound on a ceramic core with a comparatively low surface temperature at a loadinf! of 700-800 watts. It is enclosed in a reflector which permits maximum output to be applied.

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The Perihel ,. Twinray . " The exceptionally robust electrode has, we are informed, a life of over 1,500 hours, which provides up to 20,000 treatments. This appliance, which is manufactured by Perihel Ltd., London, W.8, can be used as a table or floor pedestal model. The Ultra Violet generator, Infra Red emitter and reflectors have been designed to ensure full body treatment. The irradiation arms are universally adj~stable. O nly A.c. models are available. These are supplied against a medical certificate with complete instruction chart, treatment tables and goggles, and are free from purchase tax.

AID

PRACTICAL NURSING IN THE HOME BY

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

Diet and the F eeding of the Sick OOD is essential to life, and the feeding of the sick is

such an important factor in treatment that some F knowledge of foods and their particular uses is essential to the home nurse if she is to feed her patient suitably and adequately. For satisfactory nutrition three important requirements must be met :(r) The diet must supply the energy needed for the maintenance of all the functions of the body. This depends upon the combustion of carbohydrates and fats, which utilises the oxygen carried by the blood from the lungs and produces two waste products-carbon dioxide and water vapour-both of which are excreted by the lungs in the expired air. (2) It must provide for the growth of tissues in the young and for the repair of tissues both in the young and in the adult. For these processes protein food is essential. (3) It must be capable of promoting the correct balance of all the functions of the body. \'{later, mineral salts and vitamins are necessary for this. The building up of a diet must, however, be governed by the availability of supplies and by the economic status of the family. For all practical purposes we consider carbohydrates as the energy producers, fats as the heat producers and proteins as the body builders. The more energy a person is expending, or the more heat he is losing, the greater his requirements of energy and heat producing foods; and the greater amount of cell growth, or cell destruction, that is taking place in his body the greater the need for protein. Some discussion of these factors is therefore desirable.

Carboh),drates. These can be taken into the body as starches, as complex sugars or as simple sugars. The chief starch-containing foods are bread, all substances made with flour, potatoes, rice and other cereals. By various processes of digestion, starch must be changed into complex sugar and then into simple sugar-such as glucose-before it can be absorbed. The chief complex sugars in foods are cane sugar, beet sugar and honey. Many fruit sugars are simple sugars and can, therefore, be absorbed without digestion. Hence the value of fresh fruit and glucose in skkness, and the former also contains Vitamin C, which is always necessary even in health, whilst much larger quantities are required in any condition of fever. Fats . These are mainly the heat producers, but we need to store a certain amount of fat in the various tissues of the body and between the muscles and the skin. The chief food sources are cream, butter, fat meat and both animal and vegetable oils. Certain fish, such as herrings, sprats and salmon, contain a fair amount of oil.

Proteins. Since the tissues of the body are constituted chiefly of proteins and there is continual wear and tear of these tissues, a continuous supply of protein is necessary for their reconstruction. In illness, many more tissue ceBs may be broken down than in health. Children need protein for growth as well as for repair of tissues. Animal proteins are more valuable for body building than vegetable proteins for they naturally contain a better proportion of the essential substances; but the latter are very useful adjuncts. The chief animal proteins are contained in lean meat, fish, milk, cheese and eggs. Peas, beans, lentils, nuts and cereals contain some vegetable protein. Water. About two-thirds of the weight of the body is due to the water that is an essential constituent of every tissue cell and of all body fluids; but a large proportion of solid food is also made up of water, which results in a balance. The body, however, is constantly losing water. It is estimated that at lea t one pint is lost by the skin in " insensible" perspiration without obvious dampness of the skin, and much more when profuse sweating is taking place. About half a pint is lost in the expired air, and about two and a half pints in the urine. Some water is excreted by ordinary bowel action, but if diarrhoea is present considerable quantities may be lost. This loss must be made good or a condition of dehydration will follow in which all the functions of the body become impaired. ]Ylinerai Salts. CalciuJJl is needed for the formation and healthy maintenance of bones and teeth, for the clotting of blood and for various other functions. The only rich food source of this mineral is milk and, consequently cheese, as this is a milk product. Smaller amounts are present in some vegetables, nuts and fruits. 11'011 is needed in order that the red cells of the blood can carry oxygen from the lungs to the tissues. Its deficiency leads to anaemia. It is present in red meat, egg yolk, liver, spinach, nuts and all fruits and vegetables that are rich in chlorophyll. :Milk, however, is deficient in iron, a fact that needs to be remembered when a patient is on a diet consisting chiefly of milk. Befo~e the bir~ ?f a baby, iron. is stored in its liver in suffiCIent quantItieS to supply Us needs until a mixed diet can be taken, hence the mother's need for additional iron during pregnancy. Other minerals that are necessary include phosphorus, sodium, potassium, sulphur and iodine, but these are usually present in adequate quantities in an ordinary mixed diet. Vitamins. \'{lhen the human race lived upon a variety of naturally produced foods in their normal state, vita?-Un deficiencies did not occur. The processes of cooking, reEnino- and preservino- foods tend to destroy these essential substa~ces and may lead to conditions that have b~en called "deficiency diseases." Vitamins are chetrucal substances developed, for the most part, in growing vege.table foods by the action of sunlight. They are ~ound 1?animal foods when the animals have grazed ill sunlit pastures. Before their chemical composition was known,

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vitamins were named by the commencing letters of the alphabet. Most of them have now been given scientific names but it is not necessary for the home nurse to know them. Some vitamins are fat-soluble whilst others are water-soluble. The former include Vitamins A and D, and are present only in animal fats, in liver and in fish .li:rer oils but nature has allowed us a second chance of obta1n1ng each of them. The precursor of Vitamin A is present in the pigment of carrots, tomatoe~, and all l~afy. green and yellow vegetables and yellow frwts; and this pigment can be changed into Vitamin A in the body.

Vitalllin A is necessary for growth in children and also for the healthy development of mucous membranes . These membranes line the digestive and respiratory tracts, and if they are not healthy they are the more prone to infection. Deficiency of Vitamin A also leads to "night blindness" and other ocular defects. Vitamin D is necessary for the utilisation of calcium and thus for correct formation and healthy maintenance of bones and teeth. Deficiency will cause rickets and early decay of the teeth. Vitamins Band C are water-soluble and are present chiefly in cereals and fruits. Vitamin B really consists of several factors. To a great extent, they are present in the same foods; which are the germs of cereals, yeast, nuts,

AID

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egg yolk and liver. "Bemax" and " Marmite " are good sources . When cereals are refined by processes that remove the germ with the husk the grains may be quite devoid of Vitamin B. The high extraction flour, therefore, has a richer content of this vitamin than white flour. Diets in this country are seldom so poor in Vitamin B that actual disease can result; but when specially restricted diets are taken deficiencies may occur. Vitamin C is present in tresh fruits and vegetables, but is very easily destroyed by cooking and by the addition of an alkali-such as soda to maintain the colour of green vegetables. Oranges, lemons, grapefruit, blackcurrants and rose hips are rich sources, and this vitamin is necessary to prevent scurvy. It has been shown that any condition of fever increases the body's need for Vitamin C. Of late years there have been many vitamin concentrates on the market, and whilst so many foods that contain them are in short supply, these preparations have been found most useful. Most authorities agree, however, that when it is possible to arrange a diet that is adequate in all the necessary vitamins this is by far the better course, for the diet will then be well balanced with regard to all other constituents. In illness, and especially when a patient is on a restricted diet, it is often necessary to give vitamin supplements.

AID

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(To be continued). Telephone: Elmbridge 5900.

Telegrams: Siebe, Surbiton.

PRACTICAL POINTS Depressed Fracture of Skull Case. Young lady knocked down by motor cycle. After assistance from by-stander was taken home by passing motorist. At home, she complained of thigh wound and severe headache. She was taken to hospital by 'bus and on foot to have wound attended. On admittance to hospital complained of severe headache, but no loss or impairment of consciousness. Obvious inequality of pupils. Wound was sutured and skull x-rayed when a depressed fracture was found. PRACTICAL POINTS. Though a depressed fracture had been sustained patient had no symptom other than headache and she was able to walk into hospital. First aid had been concentrated on the relatively unimportant thigh wound. The inequality of the pupils had entirely escaped nOtice. Compound, Comminuted Fracture of Fibula and Tibia Case. Accident whilst riding motor-cycle. On admittance to hospital found to be suffering very severe shock, fracture of right tibia and fibula. Suspected fracture of skull. Wounds to face and legs. Bone (tibia) was visible in leg wound but it was not protruding. Foot was rotated outwards and leg had been splinted with foot in this position. First aid dressings had been applied to wounds. Haemorrhage appeared to have been appreciable only from leg wound and nose.

In hospital, blood plasma transfusion was immediately given and radiant heat applied. Temporary splints were undisturbed for SOme time. PRACTICAL P01NT~. Wounds and fracture had been quickly treated in order to waste no time in removing patient for anti-shock treatment. Since fracture was obviously compound and (as x-ray showed) comminuted, it was left in abnormal position when splints were applied rather than risk further damage by rotating back to normal. 2/6 has been paid for eat:b of these items.--Editor.

CARE OF THE HANDS IN AND OUT OF THE FIRST AID ROOM I T is as important for the first aid worker as for the practising doctor to have clean hands at all times. Always wash the hands after doing any examination of a patient or of material which may be infected. This will go far in preventing the spread of infections. The finger nails should be short, neat and clean. Prevent hang-nails by keeping cuticle well pushed back with an orange wood stick. Ordinary hand soap, a nail brush, and an abundance of running water, if available, are the ideal cleansers. A good lather with an ordinary soap and thorough washing of (he hands will destroy and remove any ordinary bacteria that may be adhering. Soap is not only a mechanical cleanser, but has some germicidal properties. Absolute sterilization of the skin is impossible because antiseptics cannot reach the sweat ducts and so the perspiration is always laden with bacteria. Penetrating antiseptics, such as mercurochrome or acriflavine solution are perhaps exceptions to this statement, but their intense, indelible colors render their use on the hands impractical. Frequent use of chemical antiseptics produces a roughened condition of the hands, which readily harbours organisms. If the skin of the hands becomes rough it should be specially treated. Usually a good hand lotion after washing will do much to prevent this condition and also to bring them back to normal if it should occur. If the hands remain rough after a week of such treatment apply a good cold cream at nights. Soap and water, especially the soap, is a great irritant to chapped hands, so avoid soap but substitute a fairly large amount of lotion and after rubbing this gently but thoroughly into the hands, wipe it off with a clean soft towel. This lotion as a cleanser for the hands is nearly as efficient as soap. Any scratches or abrasions on the hands, no matter how insignificant they may seem, should receive proper attention at once, as any break in the skin affords an excellent port of entry for infection from anything one may have occasion to handle. - " First Aid Attendanl."

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-----------------,

Queries and Answers to Correspondents

PATENT I would therefore thank you for publishing the warning in your ever interesting replies to which I always tum first when my copy of FIRST Am reaches me. Good! Next please-for or against! !-N.CF. Treatment of Fractured Spine A . H. (WoodhotlSe) .- Rule 5 on page I I of the Supplement to the Textbook, in dealing with fracture of spine, states that pads should be placed under neck and small of back. Rule 7 gives the treatment of cervical injuries; and Rule 8 tells us to put a blanket under the calves of the patient. \X/e were discussing these instructions recently in our ambulance class and we got various views. In short, we would like you to Treatment of Crush Injuries give your ruling as to the number of pads to be used-two or C. P. (Actoll) .-ln a recent competition the patient in the team test three if we include the blanket-in all cases of fractured spine. was supposed to have sustained the following injuries : Meanwhile, our class sends its thanks in advance of your reply. compound fracture of upper third of right humetus (bleeding The pads for the neck and small of back which are named in Rule 5 had ceased), complicated fractures of the fourth and fifth ribs and the blarlket to support the calves of the patient should be used on right side, and a ctushed left foot. in the treatment of all cases of fractured spine. Strictly speaking, the On account of the fact that the patient was suffering from blanket is not part of the treatment of fractured spine but is used to cc ciush " injuries, the judge told us afterwards that we had lost make the patient more comfortable. The pads for the head mentioned marks because we had not given bi-carbonate of soda solution in Rule 7 are additional to those already named and are to be used as laid down on page 7 of the Supplement. We maintain, however, only when the fracture is in the cervical region of the spine.-N.CF. that we were correct in not ·doing so, as it specifically states Service Medal of The Order " in the event of ctush-iniury involving a limb" and that it does G. T. (Berkhalllpsted).-Will you please tell me if I am entitled to not apply where there is internal haemorrhage (in this case bleeding apply for the Service Medal of the Order through the Brigade. from the lung) when nothing should be given by the mouth. My service is as follows: 1st year, 1922; 2nd year, 1923; 3rd We would very much appreciate your rLlling on the matter. year, 1924. Then owing to unforeseen circumstances my work carried me away, and I resumed ambulance work again 4th, 1936 ; Your query does not give sufficient information with reference to 5th, 1937; 6th, 1938. This was passed under the L.M.S. Centre the crushed foot as it does not make it clear whether the pressure of the Association at Watford Junction and Tring. remained on the foot for a prolonged period or was caused by a wheel The Berkhamsted Division was formed in 1938 and I became a of the car passing over it. member at once, and I have carried on consecutively year after In the fOlmer case the effects of a crush in jury would, in my opinion, year and I am hoping to do so for many more years. arise and necessitate administration of the alkaline solution in spite I have passed out each year during which I have been with of the instruction in Rule 3, page 137, of the Textbook, to give nothing the Brigade, and I have also passed out each year at the L.M.S. by mouth to a patient who is suffering from haemorrhage from the lungs except ice to suck. Centre, Tring (Association) . So according to my working out In the latter case the tissues of the foot would be torn and btuised this represents IS years of passing the examinations. as the result of external violence; and recovery would be merely Thank you, sir, for your interesting answers and articles in a matter of time. Alkaline drinks, therefore, would not be indicated FIRST AID. Like many others I enjoy reading and take advantage of the useful information given . and Rule 3 on page 137 of Textbook, which has just been quoted, would operate in the treatment of the patient.-N. Corbet Fletcher. We regret that your ambulance work with the Railway Centre of the Association cannot COlU1t towards the Service Medal of the Order Examination Howler which is awarded for efficient service in the Brigade and other forms JvL B. (Cambridge).-In a recent examination I asked a patient what of conspicuous service. It would seem, however, that, in view of he would do if he had to treat a patient suffering from foreign the fact that your successes in the annual examinations have been body embedded in right eyeball. I was taken aback when he recorded by the Railway Centre you could ask to be considered for the replied promptly and confidently-CC I lvo!4ld lick it out with my Railway Long Service Medal.-Editor. tongue ! " Method of Loading Stretcher Good! Next please! I-N .CF. W. H. (West Kilburn).-In the May issue of FIRST AID a correspondent queries the reading in Rule 12 on page 12 of the Supplement to Treatment of Ruptured Muscle the Textbook. In your reply you refer the point to the Revision A. llI. (Blackpool) .- I was very pleased with the answer which you Committee for correction. As a matter of fact this has already gave under the above heading in the April issue of FIRST AID. been done; and in my copy of the Supplement there is a noteIf your correspondent is only a first-aider who diagnosed mpture " Substitute the words head of stretcher for the wordsfoot of stretcher." of a muscle? It is evident to me, as a qualified masseur, that he is Best thanks for letter, which is appreciated.-N.CF. mixing up amateur rubbing with skilled massage, whereas they AppLication of Lint cannot be connected. Indeed, I well remember a footballer who C. H. (New/o11m, AIont.)-We have been having a discussion on the two years ago came to me with a mptured muscle after an amateur application of lint as to which side to apply to the wound. I have had rubbed it for three weeks. It was a long and painful job to always understood that the fluffy side went on to the wound as the patient to get the muscle right again. that side is always folded inwards when received and not likely

Queries 11·ill be dealt 1vith under the joll01ving rules :I.-Letters containing Queries must be marked on the lOp l~ft-hafJd corner of the envelope cc Query," and addressed 10 cc First Aid," 46, Cannoltstreet, London, E .C. 4. 2.-AII Queries must be written on OtiC side of paper only. 3.-A1I Queries mllst be accompanied 1?Y a (, Query Coupon" cut from the current issue oj the Journal, or, in case of Queries frol/1 abroad, from a recent issue. 4.-The Textbook to 1Iihich reference /1Ja)' be made in this column is tbe 39th (1937) Edition of the S.j.AA . Manual of First Aid to the Injured.

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C. lIIustra les the same Gear with tht: top stretcher frame hinged down f~r use when only one stretcb"r case I S Cal ried.

D. Sbows the same po~i ti on a~ in .. C" only with cusbions 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 catalogue of Ambulance EQulflment No.7 A wlil be sent on reouest.

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2nd

COMPETITION TEAMS By

EDITION

"Gives dear and constructive advice on selecting and training .teams for fi~st aid competitions, and proVIdes us~ful tlps .on individual and team behavlOur durlllg competitions . . . . : should find a ready public."-Fire ProtectIon.

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Mr. Boyce-Mears advises most ~o~petently on the building of the team, on tr~llllllg for c<;>metition work, what to expe~t 1ll the test, dlagp . an d exa~ ...... ;nation routllle and. completes nOSlS £: . the booklet with a very useful and 1ll ormatlve specimen of an average judge's mark sheet.

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FIRST

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to be touched by the lingers. Also, if lightly stuck to the scab, the fluff will part from the rest of the material when it has to be removed and not pull off the scab. The problem is not one of practical importance and so is not The Editor is not responsible for opinions expressed. mentioned in the textbooks. Like many of my colleagues, I always A COURSE IN ADVANCED FIRST Am apply the smooth side of the lint when dressing a wound and the DEAR SIR, fluffy side when applying a boracic foundation for the reason that I wish to congratulate you on the excellent series by Dr. Belilios there is some free boracic acid powder on the fluffy side of boracic " A Course in Advanced First Aid." My colleagues and I find the~ lint.- .C.F. most interesting and instructive. Fractures of Femur and Leg Yours ttuly, M. L. CBirminghatJ/).-Thank you for your reply to my query which Ipswich, 4th June, 1947. E. D. READ. was published under the above heading in the May issue of FIRST Am. Perhaps my query was not made very clear to you. Having treated both injuries (fractures of left femur and right tibia) separately with one figure-8 bandage to each limb and DEAR SIR, splints i.e. (two bandages) I then apply a third figure-8 bandage . I saw a.copy of the May issue of" First Aid" and am very interested to embrace both feet and ankles and then one broad bandage round both knees. By releasing the last two bandages only the In the artIcle by Dr. Belilios on Advanced First Aid. Is it possible to surgeon would then be able to examine one or other fracture let me have the back numbers containing previous articles in this series? without disturbing both at the same time. Do you approve this I wil~ take this opportunity of telling you that I shall be a regular method of treatment, please? reader In future. 1£ you treat this combination of fractures as you suggest and finally Yours faithfully, apply three figure-8 bandages round feet and ankles, you do not in W. MILLER. my opinion, achieve any desirable result. Rather you postpone 'un- Birmingham, 9th June, I947· Th~s series started it! lvIarch. A limited number of !l1.arch, April and necessanly the completion of your work as a first-aider and thereby delay the despatch of the patient to hospital where medical aid is MO)l zssues are available, price Sd. each, post free.-Editor.

Replaces Bandages and Plasters "PORTEX" Plastic Skin was originated for use as a dressing after blood transfusion Later, surgeons discovered its special qualities made it an ideal pre-operative surgical barrier. Today it is superseding bandages and plasters as a dressing for cuts, abrasions and small burns. Not only is it neat, flexible, waterproof, transparent and selfsealing, but because of its high phenol content it also greatly accelerates healing. "Portex" Plastic Skin is now available through all chemists In tubes, price I/8d. including tax, and in larger size bottles. In case of difficulty, write direct to the proprietors, giving the name of your pharmaceutical suppliers. PORTLAND PLASTICS, LTD., 6, Victoria Street, London, S.W.I

" PORTEX " PLASTIC SKIN

available.-N.C.F.

FORMULA: Phenyl Sal£cylate,

The Casualties Union.

St. John Ambulance Brigade Final Competitions. The first. Post War Competitions were held on F'd J h . fl ay, une 13t at the Victona Halls, Bloomsbury, London . ' . . Tea ms competIng h ad qualIfied by winning Area County and Regional C .. . . d h ' ompetltlOns It IS estImate t at some 650 teams entered the 1" Th . pre Immary roun d s.. e wlnn~rs of the Ambulance Competition for "Dewar" Challenge Shield were Wolverton led by Sgt W R' h d Th . . ' " IC ar son. e WInners of the NurSIng Competition for the «Perrot" Challenge Shield were Harrow, led by A/O. D. Spiller The trophies were presented by Her Royal Hl'gh .h D h f G ness t e uc ess o loucester at the close of the Competitions. A full report and complete results will appear in the J~ly issue.

IO per cent., Resorcinol, 'S pe1' cent., Eugenol, '2S per cent., Chlorojorm, IO per cent. in a base oj poly-methyl methacrylate and solvents.

"FIRST AID"

As previously announced in these pages, the fifth Annual re-union Dear Sir, of the Casualties Union will take place at the Road Transport Depot Being. a First-aider with thirty-one years' consecutive efficiency to of the L.P.T.B. at Chiswick, on June 22nd, at 2 p.m. my credI.t, and a regular reader of" First Aid," I write to compliment The programme will include two open competitions in which you on Its new. style of layout which, together with its new bright son: e 70 teams are competing from parts as widely separated as cover makes qUIte an attractive and more pleasing magazine which I Swmdon, Chelmsford, Luton and Basingstoke. look forward to th: receipt of each month if only for the very helpful The competitions are;knowledge and gu1dance to be gained from the answers to queries I. ~irst Aid for teams of four, in which competitors will not be by our most respected Doctor N. Corbet Fletcher, this in itself being ?ermltte~ to .ask questions of judges, but must gain their diagnostic w~ll worth the sm~ll su~ of fout pence per month. Long may he l~ormatlo.n m the usual way and carry out the treatment and deal relgn to be our guIde, frIend and counsellor. WIth the SItuation as if the judges were not there. I am, Sir, 2. Diagn?sis competition in which the competitors will be called upon to dIagnose a series of casualties in a similar manner a d th Yours faithfully, two silver Challenge Trophies will be held for one yea: :y th: Cardiff, 28th May, 1947. H. ]. WATERS. successful teams.

Invitations will gladly be sent to those who send a stamped aSddressed envelope to the Hon. Organiser, 64, Chiltern Road, utton Surrey.

NEW PLASTIC SURGICAL DRESSING

Letters to the Editor.

F?llowing these competitions there will be a large-scale demonstratl.on of the wo~k. of the Union, and an information post will be proVIded so that VISitors may ask questions about th " and its work. e otgamsatlOn

AID

THE HOSPITAL FOR SICK CHILDREN Dear Sir, The Board of Management of the Hospital for Sick Children Great Ormond St~eet, London, W.c.r, announces that in an endea;our to lessen the orne spent waiting in the Out-Patient Department OutPatie~ts will be seen by members of the Consulting Mcdic~l and Sur~lcal Staff only by appointment. Such appointments should, if pOSSIble, be made by a Doctor acquainted with the case and preferably by letter.

Pa~ients .who attend without introductions from a Doctor will be examIned 10 the Receiving Room and only when necessary referred to a ~ember. of the Consulting Medical or Surgical Staff. Paoents WIll be seen by appointment between the hours of 9.30 a.m. and 12.30 p.m. except on Sundays. The Hospital is of course open day and night for urgent cases. Yours truly, London, 28th May, 1947.

(Sgd.) H. F. RUTHERFORD, House GQverl1Qr.

Miscellaneous Advertisements. Advertisements with remittance shOUld be sent to First Aid. 46. Cannon Street, London, E.C.4. Rate 6d. per word, minimum 4s. 6d. Trade Advts. 4d. per word, minimum 6s. Box numbers 1s. extra.

pOR sale. First Aid, September r939, to September, 1946. Few missing. Offers. Mason, 67, Halsbury Road East, Northolt Park, Greenford, Middlesex. Concert Tickets, 7/6. Posters, Memos, Rubber 0 Stamps. Samples free. "A" TreES, II, Oaklands Grove, London, \",(/ .12. HO\V' to Stop Smoking. Save Money. Safeguard health. Thousands cured. Send stamp for Booklet of World Famous Remedy. Stanley Institute Ltd., (Dept. 75) 265, Strand, London. R UPTURED? FORGET IT! Use Brooks Rupture Appliance-the new discovery. Wonder~ull No lumpy pads, no springs, durable, cheap. Bmds and draws parts together quickly. Sent on trial. Catalogue free. Address: Brooks Appliance Co., Ltd. (718) 80, Chancery Lane, London, \VC.2. (718) Hilton Chambers, Hilton Street, Stevenson Square, Manchester, I. cOUPO S. You can make 2 lovely pairs of Ladies or Gents Gloves. Send to-day for best Beige Chamois Skin with pattern (State Size) and directions, 16/-. Cash returned if not delighted. Clayton Leathercrafts, Sutton in Ash, Notts.

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Be prepared for an eme~gency az:d keep Cuticur:,,- Br~d Otntt;nent. ill your First Ald Kit. It bnngs mstant soothing relief to cuts, butn\3, skin lacerations- prevents spn;ad of infection. quickly beals Obtatnable at all Chemists and Stores.

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FIRST

FIRST AID IN THE OFFICE By] . W. SCOTT (continued from page 168 Mcry issue.) Foreign bodies in the eye-well, your" Black Book" deals very thoroughly with this question, but those of you who are fortunate enough to have a douche can and make use of it for this trouble, do not have the can too high, because the force of the liquid is too much for the eye, the height should not be any more than the level of the patient's shoulder. Cold water is best, this should, of course, be sterilized by boiling. Then there are the various eye drops and oils that can all be safely used. Be careful of drops at these going on your patient's clothes, from a coupon point of view, because many of these eye-drops stain. By the way, text-books tell you to "take a firm grip at the eye lash" to turn up the upper lid. This is good advice, and means that if you merely nip a few stray lashes, they will come out, and after one or two more tries, you will have removed most of a growth of lashes that many a young lady has been cultivating for a long time. The eye is very tender, and so take a good bunch in the first place, and you will have a good chance of lifting the lid at first attempt, and avojd undue pain to your patient. A minor point-show your patients what you have extracted-if anything-as they never seem to believe you. Falling down the stairs is another habit that some of our people seem to learn a lot about. They appear ;n the bay, with bruised elbows, knees, and twisted ankles, telling all and sundry about the steps in question. If you have tincture at iodine, that is good tor the bruises (not anywhere near the eyes), or euflavine is an excellent substitute (Solution). A weak solution of some form of antiseptic for any cuts (not iodine) on some clean lint, and maybe a padding of clean cotton wool for extremities. (l mention" clean" wool, because I have seen wool on some dressings that looks as jt it came from the cat's basket.) I would advise that solutions be made up to half the strength on the bottle, because the amounts as shown are often rather severe, and tend to " sting" the already sore patient. Of course, these falls are sometimes more serious, and fractures are sustained. Good, firm splinting is required, with splints that are long enough for 'he limb in question. It is as well to remember that

FIRST

AID

splints cannot be too long for the job, but can very well be too short. They should extend at least two or three in~hes past the end of the limb. Tight strapping, but not tight enough to stop circulation. Elbow injuries should all be placed in a sling no matter how slight they may be. A small arm sling, so that there is no pressure on the elbow. Cold compresses for the twisted ankles, when you are sure that they are not fractured, but if there is any doubt at all, treat as for a fracture, in this way, your treatment will not be wrong. We have one chap who has a fit now and again. It is a form of epilepsy, and fortunately, he has a feeling of giddiness some fifteen minutes before he is going to perform, and we can therefore make some form of preparadon for him. He comes to the bay, and lays on the bed and the fit comes on after a short while. He makes some very violent contortions arching the back, throwing his limbs about and knashes the teeth, and we have a touniquet stick close at hand to place between his teeth to prevent injury to his tongue. He is, as far as possible without restraining his movement, kept laying flat on the bed, the pillow used to place over the bed -rail to prevent him striking his head on it. Tummy pains that men and women have are often traced to some form of over eating, or eating something that may not have agreed with the digestion, and if a dose of soda -bjc has no effect, a visit to the doctor should be suggested. Treatment tor ladies' tummy pains should be confined to a rest on the bed, with a hot water bottle, and maybe a dose of peppermint essence in hot water. In closing, it should be remembered that Sick Bays are not supposed to resemble a clinic, and patients, after an initial treatment should be referred to their doctor for subsequent dressings or treatment, and unless the doctor advises continued treatment whilst at work, continued treatment should not be given. One last remark, with reference to Sick Bay beds. These should always be kept " made up " and ready for emergency, and kept covered over at all times to prevent dust settling.

Notice to Ambulance Secretaries.

A usefu l tip.

Will Ambulance Secretaries please forward reports of local activities as soon after the actual event as possible. \l(l e regret that owing to the shortage of paper we are not able to include all reports submitted. Preference is given to those of general interest.

A reader has wrirten to say that he finds the title" First j\id " on the covers of the Journal very useful for labelling first aid boxes and is using them at all the POStS throughout the organisation where he is in charge of first aid arrangements.

AID

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FIRST

AID

FIRST AID

Number 9

allows free movement

A new ' Ambulance by

AUSTIN

Editor: DALE ROBINSON, F.R.S.A., F.S.E.

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Practical Points

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Editorial-First Aid in the Schools -

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COM FO RT. The interior is sound-proofed a nd outside noises will not dist~rb the patients- no road ~hocks can ja r the~ for the body IS mounted on extra-soft springs and large sectIOn tyres-a heati ng and ventilation unit with thermostat control keeps fresh air circulating at an even temperature. EFFICIENCY. The forward control cab and short wheelbase ensure maximum drivin g visibility and easier manceuvring. Wide-op~nin~ rear ~oors and flush-fitting step give easy access to the mtenor while the extra nearside door is very convenient for the a ttendant. D.EPENDABILITY. The new O.H.V. 16 h.p. engine has hlg~l performance, low fuel and oil consumption, easy ma llltenance and, above all, dependability. SPECIAL FEATURES INCLUDE:

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FIRST AID is published on the 20tb of each montb. The Annual Subscription is 55. post free; single copies 4d. . Its aim. B.nd objects being the advancement 01 Ambu lan<;e and First ~id Work in all branches, the Editor invites Readers to send Articles and Re arts on subects pertammg to the Movements and also welcomes suggesltons lor Pracltcal Papers. P All Reports. &c .• should be addressed to the Editor at the address below, and sbould reach him before the 8tb 01 each month and must be acco . d (not necessarily jar publication) by the name and address of the Correspondent. ,moame Subscriptions, Advertisements and other business Communications connected with FIRST AID should be forwarded to the Publishers. DALE, REYNOLDS & CO., LTD ., 46, CANNON STREET. LONDON, E.C.4. Telesraphic Address-" Twenty-jour, London:' Telephon~CilIl3710.

Editorial FIRST

AID

THE

SCHOOLS

TH AT every man and woman in the country should possess at least some knowledge of first aid, is one of those ideals with which most people cordially agree but do nothing to make an accomplished fact. In these days of speed and mechanisation it would obviously be a good thing if everyone knew howto apply first aid to the injured; is there any reason why that knowledge should not be possessed by all as a regular course? During the war many people who previously had no knowledge of first aid took it up as a matter of duty, and found the work interesting and absorbing as well as of the greatest importance. Many of these enthusiasts are continuing the good work in voluntary service, or are preaching it in the homes and workplaces. There is no doubt that most people find the work interesting, and the service they can render to their fellow creatures is a source of great satisfaction. What can be done, then, to interest more people in first aid? We consider that one of the most important things is to see that the subject is taught in schools. After all, many more subjects than the Three R's are now taught, and the aim of education is sure ly to equip the child for a useful life when the school doors close on him for the last time. What better subject can be taught him than first aid? Instru ction should be given to all children, and certainly the best place is the schoolroom. Now that the school age has been raised we suggest that first aid is something which can very well be taken by children in their last year. We believe that this final year

of schooling is providing something of a problem to teachers just now with the present shortages of staff and materials. Here is a subject, however, which needs but little apparatus, and as for the instruction, many teachers, as we know, are first aiders, and in any case there should be no trouble in enlisting the aid of local ambulance bodies. There may be some objection that the subject is unsuitable for children, but we are referring to the fourteen-yearolds, and anyone who has any knowledge of the work of such bodies as the Scouts or Guides, will know that young people of that age take to first aid with enthusiasm and pl'actice it with accuracy and discretion. And in any case it is the instruction for later life that matters, the child is the potential fi rst aider of to-mor row, and principles learned at school will stand him in good stead later in life. We have recently had something to say in this column concerning the wastage of young life in accidents on the road and in the home. Would it not be possible that first aid instruction in the schools, besides equipping the child to deal with such emergencies, would also have some bearing on the incident of these accidents? Many of them are due to carelessness and thoughtlessness on the part of the child; we believe that first aid instruction would give him a new insight into such matters, and would encourage a growing responsibility to see that accidents should not happen . ' There would be other benefits, but the main thing is that every child should leave school with an ability to apply first aid . This is a suggestion which we feel might well be taken up by the educationalists.

FIRS T 4

FIRST

AID

A COURSE IN ADVANCED FIRST AID by

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

EMERGENCIES OF THE CIRCULATORY SYSTEM (contd.) IF there is one observation which the first-aider is expected to make on almost every patient that he attends, it is on the condition of the pulse. The pulse is the wave of expansion felt in the arteries which results from the contraction of the left ventricle. The arteries are always full, but each time the heart contracts they become di~tended by the extra amount of blood that is forced into them. The pulse can ce felt wherever a superficial artery runs oyer a bone. For convenience it is the radial pulse which is usually examined, but when necessary the facial, temporal, posterior tibial at the ankle or dorsal artery of the foot can be used as alternatives. Examination of the pulse provides a valuable guide to the general condition of the patient and to the working condition of the heart. The artery is best felt by placing the first and second fingers over it, never the thumb, and noticing (r) the rate, (2) the rhythm, (3) the volume, (4) the tension. (r) The Rate. The normal rate varies in individuals from 60 to 80 beats per minute, being more rapid in children and slo,\-er in elderly people. \X hen taking the pulse it is essential to use the second hand of a watch and to count the numcer of beats that occur in a full minute. An lncrease in rate is called tachycardia and may be caused by (a) feverish conditions, e.g., pneumonia, when the rate rises by about TO beats per minute for every r OF. rise in temperature, (b) haemorrhage, (c) shock, (d) most diseases of th~ heart, especially those in which the muscle is failing, (e) palO. It.must never be forgotten that the rate normally lOcreases WIth muscular exercise, emotion and nervousness. A s.lo.w ,Pulse is called bradycardia arid may occur in (a) r.ead lOJunes such as compression of the brain, (b) cerebral haemC?rrh~ge or thrombosis, (c) uraemia, (d) certain cases of p01soOlng, e.g., opium and digitalis. _(2) The Rh),thm. This refers to the regularity of the beat. ormally the spacing and force of the beats are even. Irregularity can .take the form of missing a beat every now and then, In which case the pulse is said to be intermittent, or the pulse may be uneven both in time and in force-a sign of a common form of heart disease known as auricular fibrillation. (3) The Volume. This indicates the amount of fluid in the ci~culation and also the strength of the heart. It is small 10 shock, fainting, haemorrhage and in heart failure. (4). The Tension. Thjs refers chiefly to the v"alls of the ~rtenes . 1£ the puls~ is of high tension considerable pressure IS reqU1red to oblIterate it. This is found in apoplexy,

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compression of the brain and in the bounding pulse of fever.

Acute and Chronic Diseases. Diseases of :lhe heart and circulatory system may be acute or chronic. An acute illness is one which has an abrupt onset, runs a rapid course and generally ends comparatiyely qillckly. A chronic ailment, on the other hand, develops slowly and continues for a prolonged period of time, occasionally remaining stationary for long intervals. Sometimes, however, an acute illness may become chronic. The two most common acute ailments of the heart of importance to the first-aider have already been describednamely, coronary thrombosis and angina pectoris, although the latter is sometimes regarded as chronic in that the patient may haye recurrent attacks for many years . First aid is not usually concerned with chronic illnesses since they should always be under the care of a doctor. From the point of view of general knowledge, however, the first-aider should know a little about chronic disease of the heart since it may arise so insiduously that the patient may not appreciate that there is anything wrong with him beyond "being run down," and the first-aider may run into a case quite unexpectedly in the course of his routine duties. An example of this recently occurred in the ambulance department of a factory. An elderly worker injured his knee and applied for treatment. W'hile examining the injury and comparing the injured limb with its fellow of the opposite side the first-aider noticed that bot~ the legs were somewhat swollen. This the patient a~tnbuted ~o varicC?se ,:"eins, but examination of the pulse disclosed uregulanty In the rhythm. The patient was therefore advised to consult his doctor and was ordered complete rest for several weeks, after which he was able to return to work with a recommendation, however, that he should be given a sedentary occupation. He stated that he felt fitter than he had been for months and there is no doubt that the injury to his knee and the observations made by the first-aider saved him from a prolonaed illness. b It is obviously impossible to describe in any detail the numerous chrC?nic ailments of the heart. They are mostly named according to the parts affected, e.g., endocarditis, myocarditis and valvular disease; they do not, however, ~1'A~ays cause symptoms and usually when symptoms arise it IS because the myocardium has become affected. The patient then suffers from chronic car iliac or myocardial failure.

immediately. Prompt injections of certain drugs may saye Chronic Myocardial Failure. This may arise suddenly or gradually. The patient life. (2) l!0sitioll . The patient sh~:)Uld be propped up like a complains of increasing shortness of breath, noticed at first only on exertion,but later occurring e,ren from slight case ot asthm9.. He may lean forward and grasp a support effort. The pulse rate is increased and sometimes to aid him in his breatillng. irregular in rhythm. Cyanosis is often present while (3). General P~inciples. These inciude undoing tight cough, dyspepsia and loss of appetite are often common clotiling, supplpng warmth and gi\'ing inhalations of symptoms. oxygen if available. Flu.ids should be withheld. A characteristic sign is dropsy, or oedema, as it is called Phlebitis. technically, which means an accumulation of fluid in the Phlebitis is a disease which affects the yeins of the fat under the skin. This oedema usually begins in the ankles, which become puffy towards the end of the day. body especially those which ha,re become varicose. Hence Gradually, however, it extends, causing the 10,Yer limbs to it usually occurs in the leg, when it re ults in the become swollen, the skill being stretched, tense and shiny. formation of a clot of blood within the blood-\'essel, often Oedema can easily be distinguished from fat since it " pits quite close to one of the valyes. The condition may be on pressure." This means that if the s,Yollen area is caused by a slight injury such as a knock. The patient complains of pain in the limb, particularly pressed with a finger an impression is formed on the skin which can easily be seen and which fills in only slowly. along the course of the yes el which is affected. On If, however, the supposed swelling is due to fat inlffiedi- examination a small area of the skin is noticed to haye ately the finger is removed the skill is restored to its former become red and inflamed; the yein itself may appear more prominent than normal and a small swelling may be condition. It must not be thought that oedema is ahTays a sign of observed at some part of its course. ometimes there is heart disease; it occurs in many other first-aid conditions, oedema of the limb. Phlebitis may be dangerous since there is a risk that the e.g., fractures, sprains, strains, etc. In these cases, ho"\.yever, the oedema is confined to the seat of injury and is of no clot of blood may become dislodged and enter the general circulation-a complication v:hich may be fatal. serious significance. Finally, it must be emphasised that, although the con- FIR T AID dition which has been described is called chronic myocardial Phlebitis is only a first-aid condition in that patients failure, in many cases there is usually no reason 'why the often do not appreciate the nature of the complaint from patient should not make a good reco,rery and live for ,,'hich they are suffering and may apply at an ambulance years afterwards although ills activities may be curtailed. room for attendance, attributing their trouble to an injun". Modern methods of treating heart disease haye resulted in It is \"ery important that eyery ~first-aider should recognise much saving of life. There is of course no first-aid treatment. the possibility of phlebitis An\' examination which is undertaken should be yi ual Acute Pulmonary Oedema. This is a condition which could well have been only;' the swelling must not be touched owing to the described under emergencies of the respiratory system. risk of disturbing the clot. Indeed war-time first-aiders learnt all about it 'when The patient should be taken home immediately and his studyin'g the effects of the lung irritant gases such as doctor asked to call and see him. \\'hile a\'\'aiting medical phosgene. Usually, however, it. occurs as ~ result C?f advice he should lie in bed, keeping his limbs as still as sudden failure of the heart and IS therefore lOcluded In possible. He should be warned to make no. at,tempt t.o \,-alk or eyen get out of bed without p~rmL~lOn .. HIS tills article. Acute pulmonary oedema, as the name implie~, mea~s relatives mu t therefore be advised to proYlde him \yuh a dropsy of the lungs. The air cells tend to ~ll up With !luld urinal bottle and a bed-pan. derived from the blood and hence the patient suffers trom (To be contiJlllfd.) partial asphyxia. The condition usually occurs in elderly patients who REVIEW have developed high blood pressure and enlarge~ he~rts. Sometimes they are not a\l,'are that they are sufferlng trom Aids to Practical Nursing a cardiac complaint. By ~L-\RJOR[E HOl;GHTO~, S.R. ., S.c."I1. The disease begins suddenly, the p~tient e:s:.perienci?g London: Bailliere Tindall & Cox. Price 5S • oppression in his chest and di1ficu~ty In breathIng \\·hlCh This is tbe 11fth edition of Aids lo.Prortiroi SIII'silig which \\'a tlrst soon becomes extreme, There are Signs of shock- namely, published in 193. In its preparation it was t~ought that more pallor and a cold clammy sweat; later there. is cyanosis. The pulse becomes quick and feeble and the paa.ent deve~ops extensi,'c alterations and additions were now reqUIred than had been a short and frequent cough, often prodUCIng COplOUS possible or necessary in the earlier edirions which ~ade their appearance during \'Y'odd \'\'ar 10. '2. Funher, the eXpCfl(;nCeS of the past quantities of watery, frothy phlegm. six years ha\e produced changes in nursing procedures as the result A characteristic feature is the bubbling respiration, which of new methods of treatment and neW' concepts of pathology. In can be distinctly heard. these circumstances thi edition will proyc as acceptable as its predecesFIRST AID (1) ·.Medical .Aid. Acute pulmonary ocden1a. may pr.o\·c rapidly fatal, hence the doctor's presence IS requIred

sors and will continue to be useful ro the new student by pro\'iding an imroduction to the most es ential pan of her training, a sounJ kno\\'lcJgc of the art of nur-ing.

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FIRST

News From All Quarters ST. JOHN AMBULANCE BRIGADE. THE FINAL COMPETITIO N S As briefly reponed in our last issue the final Ambulance and Nursing Competitions of the Brigade took place in the Victoria Halls, Bloomsbury Square, London, on June 13th. The Competitions ""ere under the direction of Lieur.-General Sir Henry Pownall, K.CB., K.B.E., D.S.O., M.C (the Chief Commissioner), assisted by N. Corbet Fletcher, Esq., M.A., i\I.B., B.Chir., M.R.CS., L.R.CP. (Surgeon-in-Chief), Major P. G. Darvil-Smith, CB.E. (Brigade Secretary and County Commissioner, Bucks.), and Assistant Commissioner H. J. Wrigglesworth, M.B.E. The referee for the Ambulance Competitions was Capt. 1:,... C. White-Knox, M.e., M.B., Ch.B. and for the Nursing Comperitons W. C. Ben tall, Esq., O.B.E., F.R.CS.

At the conclusion, challenge shields, cups, trophies and prizes were presented by Her Royal Highness The Duchess of Gloucester. Prince of Wales's D istrict BEXLEYHEATH AND BEXLEY DIVISIONS A Social Evening was held at the Congregational Hall, Bexleyheath, on June 2fst, at which members and friends attended. The guests included District Officer Hallock, Corps. Officer Whehle, Div. Supt. Aylott (I20th Division). Dancing, games and entertainment followed. HARLESDE DIVISION A Divisional Inspection was made on June 5th, at Leopold Road School, by the Assistant Commissioner, Dr. G. H. R. Wrangham, aided by District Officer II. V.

importance of maintaining a constant watch on shocked patients against further collapse. The blanketing of the stretcher and the "slouching" method of walking when carrying (demonstrated in the femoral fracture) were favourably commented upon. District Officer Shrosbree commented upon the smartness of the parade, and expressed his hope that the Division would find itself able to enter a team for the " Ninnis" Efficiency Competition next year. The Mayor, in a brief address, expressed his confidence that the first-aid needs of his district were well provided for, but stressed the need for more Cadets, as they were potential future members of the adult division. County of B erkshire ASCOT DIVISION The first aid services covering Ascot Races, which were held during the week June 17th-20th, were in the hands of Bracknell St. John Ambulance Brigade under Div. Supt. W. A. Green and the Ascot Detachment of the British Red Cross Society under Miss H. K. Henry, Divisional President, Windsor Rural Division. On the stand side of the course there were tlAro hospitals staffed by members of the B.R.CS. with two doctors in attendance. All outside work was done by members of the Brigade, three ambulances being on duty for the week. One of these was in the paddock for the jockeys, one in the road for the stands or any road accidents, and one on the heath

SHIELD.

Shrosbree, in the presence of the Mayor of Willesden, Aldenilan S. Scott, who is President of the Division, and the Divisional Surgeon, Dr. H . M . Setna. Following the parade inspection, demonstrations were given of artificial respiration by the Sylvester and Schafer methods, and first aid as applied in cases of fractured femur, elbow joint and a simple fracture of the rib. The method of lifting and carrying the fractured femur case was shown, and demonstrations were also given of 2- and 4-handed seat carrying, and 3-handed seat carrying, supporting left leg and, alternatively, right leg, respectively. In his subsequent address to the Division, the Assistant Commissioner, aftercongratulating the men on their smart appearance and efficiency, spoke on the effects of traction in cases of fracture and asked questions on several subjects including the treatment of shock, correct use of stimulants, etc. He cited cases illustrating the need for care in the use of hot water bottles, and the

DIDCO T AND· WALLINGFORD DIVISIO N O n Sunday, June 1st, at Didcot .Senior Boys' School, the Annual InspectlOn of Didcot and Wallingford Divisions was carried out by the County Commissioner (Mr. CA. Poole) who was accompanied by members of the County Staff. About seventy officers and members were on parade under the command of Div. Supt. W. J. Fisher. HUNGERFORD DIVISION On Sunday, June 1st, at the Corn Exchange, Hungerford, the Annual I.n~p.ec tion of the Hungerford Ambulance DIVISlOn was carried out by the County Commissioner who was accompanied by members of the County Staff. There were sixteen on parade under the command of Div. Supt. A. G. Martin. The Commissioner congratulated the Division on their smart appearance and turn-out. He also congratulated the first aid team, captained by Cpl. A. C. Eatwell, on their success in winning the Shield at the recent County Competitions. Mter the Inspection, which included the motor ambulance the Commissioner presented each member of the team with a polished pewter tankard. Div. Surgeon Stuart Boyd was prevented from attending. READING CORPS On Monday, June 16th, at the Abbey Gateway, Reading, a meeting ,?f Readi,ng Nursing Corps was held dunng whICh Sergt. Miss E. ~linch presente~ the Cup, which she had gIven, to the wmners of a recent Child Welfare Competition. THEALE DIVISION On Sunday, June 22nd, Theale Nursing, Ambulance and Nursing Cadet Divisions and Woolhampton and Brimpton Nursing Division held their Annual Church Parade at Holy Trinity Church, Theale. During the Service, which was conducted by the Rector, the Rev. W. H. Trebble, an Enrolment Cremony was held.

THE PRESENTATION OF THE" DEWAR" CHALLENGE

The winners of the Trophies were as follows : Afllbulal1ce.-cc Dewar" Challenge Shield ~}1ighest marks), Wolverton, 390t; Symons Eccles" Challenge Cup (second hIghest marks), March L.N.E.R., 380; " Hong Kong" Cup (third highest marks), C~mden L.M.S., 378~; "Trimble" Trophy (hIghest marks in individual and dual practicals), Wolverton, I93t; "Ellis" Cup (officer or leader of team gaining highest marks in practical), Camden L.M.S., SIt. Nursing.- cc Perrot" Challenge Shield (highest marks), Harrow, 455~- ; cc Corbet Fletcher" Trophy (second highest marks) W.eymouth, 447t; "Chalmers" Trophy (hIghest marks individual and dual practic~ls), Harrow, 190 ; "Mountgarret" Cup (hlghest marks bedmaking tests, Sisters ~ an~ ~{, Vaughan College (Leicester), 95 ; EllIS ~up (leader of team gaining highest marks ill practicals), Blackpool, 54; " M~rgarette Golding" Trophy (individual nursl11g test), Weymouth, 58.

for the general public. On this side also was the Bracknell St. John First Aid Hut in charge of Div. Supt. Mrs. W. A . Green, of Bracknell, assisted by Div. Supt. Mrs . L. Cox, of Ascot. All duties were coveted by members of Bracknell Am?ulan~e. ~nd Nursing Divisions, Ascot Nursl11g DlvislOn and Reading Corps, who sent out an ambulance and staff each day. The whole of the arrangements worked satisfactorily and 268 people received attention.

TWYFORD DNISION On Tuesday, June 17th, at Twyford Almshouses, the Annual Inspection of the Division was carried out by the County Commissioner, who was accompanied by Mrs. Poole. There were nine men on parade under Div. Supt. H. T. Whitlock. The Commissioner gave each man a test ~d expressed his satisfaction at the high standard of efficiency shown by the Division. He also thanked Dr. Jenkins, who attended the Inspection, for all the help he was giving the Brigade at Twyford.

THE PRESENTATION OF THE "PERROTT" CHALLENGE SHIELD.

County of Dore~t WEYMOUTH DIVISION The Earl of Shaftesbury, Bailiff of the Grand Cross of the Order of St. John, paid tribute to Alderman Bert Biles at a ceremony at the St. John Hall, the headquart.ers of .t~e Weymouth Ambulance and Nursl11g DIVl-

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sions, during which he accepted the deeds of the building on behalf of the O rder recently. A guard of honour was formed outside the hall by members of the Ambulance, Nursing and Cadets Divisions . The ceremony was attended by many guests .including officials of the movement. • The Mayor (Mr. C. H. J. Kaile) said how pleased they were that their proceedings were graced by the presence of the Earl of Shaftesbury and Lady Ellenborough, County President of the Nursing Division, on what was a red letter day in the annals of the Weymouth Brigade. He referred to the splendid work of the Brigade and said the mainspring of the movement in getting the hall was Alderman Biles, through whose untiring energy it had been brought to fruition and was now free of debt. It was a remarkable achievement and reflected great credit on him and the Brigade. On behalf of the town he thanked the Brigade for all the work they had done, much of it unobserved. Sergt. E. J. Honebon, Acting Secretary, read apologies for absence from Lord Hinchingbrooke, M.P., Dr. and Mrs. R. V. S. Cooper, County Commissioner and County Superintendent, respectively. County of Hampshire ISLE OF WIGHT AREA The Spicer Challenge Cup, which is competed for annually .by ..;\mbulance Divisions in the Isle of WIght, IS awarded on the results of a team test, together with marks gained during the year by the Divisions for efficiency and the keepl11g of records and equipment. The team test portion of the Competition was held at Newport in April, when the tests were set and judged by Divisional Surgeon C. N. Burnham-Slipper (collective), and Divisional Surgeon F. Keane (individual), of the County of Hampshire. Teams from the Cowes and East Cowes, Newport and Ryde Ambulance Divisions entered for the team tests, and that portipn of the Competition was won by the Cowes and East Cowes Ambulance Division, Newport being second, and Ryde third. The Cup, however, awarded on the total marks gained during the year, was won by the Ryde Ambulance Division, Cowes and East Cowes being second, and Newport third. The Cowes and East Cowes team represented the County of Isle of Wight ~n the Regional Competition held at Read111g. C ounty of Hertford WELWYN GARDEN CITY DIVISION Members of the Welwyn Garden City Division competed for the "Dr. H. J. B. Fry" Memorial Cup, on Sunday, June 15th. The Competition was held at the Cherry Tree and was attended by the County Co~s sioner (Mr. H. Langley Jones~, the PreSIdent of the Division (Mr. G. S. Lmdgren, M.P., Under Secretary of State for Civil Aviation), members of the County Staff and many relatives and friends of members of the Division. The object of the Competitiot.'l was ~o test the general ability of the men ill thel~ first aid work. It consisted of three sectlOns: a written paper, an oral examinat~on and a practical test in wh.ich the c.ompetJtor~ were 'r equired to deal WIth a patJent ~ho, It :vas assumed, had taken poison. This pracbcal

7 test, which was the interesting part from the spectator's point of view, was effectively staged and took the competitors by surprise. Dr. D. H. Kinmont (St. Albans) conducted the oral portion of the Competition, and Dr. J. Clay (Letchworth) the practical test. Both doctors commented upon the satisfactory standard of work. Awards for previous years' service were also presented to members of the Division by the Commissioner. County of Lancashire ST. HELENS PARR DIVISION A first aid quiz league has been formed in the St. Helens area and a number of neighbouring Divisions agreed to compete. The meetings have so far proved to ?e exceedingly interesting and pleasant Urnes have been experienced. County of Leicester MELTON MOWBRAY AND DISTRICT DIVISION Grey sides and the threat of rain did not prevent the annual parade and inspection of the Ambulance and Nursing Divisions from taking place as planned at New Park on Sunday, June 15 th . . . Assistant County ComrrusslOner, Dr. L. Duncan Porteous, deputising for the Commissioner, inspected the parade and later took the salute at the march-past at Egerton Lodge. The parade, headed by the Leice.ster St. John Ambulance Cadet Band, consisted of Melton Division, Holwell Ambulance Division Melton Nursing Division, Melton Ambula~ce Cadets and Melton Nursing Cadets. Commanding the parade was Melton's Divisional Superintendent, C. Towell. , Mter tea, held in the Oddfellows. Hall, Pte. William Paling was presented Wlth the Lindsay Everard Efficiency Cup by Dr. Porteous. Speeches were made by ~r. Porteous and County Superintendent, :Miss G. E. Partridge. County of Worcester HALESOWEN NURSING DIVISION The Annual Inspection, by the Corps Officers of the Nursing Division, was held at Church House, Halesowen, recently. The Inspecting Officers were Corps Supt. Miss Fearnside and Corps Officers Mrs. Northwood and Miss Wakefield. Mtcr the inspection of uniform by Corps Supt. Miss Fearnside the mem?ers demonstrated bed-making and bandagll1g. A .team test arranged by the newly-apP0l11ted Divisional Surgeon, Dr. Newton, was then staged. . d h . The Division were complimente on t .el! smartness and efficiency by the Inspectlng Officers, after which light refreshments were served. CENTRAL LYE NURSING DIVISION The Annual Inspection. ?r the Corps Officers of the Nursing DIVISIon was held recently. . The Inspection was cawed out by Corps Supt Miss Fearnside and Corps Officers Mrs: Northwood and Miss Wa.kefield. Also present was County Officer Miss Ashton .. All the inspecting officers expressed t?el! satisfaction with uniforms, demonstratJ~ns of first aid and home nursing and also With the books and records.

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8 West Riding of Yorkshire SOliTH-WESTER AREA The Competition for the Grundy Cup was held on Saturday, June 21st, in Willholme Park, Brighouse. Seven teams entered, the winners being Saddleworth " A," Saddleworth" B" came second. The winners of this Cup go forward into the Competition for the "Dewar" Shield next year. The Cup was presented to the winning team by' the Deputy Mayor of Brighouse. He praIsed the work ' of the SL John Ambulance Brigade as a whole, and hoped that they would continue to function as a voluntary organisation for many years to come. Lieut.-Col. C. B. Ball, M.B.E., who had judged the teams, said he was very pleased to have been asked to do so. He praised the work of the teams and said that he always learnt something himself at competitions, and asked the teams to be more careful in the diagnosis, especially when internal heamorrhage was present, if the teams learnt this, then his time taken in judging had not been wasted. Midland Area CASTLEFORD DIVISION The Annual Inspection of the Castleford Corps was held at Kippa.\: on June 15th. The Inspecting Officer was Assistant Com. \Xfest-Watson, M.D., missioner W. accompanied by District Officer Baker and two other District Officers. In the ab~ence of the Corps Supt. A. AddlOell through indisposition, the parade was In charge of Corps Officer H. Moore. Men and women of the three Ambulance and three Nursing Divisions comprising the Corps , ,\'er~ present for the Inspection. Dr. \X est-Watson, after the Inspection, said he was sorry the Corps Supt. was absent as he was going into hospital for an operation. He wished him. a good and speedy recovery. Remarklng on the decrease in m~mb~rs he said e\'eryone should get more Splflt IOtO the work and encourage new members. The J:?i.vision held its Annual Open Team COmpetHI0n on July 5th. The judges were County Surgeon Hargraves and Corps Surgeon White. New Stubbin Colliery came first with 1~1 marks and Pontefract No . I second with 168 marks. The" Compton Rickett " Cup was presented to the winners at the conclusion of the Competition.

RAILWAYS The Inter-Railway Competition ~~e first post-war Inter-Railway CompetltJon was held on Friday, June 20th, at the .Borough Polytechnic, London. The Judges were Capt. A. C. White-Knox O.B.E., M .e., M.B., Ch.B., William Duncan: Esq., M.B., Ch.B., and W. L. M. Bigby Esq., M.B.E., M.B., B.S. Mr. G. E. Craf~ acted as Competition Secretary. The results were as follows : -

j'vIarks Southern Railway (Horsham) Great Western Railway (Swindon) '" ... ... .. 3· London, l1idland & Scottish Railway (Crewe Works) ... 4· London, l1idland & Scottish Railway (\'V'olverton Works) ....

1. 2.

45 8t 426~

4I I 388

orth Eastern 5· London & Railway (March) ... ... 377 6 . Southern Railway (Waterloo) ... 374 orthern 7· Midland & Great Joint (Melton Constable) 373i 8. London & orth Eastern Railway (Nottingham) ... 36 9 9· Great Western Railway (Cardiff Docks) ... 347i 600 Maximum marks obtainable ... Sir Robert Burrows, Chairman of the London Midland & Scottish Railway, presented the trophy and prizes to each team. In an address he paid warm tribute to the St. John Ambulance cause and congratulated the winners and those who were not quite so fortunate, to whom he offered his best wishes for the next time. . Capt. W~te Knox, replying for the Judges,. said It was a privilege to judge the recogmsed " cream" of the Railway j\mbulance Teams. IIe stated that he was not surprised at the result and congratulated the Horsham team on their work. Great Western Mr. A. Morgan, Dock Manager's C?ffice, CardIff, has been appointed DivislOnal Secretary to the South Wales Docks Division in succession to the late Mr. G. H. !les.

SHIFNAL To mark appreciation of his work as Ambulance Class Secretary, Mr. J. H. Abrahams was recently presented with a wall.et of treasury foLotes. Mr. N. H. Jones, StatIOnmaster, preSIded, and was supported by 1r. J. H. Swann, Divisional Ambulance Secretary, and Messrs. J. H. Evans and H. Martin, Stationmasters, rarket Drayton and Cod sail. The presentation was made by Mr. S. A. Housden, who was a member of Mr. Abrahams' first class. Mr. Abrahams organised his first class at Horsehay in 1905. In I920 he became Secretary of the Shifnal class and has o~ganised a class and acted as Secretary and Instructor each year since. He was admitted to the Order of St. John of Jerusalem In the Grade of Serving Brother 111 1930. DAWLISH The annual dinner and presentation of awards was held at the Grand Hotel under the chairm.anship of Mr. G. MitchelL Class Sec~etary, In the unavoidable absence of the StatlOnmaster, Mr. S. C. Connett. Dr. H. A . Constable, the lecturer of the class proposed the toast of the G.W.R., which was rephed to by Mr. H. A. G. Worth Divisional Superintendent, who also mad~ the presentatIons. ~ther spea.k~r~ included Mr. H. L. Squire, ASSistant DIVISIonal Superintendent Mr. H. J. Potter, Divisional Ambulance 'Secretary, and Mr. H. E. T. Cornish. An enjoyable entertainment was provided . WOMEN'S FIRST AID COMPETITION This Competition was held in the Porcheste~ Hall, Pa~dington, recently, the first occasIOn on whIch it has been possible to hold the contest since 1939. The result was as follows:1s~~Plymouth,

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LVIarks (Max. 360)

winners of . F~o!ence M. Lean" Cup, ll1dlVldual cups and prizes ...

2nd-Padding ton, winners of " Mabel A. Potter" Cup and prizes ... ... 3rd-Swindon " B " 4th-Swindon " A " 5th-Teignmouth ~ol.onel

AGNES E. PAVEY, S.R.N. Diploma 1ll Nursing

? J. Selby, O.B.E., was the

London and North Eastern Fifty-three members of the L.N.E.R. first aid organisation became entitled to Lon~ Service Gold Medals on May 31St. ServIce Bar qualifications were as follows: 20 years, 19; 25 years, 7; 30 years, 4; 35 years, 3; 40 years, I. Southern AUDIT DEPARTME T The "Ben Allen" Pairs Competition took place in the Canteen Hut on June 2nd. The draw for partners was made on the day of the contest- 14 members of the class entering. The test "was drawn up and judged by 1\1r. F. ~. Trott (Centre Secretary), who was asslst~d by Mr. G. Gibb, Chief Accountant s Office, Deepdene House. The winners were: 1st, H. Maultby and J. Haddon; 2nd, A. Potterill and W. Clayton. The contestants were very evenly matched as .only 9 marks separated the first and last palfs. The Cup was presented to the winners by the donor, Mr. C. G. Allen, and a few re.marks from Mr. Trott provided that stimulus which his presence imparts to such events. Mt. A. Potterill thanked the judges, Mr. Co?mbs,. Mr. Allen, the patient and his acting Wife, for their interest on such a hot evening, and Mr. Coombs (Chairman) suitably responded. EASTLEIGH WORK.S As the result of garden shows, concerts, etc., £r,5Io. 12S. 9d. was raised at Eastleigh Works dutlng the war for the Red Cross and St. John Fund. At the end of hostilities £360 was handed over to local hospitals. In the early part of 1946 the Committee decided that a motor ambulance should be provided with the balance in hand so that a veI:icle would always be available on the premIses. Accordingly a 14 h.p. Morris ambulance :Vlth c.anvas body was obtained, but. when It a!I1ved at Eastleigh it was deCided to prOVIde a new and roomier body. ~he cost of the body together with all ma1Otenan~e charges is covered by the moneys raised by the Committee responsible for the vanous activities in the works and apart ,from the provision of a driver d~ring working hou rs, the Company is not called upon to cover any costs of maintenance etc. The vehicle is allocated for the sole u~e of works employees, but it can also be used for their families. One of its first long di~tance jobs was to transport an employee's chIld from Stanmore, Middlesex, to Southampton.

PRACTICAL NURSING IN THE IIOME

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215 206 165

adjudIcator 10 both the team and individual contests . The .subsequent presentation of trophies and pnzes was presided over by Mr. H. Adams Clarke, Chief Staff and Establishment Officer, who was supported by Mr. A. S. Quartermaine, Chief Engineer.

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an occasional glass of milk would become nauseated if it w:ere offered to them two-hourly .. \Vith thoughtful planY condition associated with a rise of temperature rung an~ preparatlOn, however, It can be presented in above the normal is considered to be a fever, but many ,different for.ms, and with various flavourings. this is never the only symptom; and with all the increased Benger s food, HorlICk s malted mIlk, Ovaltine, tea, coffee activity within the body there is greater combustion and and cocoa are nearly always allowed, and all these can be an accumulation of waste products, especially of the made entirely with milk when the object is to increase the poisonous toxins produced by the invading germs . Unless intake of nourishment. Many patients like sweet drinks, sufficient food is taken the required fuel must be obtained so that sugar can he added. As a change from sweet drinks from the reserves in the liver, the fatty tissues and the an occasional feed can be flavoured with cinnamon or muscles; so that the old practice of " starving a fever" ot?er .spice, ?r the cC?nsistency. can be varied by giving a is now regarded as irrational. rmlk Jelly wlth a frult flavounng and colouring. Variety There are, however, difficulties in feeding the patient can also be introduced by giving some feeds hot and others because, during the acute stage of most illnesses, appetite cold or iced. is lost and digestion is impaired. For the well-nourished \'Chen eggs and soups are allowed much more variety can person a few days of comparatiYe starvation will do no be introduced. An egg may be beaten up with the 'milk harm; but, if he is losing fluid from the body by sweating or made into a custard. An ordinary egg flip can be made or by diarrhoea, copious drinks are very necessary, and by beating the white to a stiff froth, adding sugar and a so also is vitamin C. few drops of vanilla or other essence, or salt and pepper, Sugar in some form is essential because it supplies the and then pouring hot milk over it slowly, stirring all the fuel for the production of muscular energy and it requires time. The yolk of the egg can be beaten into the milk less digestion than starchy foods-the other form in which before it is heated, or it can be used cold. One-third of the carbohydrate can be taken into the body. Failure to keep white can be piled on the top of the mixture instead of up the supplies of carbohydrate will result in the muscles being beaten into it. Fruit flip is made in the same way as becoming flabby and weak and, even if the patient is egg flip, but using five ounces of orange, grapefruit or resting his voluntary muscles, it must not be forgotten other fruit juice in place of the milk. Instead of sugar that the heart and the bloodvessels consist largely of and vanilla flavouring a little Bovril or lIarmite may be muscular tissue. Copious fluids aiel in the dilution and used; or a tablespoonful of brandy, sherry or wine may removal of waste products from the body. be added to a fup if allowed and desired.

DIET I

ACUTE ILLNESS

ARRA GING A FLUID DIET. During the acute stage the maximum amount of water that the patient tolerate must be taken, for three reasons: to allay thirst, to prevent dehydration and to assist excretion. It need not be given as plain water, lemonade, orangeade, ba~ley wat.er, broths, clear soups, tea, coffee and cocoa prOVIde vaned and palatable means of giving fluid. They may be taken hot, cold or iced, and glucose, sugar or salt can be introduced into many of them. A small but attractive tray of refreshing drinks should be kept at the patient'~ ~e~side. The tray may contain a bottle of sweetene.d frUlt Ju~ce, .a jug of water covered with weighted muslin, some Ice If procurable, and a tumbler. Fruit juices contain both suo-ar and vitamins and their acid taste is pleasant. Aerated w:ters may be given unless the patient has a tendency to develop flatulence. In addition to t~ese drinks, .twohourly nourishing drinks should be gIven, the baSIS of most of these being milk. Milk contains most of the necessary food elements, but it is deficient in iron-the lack of which is a cause of anaemia-and some of its vitamins become impaired during the preparation of the ~eeds. . ~any patients are not fond of milk and the ordlllary cltlzen has become unused to taking it as a beverage owing to the v~ry restricted rationing; but even those who could enJoy

Egg nog is both stimulating and nourishing. It is made

by putting the beaten-up white of an egg into a tumbler :will and adding a tablespoonful of cream and of brandy or whisky, with sugar to taste, and mixing it well. Artificial cream, or even condensed milk, may be used. For treacle llog a tablespoonful of black treacle is stirred into a quarter of a pint of milk, which may be hot or cold, and is poured over a beaten-up egg. Chocolate flog is made by whisking an egg and then straining a cup of hot chocolate over it, \.vhisking the mixture until it is frothy. Broths and soups give variety to a fluid diet, but it must be remembered that 0~y when containing milk, cream, yolk of egg or vegetable puree have they much food value; and this is true of Bovril, Oxo and other much advertised preparations. J\1armite, however, IS a rich source of vitamin B. Cereal milk gruel with sugar or salt, junket and ice cream are welcome additions to a liquid diet, and fruit drinks form a medium in which extra sugar can be given. If glucose is used in.stead ~f ordinary. sugar mu~h more food value can be glven without making the drInks too sweet for the ordinary palate. A fluid diet should not be continued longer than necessary, and should then give place to a light diet.

ARRA TGING A LIGHT DIET. The composition of a light diet depends largely upon the type of illness from which the patient has been, or is, suffering. In addition to the feeds already mentioned it can include soft, easily digested solids, such as milk jelly, baked custard, lightly cooked eggs omelettes, breakfast cereals, milk puddings, thick soups, stewed or raw fruits and vegetable or fruit purees. Bread and butter is allowed and crisp toast is often welcomed by the patient as a change from soft foods, for it gives exercise to the muscles of mastication and helps in cleansing the mouth.

TRA SITIO TO A FULL DIET. As the illness subsides and the convalescent stage approaches, the intervals between feedings are lengthened unt.il three meals are taken daily, with intermediate refreshing and nourishing drinks. The main additions to the diet are in the protein foods, such as fish, chicken, and other poul~ry, sweetbreads, tripe, lamb, mutton and beef; these bemg added gradually in order of digestibility, and they should be adequate to make up the tissue losses sustained during the illness. Convalescence is a trying period, the patient is often bored and somewhat irritable, he is apt to worry over his inability to engage in full normal activities and he feels that everyone expects him to " pull himself together" Later, grilled or steamed fi~h, chicken or rabbit ~nd much quicker than he finds himself able to do. He becomes . green and root vegetables are mt~oduce~, potatoes bemg tired and depressed very easily and all these factors mashed and other vegetables s1eved if necessary. If adversely affect the taking and utilising of a suitable diet. insufficient amounts of fruits and raw vegetables are taken Some interesting and not too exacting an occupation in the diet it is unlikely that the patient will obtain an should be found for him so that the days pass more adequate amount of vitarrun C, so that rose hip or black- quickly. Fresh air and moderate exercise between meals currant syrup or the juice of citrus fruits should be added, stimulate appetite and aid digestion; but an excess of but these must not be heated or the vitamin may be alcohol or tobacco should be avoided, and a short period destroyed. \,\'hen fruit juices are. n?t available. tablets of of rest should be taken before and after each meal. In ascorbic acid may be gIven. This 1S a synthet1c form of planning the menu, the digestibility and size of the meals vitamin C which is identical in effect with the natural should be taken into consideration and so also should the vitamin. Three-hourly feedings from '7 a.m. till 10 p.m., patient's usual dietary habits, unless these were previously with intermediate fruit drinks, are advisable, with modi- unsuitable. fications to meet special difficulties or needs. (To be continued) .

J. W. SCOTT.

I HAVE many times watched first aid competitions, and from the work performed by the entrants, I have concluded that, as a general rule, the training of most of the teams has been of the best, also, the keen interest shown by the teams, has made the whole petformance really well worth watching. Apart from the first aid work that has been performed however, the amount of" imagination" that has had to be used by the competitors has varied wildly, and how some have been able to " assume" to the extent of obtaining that amount of" realism" into the scene or action, has been beyond my comprehension. During the war, I took part in a competition that was set for the fin.als of a District contest, and the scene was supposed to represent a bombing incident, and one of the seven casualties was lying under a pile of chairs and tables, with a thin red handkerchief wrapped round the whole of his head. Unfortunately, I was the victim who cc discovered" him, and I just stood looking at him, completely puzzled as to what was supposed to be the matter with him. I remember that I gave a look of enquiry to one of the umpires, who quietly informed me that the chap had had a wall fallon his head, almost pulping it. It 'was quite a case of cc What would you do chums." Through the thin red handkerchief I could see that his features were quite normal, so much so that he s')lemnly winked at me. At that moment, however, I was called to another cc case" by the leader, and I was only too pleased to leave that problem. I am quite sure that his appearance could have been made far more like the real thing than by merely tying a handkerchief round his head. With the aid of Some plasticine and cochineal, quite an effective mutilated skull can be " made up."

Have you tried this making up of wounds and lacerations? It is a fascinating pastime. If you want to represent a clean cut-which is really the easiest wound to start with-you must get some fleshcoloured plasticine, and place about an eighth of an inch thick, grafting it well into the skin round the edge; then place some light red grease paint over that, and then make your incision with a sharp edge (not too deep or else you will get the real thing), and fill the cut with vaseline and cochineal mixed, and you will be surprised at the result. With practice you can extend to anything from lacerations, burns, scalds, and such like, to far more serious injuries such as deep abdominal wounds. One of the most effective" abdominals " that I have seen was at a competition during the war at one of the Kingston Civil Defence First Aid finals. The casualities were laid out in some real bomb debris, and they were well trained to act the real thing. So well was the " stage" set, that it was hardly necessary to explain any details to the team. The wounds were made up to perfection, and the particular case I want to refer to was by far the best. He was lying on his side, and was slightly groaning, and was sufficiently pale faced to denote that he was very ill. Close to his face on the ground was a little heap of " vomit" (made with a mixture of cooked vegetable and loganberry). The team had been told that all wounds were to be discovered, and so they commenced to "expose the wound." They felt over his clothes for damp patches, and found some at the lower region; of his waistcoat, and so they loosened his waistcoat and the top of his trousers and on pulling up his shirt, found the wound, a deep incision across his tummy, which had been bleeding

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freely. It was quite apparent that the cause was a bomb splinter, or maybe a glass splinter, which was found just inside his clothes later. Now this wound was made up by a section of tripe (the pimple side inwards). It did really look like real flesh, and was strapped each side to his skin with adhesive tape. The cut was about four inches long, and filled \1,;ith vaseline and cochineal, and looked very real. The team were able to dress it and treat it easily as if it was real. At a recent Police competition, the scene was a country road, and at the corner of the road was a coffee stall. This was built up in a splendid manner, and in a way that only is seen at these Police contests. But it was wonderful what this coffee stall was able to produce in the way of things that the first-aider wanted. Among other things, two blankets were produced. How a coffee stall came by two 'blankets is nobody's business of course, but still, they were there for the asking, and so they were made good use of for the patient that had been injured. He was ill, yes, "ery ill because his face was just one big pure white blob, almost as if he had plunged his entire head in a pail of whitewash; it ,yas only possible to recognise that it was a face by the three black cavities of the two eyes and mouth, and had a mask like appearance, very much an overdone pale face. The coffee stall keeper had previously been insttucted to be very awkward if any of the team approached him, and if they went as far as asking him to come out of the stall to assist them, he was to be very cross, etc. ; and ask them" what they thought he was." Well, of course, all this sort of thing is not really necessary, in fact I am sure that most coffee stall keepers would do all in their power to assist under such circumstances. If I may return to the Kingston contest, I remember that as the team were attending to the abdominal casualty, a girl walked on to the scene, and when she saw the plight of the chap on the floor, she let out the most blood curdling scream that I have ever heard, and then went into the finest attack of hysterics that I have seen. She really was good, and when two of the team went to take her away from the scene, she raised a terrible fuss and blankly refused to leave, and so was" assisted." That was the trap, because as she was left unattended, it was not long before she was back again and making much more row than ever. That team will never again leave an " hysterical" unattended. Then there was a man sitting in the corner of the" stage" on a chair, and after a short while, he slowly slid off the chair, and came an awful smack on the floor, so hard in fact that he fractured his arm. Had a member of the team gone to him earlier on, his trouble consisted merely of a fit of giddiness, and faintness after the" bombing," and so not haying any attention, he "fainted" and sustained the further injury. Such happenings are very helpful for training, and although they were staged for circumstances surrounding bombing incidents, it is not difficult to adapt them for present day use, by means or a few slight" scene" alterations. The coffee stall scene is typical, another favourite being the car and cycle affair, involving one or sometimes two casualities. In the competition that I saw with the car (another Police affair), the car, for some reason or other, was parked tight up against a wall, so that entrance could be made in only the offside of the car, and as the driver had some internal injury, caused by the steering wheel it was extremely awkward for more than one of the team to get at the casualty; and for some unknown reason the team were not allowed to enter the car by the rear door. These obstacles are really not necessary, and only a means of frustration, and tend to cause t~e team to have that feeling that they are not having at least a sporting chance. If the case was real, the Police would not hesitate to move tl:e car, in fact, anyone would, and why not get in the back of the car, anyway? We once had a first aid contest in our depot, and we arranged the scene and " props" to be as near the « usual" thing as possible. The scene was just an ordinary kitchen. On the floor was the casualty. He was

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semi-conscious, and had a cut in the palm of his hand: a clean, long cut, which, as his " wife" told the team, he had sustained as she and him were playing about, she trying to get a knife away from him, and she had pulled the knife causing the cut. He had just turned giddy, following the shock of seeing what was rather a serious injury. When the team started work, the « wife" went into a faint, and so we had two casualties . There was the 'phone in the hall, and on the shelf, a First Aid box (the team were not supplied with kits). No traps, or unforeseen happenings. The work was judged solely on its merits and entirely from a " first aid" point of view. Three teams took part, and what was very important, was the debate that took place afterwards, all three teams, plus a very critical audience, took part, the chair being taken by the Umpire. The First Aid man's skill is unavailing if the victim's respiration is allowed to. fall-~ron:pt action with the Sparklets ReSUSCitator IS Vital to successful recovery.

Practical Points

SPECIAL AMBULANCE OUTf iT 152/ 6 CO M P LET E (British Isles)

Potts Fractur e

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Case.-Workman age 45. Severe pain in ankle. Stepped off tramcar and twisted foot inwards. Limped 50 yards to factory. Removed own shoe. Ankle swollen, but no other abnormality. Tenderness over ligaments, pain worse with movement of foot. Applied roller bandage and kept moistened. Treated for slight shock. \Xlann sweetened tea given. Re-assured-made comfortable by resting and raising footusing two chairs. Patient, however, complained of feeling no better and began to show definite signs of increased shock. Decided to treat case as a fracture. Splinted limb and transported to hospital in ta-xi. X-ray examination revealed Potts Fracture.

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PI"actical Poinfs .-Patient walking on injured limb probably contributed to fracture. Increased shock gave clue to probable fracture. Moral.-When in doubt-treat as a fracture .

S light Wound of Finge r of Old Person Cose.-Patielo1t aged 81. Involved in road accident. Several wounds to scalp found on admission to hospital, none serious enough to require surtures and apparently trivial wound to posterior of fingers and hand. Head wounds were cleaned up and dressed, but on careful examination of finger wounds it was found that tendons were clearly exposed. There had been little haemorrhage and wounds were quite small, but due to age of patient and lack of muscular tissue tendons were exposed. These wounds were sutured.

Practical. Poil/ts.-The head wounds which appeared most serious actually required less treatment than the finger wounds which had been ignored-th~ first aid treatment given.

S ever e Lacer ation s to Thumb Case.-Farmer was bitten whilst examining horse's mouth. O n admission to hospital top of thumb was completely amputated, but with no bone injury. Haemorrhage appeared to have been profuse. Wound was covered with rough cotton dressing and much blood had soaked through. Though patient walked into casualty ward alone he was badly shocked and appeared faint. Anti shock treatment had to be given before surgical toilet.

Practical Points.-A good dressing would have efficiently controlled haemorrhage and much primary shock would have been prevented . A person having even such a misfortune should not have been allowed to go to hospital alone. .

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THE TRAINING OF F IRST AID TEAMS 2nd COMPETITION 2nd By

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FIRE FIGHTING FOR FIRST AlDERS

18th Edition. Fully Revised 232nd Thousand. 313 IIlus. Some coloured.

by JOHN WILLIAMSON.

Stiff Boards. net. TO THE INJURED & SICK. Postage 4d. An Advanced Ambulance Handbook. Edited by NOR MAN HAMMER. M.R.C.S.,Major,lateR.A.M.C.,T.A. FIRST AID JOURNAL.-" One of the most concise works on the subject publishe d at a popular price.

TIlE incidence of fire is an ever present menace in our works, homes and places of entertainment, and the treatment of resultant injuries are adequately dealt with elsewhere. It is the valuable use of the first few minutes at an outbreak that often decides the extent of the damage and injury. \'V'ith the old adage" Prevention is better than cure" in mind I propose to deal with some simple expedients to assist the first aider jf he or she is first on the scene, to give some hints that will enable to save life and property by resolute action in these few minutes when panic causes disaster.

great heat, you will be able to do so in greater safety; if it is possible to soak yourself in water first. (5) If there is a wind blowing you can get much nearer to the outbreak from windward, but remember that by soaking the area up wind you will help to control its rapid spread. (6) If you are attempting to gain encry to locked or bolted premises remember that less damage is done by smashing onc panel of a door, or one pane of glass big enough to allow you to crawl through, than by hacking recklessly at the whole stmcture. PRINCIPLES OF FJREFIGHTING (7) \'Xlhen smoke is seen coming through floorboards do not stan To understand our enemy is to conquer him and it is necessary to saturating all the floor, prize up a board or so and endeavour to locate know the simpler principles inyoh'ed in dealing with an outbreak of the origin of the fire, it will enable you to check the outbreak with less damage. fire. The two main methods of attack are (1) to exclude oxygen from the (8) Always remember to turn off electricity from the main where flames, as \"ithout oxygen no normal fire can exist, (.~) to beat out the there is a risk of current corning in contact with any water being used, flames by applying pressure with some smothering device, or with as the danger of electrocution is very great. water delivered at high pressure. (9) Where there is oil on fire, the use of water will only help to The first method invoh'es the use of chemical Ere extinguishers, spread the outbreak as the flaming oil will float on the water and foam making apparatus, inert gas generators, etc. Probably the most spread more rapidly. Earth, sand, or any blanketing device \."ill serye important method to be remembered in our case, the closing of doors until a supply of foam and foam making apparatus is available. A and windows to exclude unlimited supplies of fresh air and with it fire extinguisher of the" Pyrene " (C.T.c.) type will be suitable, l;lUt oxygen. This will retard the progress of the fire very considerably shou ld not be used in confined spaces owing to the poisonous nature of the gas generated. and confine the outbreak until the Fire Service arrive. The second method is the principle we see in operation when a (ro) \'V'hen about to enter a room in which fire has started be very blanket or coat is yigourosly brought to bear on the fire or the firemen careful not to fling the door wide open and dash in, for the additional \\:ith their hose get as near to the " seat" of the fire ~s possible and su~ply of m..'ygen entering through an open door may cause smoulding direct a stream of water at pressures ranging from 60 to 120 lbs. or articles to burst into roaring flames, or if the fire is already burning more, ~er square. inch, hard on to the outbreak. The layman may fiercely, the sudden opening of the door \vill cause the flames to rush not realrse that prImary effect of water deliyered at pressure is to beat out and the d~ger of becoming enveloped in them is very great; out fire although its "wetness" helps by cooling the surrounding therefore exercise the utmost caution in these circumstances. areas so that eyentually they will not burn. It is a point of interest (Next month" Life Sal'illg Hints.") that no amount of water will extinguish burning gas, rather will it roar more fiercely as it consumes the additional supply of OJ."'Yg en in the water vapour itself. An escape of gas which has ignited is best left to burn until it can be turned off at the source, as to beat out the flames. will !eave a "\ ery real danger of the escaping gas causing an exploslOn WIth further fire and injury. Eyery effect should of course be made to prevent the gas flames igniting combustible materials. POI TS TO RE\IE\IBER I TACKLING FIRE ?here are a fair number of points to remember when confronted wnh fire and although ob-dous on reflection it is surprising to find how few people stop to think what they are doing. (r) Probably of most importance is to keep quite calm; fire is ge~erally .a spectacular and awesome sight, but it is surprising how qUl(~ a f~lr blaze can be subdued by resolute action. I have seen the blazlOg tlmbcrs of a roof extinguished by one stirrup pump directed on the flame through the trap in a loft. ('2 ) Get as near to the" seat" of the fire as you can, one bucketful of water. dashed with force in the heart of the outbreak is worth gallons aImed from a distance. . (3) When e.ntering a room with an ,,-rticle of furniture burning such as an ar~chall', carpet, bedding, etc., make every effort to throw it from 13. wlOdo\v, or if possible, remoYe it from the house in some other \.vay rather than stat' flooding it \\'ith water. It must be remembered that water often does as much damage as fire, so if possible, extinguish the fire out of doors, or with a minimum of water when there is a danger of water damage becoming great. (4) Rem~mber that you can get much closer to fire if your clothes ~re wet, so If you are trapped and have to make a dash through or ncar

Letters to the Editor.

THE HOUSE FOR

HUMAN SKELETONS Articulated & Disarticulated HALF SKELETONS, Etc. Etc.

ADAM, ROUILL Y & CO , Human Osteology, Anatomy, etc., 18, FITZROY SJREET. FITZROY SQUARE, LONDON . W.1. TELEPHONE: MUSEUM 2703.

DEAR

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I think your wonderful magazine could do with a "IIint" or " Tip" column in Erst aid. Some divisions have little ideas of their own which would be beneficial to all divisions. For an ~xample, in treating fracture of the jaw, we place a pad or ha~dker.chJef on top of the head, because when tying the knots the haIr eaSIly becomes entangled which is unpleasant, the pad preyents thIS, also helps to keep the bandage in place. This is only one example we use, perhaps other readers haye something much better than this. I am sure this colulTlll would be one of the highlights of our magazine. 'Yours, etc.,

J. J\f A TTIIEWS. VILLE LASALLE, QUEBEC, CANADA. JlIIIC,

1947.

Thanks to our CanadialJ rfader Jor tbis ,good ie/fa. be done I-Editor.

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- TEA CHERS PET TOY SETS. CO ST RUCTIONAL TEDDY BEARS. Send for list "TEACHERS PET" Bk. Artillery Place, Leeds. 7· Concert Tickets, 7/6. P osters, Memos, Rubber 0 Stamps. Samples free. "A" TreES, II, Oaklands Grove, London, \~/ .I2. OWl to Stop Smoking. Save Money. Safeguard health. Thousands cured. Send stamp for Booklet of \Xlorld Famous Remedy. Stanley Institute Ltd., (Dept. 75) 265, Strand, London. RUPTURED? FORGET IT! Use Brooks Rupture Appliance-the new discovery. \,\londerful ! 0 lumpy pads, no springs, durable, cheap. Binds and draws parts together quickly. Sent on tnal. Catalogue free. Address: Brooks Appliance Co., Ltd. (7 18 ) 0, Chancery Lane, London, WI .C.2. (718) Hilton Chambers, Hilton Street Stevenson Square, Manchester, 1. OMPETITION for the D onisthorpe Ambulance Challenge Cups. (Senior and Cadets) . To be held in the Donisthorpe Church IIall, .Saturday, Sept., 6.th. 1947. Entry forms from J. Fwch D aybcll, MOIra, Burton-o n-Trent.

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QUERIES and ANSWERS COUPON To be cut out and enclosed with all Queries. July, 1947.

120 YEARS' EXPERIENCE in supplying first - class dressings for the med ical world.

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EMERGENCY TREAlM'_ Queries and Answers to ~orrespondents Queries )llill be dealt with tll1der the folloJving mles ;I.-Letters containing Queries must be marked on the top left-hand corner of the eJ1velope "Query," and addressed to " First Aid," 46, Cannonstreet, London, E .C. 4. 2.-AII Queries must be written on one side of paper only. 3.-AII Queries !mlSt be accompanied by a " Query Coupon" cut from the current issue of the Journal, or, ill case of Queries from abroad, from a recent issue. 4.- The Textbook to IIlhich f'eference 1Ilt?J' be made ill this column is the 39th (1937) Edition of the S.j.A.A. Ma1lual of First Aid to the 1l1jured.

Treatment of Fractured Ankle G. E. (New Cross).- In a recent examination all examinee 1})as asked to treat a fractured ankle. The trea/1IIm! gillen ,vas that for the leg (tibia alld fib1lla) keeping the bandages 101v and finall), placing a cold compress 011 the joillt to reduce SlJ)elling. This treatment was apparently llirong, beillg too much. The examillee lI'as told that the ans,ver was ill the Textbook. NOlie of us can find il and would all have treated similarlY. Can ) '011 please te!1 me ,vhere the answer is in the Textbook, or failing that, the treatment? The term" fractured ankle" is usually applied to fractures of lower end of the tibia and/or the fibula at the ankle joint, consequently treatment should be as laid down in the Textbook for fractured leg (pp. 91 and 9z).-N. Corbet Fletcher. Examination Howler L. R. (Charlton Park).- In a recent examination I asked a candidate how he would act if he ,vere called to a patient ,vho had just been pulled out of the sea apparentlY dro)vned. I was vastfy amused when he replied: " I would at once do superficial eructation! " Good! Next please! !-N.C.F.

Fractures of Clavicle and Humerus P. T. (Marlow).-We shall be grateful if )'OU will tell us how)'ou would treat a patient who is suffering from a simple fracture of the left clavicle and a compound fractwoe of the left humerus. With such a combination of injuries, shock will almost certainly be pronounced, and the patient will require removal on stretcher. Of the two the compound fracture of humerus is the more serious from the first aid~ viewpoint, and demands priority in treatment. In these circumstances, if I were the first-aider, I would concentrate on its treatment and content myself with dressing the wound and with keeping the patient recumbent and the left upper limb in close contact to the body whereby the dangers of aggravating both fractures are eliminated.-N.C.F.

OF SKIN INJURIES Be prepared for an eme!gency ~d keep Cuticur~ Br~d Omu;nent. 10 your First Aid Kit. It br10gs ill' stant soothing relief to cuts, burns. skin lacerations - prevents spread of infection. quickly beals . Obtainable at all Chemists and Stores_

The cerebellum, however, is the centre for co-ordination of muscular movements and especially the harmonious adjustment of the muscles which are concerned with keeping the body erect and in a position of equilibrium.-N.C.F. -

Treatment of Monkey Bite P. S. (Wellington, New Zealand).-Recmtly a member of our ambulance class was called lipan to treat a bO)' l1)ho had been bitfel1 on the forearm' b)1 a fIIol1kC),. Conflicting opiniolls arose as to the correct treatment. One member stated that the bite should have been cauterised whereas another said that, as the lJIotlkf!)1 1I)as not sufferillgfrom rabies, the general ndes of treatment for wounds should be applied. You,o views, therefore, as to tbe correct method of treatment will be much appreciated. As no suggestion was made that the monkey was suffetoing from rabies, treatment should be as for an ordinary wound. In other words, the suggestion that the special treatment for rabid animal bites is indicated, is contrary to fact and the Textbook.-N.C.F. Turpentine as Antiseptic

FOR A.R.P. and other First Aid Students

"QUICK-AID" ANATOMICAL CHARTS By G. DOUGLAS DREVER, M.B., Ch.B. I. FRONT VIEW. 2. BACK VIEW. 3. BONESOFTHESKULL. ... ARTERIAL CIRCULATION AND PRESSURE P~INTS. . 5. TYPES OF FRACTURES (Each size 10 x 7t IflS.) Price per set of 5 cards in stout envelope

M. O. (Chepstow).-Please tell me if turpentine is of service as an antisepdc

Is. 6d. net i postage 2d.

in an emergenC)l. My friend says that it is; but 1 am doubtful. So 1 ask your advice. Your friend is right when he says that oil of turpentine is a useful antiseptic in an amergency. Since, however, it is also an irritant, it is wise to sponge the wound with a swab of cotton wool wrung out of the oil.-N.C.F.

15s. 6d. per doz .. postage 7d.; 305. per 24. postage 9d.; £3 per 50 ; £5 165. per 100. Obtainable of all Booksellers.

N.C.O.'s Stripes E . W. (Scarborough).-The question regarding the weari1lg of stripes on both arms has cropped up 1IIore than once at our Divisional Practices' and ,ve, as N .C.O's, cannot understand )vh)' stripes are not allowed t~ be ,vorn on both arms. It has been said that Brigade Headquarters adopted this method years ago, because the Police then onlY wore stripes on one arm. Ma)' 1 ask, howevfr, if this )vas the case, ,vbat has the Police to do ,vith the St. John Ambulance Brigade? We are an organitation of our own and as such should set ow' 01Vl1 standards. Further, as the Police now wear stripes 011 both arms, 1vhy should not Brigade N.C.O's? Meanwhile, our thank.s. It is correct that at its origin the Brigade copied the custom of the Police with reference to the stripes on one arm because they were so often on duty together. We have, however, been told that the question of stripes on both arms has recently been under consideration and so must await the ruling of Brigade Headquarters.-Editor.

LONDON: H. K. LEWIS & Co. Ltd. 136 Gower Street, London, W. C. I. ,

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~~~

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S.J.A.A. L a bels and Medallions

C. D. (Fulham).-I )vou!d be greatfy obliged if )'OU could give the members of our Division some information regarding the issue of S.J.A .A. labels and medallions ,vhich )ve would normalfy have received if ,ve had not been serving with H.M. Forces from 1939 to 1945. I ,vould like to point out that man)' members of the Brigade served Functions of Brain with the Medical Services and had to maintain their elJiciency in first aid. N. T. (pinner).-RecentIY some pals and I were discussing the fUl1ctions of I trust that )'OU will give us a satisfactOlY anSlver. the brain. At )ve could 110t agree as to lvhether the cerebrum or the We understand that members of the Brigade serving in H.M. Forces cerebellum contro.'led the subconscious mind we decided to submit our during the war period became entitled to S. J .A.A. labels and medallions problem to you " and )ve alvait )'our comments with interest especially which they would have received had they been at home and passed as to the exact seat of" the soul." the necessary examination each year. This, however, is contingent T~e .soul is that part of man which thinks, feels, desires and so on ; upon members resuming attendance with Brigade units on dcmobilisaand It IS supposedly situated in the cerebrum which, as the Textbook tion and on their passing an examination in first aid within six months.tells OG p. 153, is " the seat of the intellect, the emotions and the will. " Editor.

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CONTENTS

S ~, RV ICE, . :....,'

• • '

~ \.

. .-,.... -,.

Editorial-New M.ethods fo r T reating Burns A Course in Advanced F irst Aid P ractical Nursing in the H o me Fire F igh ting For First Aiders

4 6 7

M arkin g Sheets N ews from all Quarters L etters to the Editor Queries and Answers to Correspondents

8 II

14 r6

NOTICE TO READE R S. FIRST AID is published on the 20th of each mo~th.

:.. 'i: " ' .:, ~ : ..

.. . ~:

The Annual Subscription is 5s. post free; single copies 4d, . Its aim. a.nd objects being the advancement of Ambulan~e and First ~id Work in all branches, the Editor invites Readers to send Articles and Re rts on subjects pertammg to the Movements and also welcomes suggestlons for PractIcal Papers. po All Reports. &c .. should be addressed to the Editor !it the address below, and should reach him before the 8th of each month and must be . d (nol necessariLy for publication) by the name and address of the Correspondent. ' 'ccomoanle SubscripLions, Advertisements and other business Communications connected with FIRST AID should be forwarded to the Publishers. DALE, REYNOLDS & CO., LTD., 46, CANNON STREET. LONDON, E.C. 4. TeLegraphic Address-" Twenty-fouT, London." Telephon~City 3710.

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NEW

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Editorial .. T s.

". PATENT

"PORTLAND"

AMBULANCE

GEAR

The ~ear Illustrated (A.B.C.D.) carnes 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.

Shows t ~ e top stretcher lowere d ready for load mg.

C. Ill us trates the same Gear with th e top stretcher fra me hing-ed down for ~!~ri:~~n only one stretcher case is

D. Show s the same position as in ., e" only with cushions and back res t fitted for convalescent ca ses.

Where Ambulances are reqUired t o carry four beds two Gears are fitted. one on EITHER SIDE, and the same advantages apply as described above. Full catalogue of Ambulance E.qullJment No. 7A will be sent on request.

ST., LONDON, W.1 ~----.----------- GREAT PORTLAND 'Phone: Langham 1049. , Te/egralJhlc Address:-

KARVAL/D. WfSDO. LONDON

qui.ckly. I~ a doctor is not available without delay do not walt for him-delay may be fatal. If an ambulance is not have recently commented in this column on the available send the patient in a car, lying down. Comlarge number of people-most of them children- ments Dr. Colebrook, " This is far more important than who are injured by burning and scalding accidents every any first aid treatment of the burn itself." As to first year. Our readers will be interested to read of an account aid treatment of the burn Dr. Colebrook says that which Dr. Leonard Colebrook, a member of the scientific the experience of the war has completely changed our staff of the Medical Research Council and The Burns outlook. We know now that septic infection of a burnUnit, Birmingham Accident Hospital, gives in our con- the most serious threat to a burned patient-is not temporary " Mother and Child" (official organ of the inevitable, as it seemed to be a few years ago. It can be National Baby Welfare Council) of the best first aid for avoided if strict precautions are taken right from the burns and scalds. Dr . Colebrook says that at his hospital beginning of treatment-and that includes first aid. The they have to treat more than a thousand people each heat of the burning usually destroys any dangerous germs year injured by burning or scalding, and before these that may have been on the skin. It is rare to find any cases come to them they have had all kinds of first aid when a patient arrives at the hospital within an hour or treatment. Many of the remedies used, he says, have two of the accident; but first aid wrongly carried out come down to us from a time when our understanding can easi Iy sow the seeds of infection, and has, in fact, of these injuries was in a very unsatisfactory state, and often done so in the past . First aid rule No.2, therefore, they have never been critically considered in the light should be-Protect the burn from becoming infected: of our new knowledge. The recent war taught us more and relieve pain if this can be done without risk of infecabout burns than we had learnt in the previous 50 years, tion . (If pain is severe, remarks Dr. Colebrook, the first and (says Dr . Colebrook) we should do well to revise aid worker will usually not be able to relieve it-morphia our first aid methods to keep step with changes in the will be required.) The first aid to the burned surface latest treatment. Discussi ng the so-called "shock" of bu rns will vary according to the severity of the injury. If it is 01-. Colebrook says that this condition is usually quite extensive, involving the trunk, shoulders or thighs, so different from the typical "shock" associated with a that clothes would have to be removed before attempting street accident and bleeding. The severely burned any first aid application, do nothing. Get the patient to patient is seldom faint and prostrated-his shock develops. hospital, iust as he is, at once. If the burn involves only mOI"e gradually, in an hour or two , and is largely due to parts of the body which can be easily exposed, and is loss of serum (the fluid part of blood) from the burned causing pain, this can be best relieved by holding the surface and into the bu rned tissues . It can be prevented part under a cold water tap for a short time. After relieving or controlled, to a large extent, by transfusion of blood the pain, if this has been necessary, cover the burn with or serum, but this should be started early, before" shock" a freshly laundered towel, or better still, a piece of has developed; and the transfusion should only be done sterilised linen . Then get your patient to a doctor or hospital. Dr. Colebrook's interesting article is of flrstin a hospital. This, goes on Dr. Colebrook, gives us the importance, we shall return to it next month. class first aid rule No. I-get every severe burn to hospital

New Methods for Treating Burns

FIRST AID

A COURSE IN ADVANCED FIRST AID by A. D. BELILIOS, M.B., B.S. (Lond.) D .P.H. ~Eng . )

EMERGENCIES OF THE DIGESTIVE SYSTEM EMERGENCIES of the digestive system provide a large and important chapter in Advanced First Aid; they include not only conditions such as internal ha::morrhage, rupture and penetrating wounds of the abdominal wall which are already described in standard text books, but also diseases of an urgent character for example, peritonitis, appendicitis and intestinal obstruction. The diagnosis of some of these serious abdominal conditions is often exceedingly difficult even for the medical man and sometimes all that a doctor is able to say is that the patient is suffering from " an acute abdomen" which means that there is an urgent and grave condition within the abdomen which requires an immediate operation; the exact nature of the condition is often only disclosed while the operation is being performed. The Digestive System. This consists of (a) the alimentary canal, the passage along which food passes while digestion is taking place, (b) the digestive glands secreting juices which enter the alimentary canal and act upon the foodstuffs converting them into simple substances. There is no need to describe these glands for first aid purposes. The alimentary canal is nearly 30 feet in length. It is lined with mucous membrane which secretes mucus to lubricate the passage of food; under the mucous membrane is a layer of connective tissue rich in bloodvessels called the submucous coat which holds the mucous membrane to the muscular coat. Finally, covering all that part of the alimentary canal within the abdomen, is the serous coat which is derived from the peritoneum. The alimentary canal consists of (r) the mouth, (2) the pharynx, (3) the <:esophagus, (4) the stomach, (') the small intestine, (6) the large intestine. Of these parts the mouth d?es not -?eed special description while the pharynx was discussed In the first article of this series. The <:esophagus is a long thin tube connecting the pharynx to the stomach. It passes down the back of the neck and thorax and pierces the diaphragm to enter the abdomen where it opens into the stomach. The stomach is a bag-like organ lying in the upper part of the .abdomen chiefly on the left side. From the stomach, the alunentary canal is continued as the small intestine which, except for the first 10 inches called the duodenum is fold.ed upon itself. to for~ innumerable coils fitting neatly lr:to t.he abdomtnal caVIty. The small intestine ends by opellillg llltO the large intestine in the lower part of the right side of the abdomen. The large intestinel six feet in length, is divided into

(r) the crecum, (2) the colon, (3) the rectum. The crecum is a small pouch-like organ to which is attached the appendix, a fine blind tube looking rather like a worm, average length 2! inches. The colon passes upwards from the crecum to the upper part of the abdomen, then turns and passes across the abdomen to the left side where it turns again and passes downwards once more, ending finally by becoming the rectum, 6 to 8 inches long, which opens to the external skin at the anus. Food is forced along the intestines by waves of muscular contraction called peristalsis. The peritoneum is a glistening membrane which lines the abdomen and also covers the abdominal organs; it prevents friction when the abdominal organs move on one another and also carries bloodvessels and nerves. The peritoneum is particularly liable to inflammation in many, abdominal emergencies and for this reason peritonitis will be discussed first in this article. A cu te General P eritonitis. This occurs when the peritoneum becomes infected by germs. It may result from injury or disease. Thus any wound of the abdominal wall which penetrates the abdominal cavity will allow germs to enter, while the diseases responsible include appendicitis and perforated gastric or duodenal ulcer. Symptoms begin suddenly; the patient complains of intense abdominal pain sufficient to cause him to writhe in agony and become extremely restless. This pain is increased by pressure and by all movements. Accompanying the pain are most of the typical symptoms and signs of shock. The face is pale, the skin cold and clammy, the temperature subnormal and the pulse rapid. Vomiting is an early symptom, small quantities being brought up at frequent intervals. A characteristic feature is the posture adopted by the patient in an unconscious endeavour to relieve the pain. He lies on his back with his knees drawn up, his shoulders raised and his arms often above his head. It will be further noticed that his breathing is shallow ann that he breathes as far as possible with his chest, his abdominal muscles being restricted in their activity. Finally, if tbe first-aider touches the abdomen he will find that the abdominal muscles are as hard " as a board" or rigid as they are termed in medical language, FIRST AID (r) Provide for Medical Aid. Peritonitis is a most urgent condition and the patient's one hope usually lies in having an immediate operation. Hence a doctor must be sent for

FIRST

AID

be rung out before application to remove exces~ of fl.~~d ; immediately whatever the time of day or night: . (2) Position. The patient must be placed m what IS it should be covered with cotton wool and held m positIon known as Fowler's position .. His h~a~ and ~~oulders by a tight bandage. T~e fom~ntati~ns should be ren~wed st be well raised up almost mto a slttmg pOSItIOn and every ten minutes until me.dical aId has been obtaIned. ~~ back supported by a bed rest or built-up pillows. A During the interval the patIent should be treated as for knee pillow should be placed under the. knees to keep incipient peritonitis. them well bent and a support can be suppl~ed for t~e .f~et. Fowler's position is adopted with the ~bJe~t of 11ffi1~mg Swallowed Foreign Bodies. Foreign bodies such ~s coins, be~ds, pebbles, etc., are the peritonitis to the lower abdomen which IS less serIOUS often swallowed by children and If small are usually than when the upper abdomen is involved. (3) T1"eat for Shock. -r:his s?ould be ~onfined t? general carried throughout the length of the ~limentary canal and principles such as undomg tIght clothIng, ensurIng com- ultimately passed naturally. Larger objects. however, may fort and supplying warmth. N,o drugs or food ~~y b.e lodge at the back of the throat causing choking or if . en but small quantities of boiled water are perrrussible If they pass down the <:esoph~gus into the stomach m~y giv , ' r ' b desired. To relieve the pam, ho~ l<;>mentatlOns may ,e remain in that organ; . occaslOnally they become stuck m , applied to the abdomen if there IS likely to be delay m some other part of the digestive tract. The treatment described below excludes that for choking obtaining medical aid, but gr~at c~re. should be taken to test them before application smce It IS very easy to burn which is an emergency of the respiratory system. FIRST AIDthe skin. (4) Maintain Observation. The pulse r~te should be (r) Medical Aid. If a foreign body has been swallowed taken every ten minutes and the :esults WrItten down for and passed down the <:esophagus, a doc~or should be ~sked the doctor to see . Usually it wII~ ~e found to become to see the patient as soon as converuent. There IS no progressively faster each time that It .1S taken. Samples of need to " flap" for a doctor to come immediately unless vomit and a specimen of the mot10n~ should al~o b,e the patient is in obvious discomfort. preserved. The fi~st-aider should particularly notIce If (2) Stodgy Food. ew bread, porri~ge, doughnuts, or his patient passes wmd. some similar stodgy food should be gIven ~o the patIent with the object of wrapp~g round th~ foreIgn body and Wounds of the Abdominal Wall. preventing it from damagmg the delicate .mucous memThis is a convenient time in this article to dis~uss brane of the stomach or intestines. FIUlds should be wounds of the abdominal wall. T~ey may be claSSIfied avoided. as (a) simple - affectinfS the skin fat or mus~le, (4) Don'ts. (i) Don't give an emetic; it might cause (b) penetrating, i.e., enterIng or s,":spected to b~ entermg asphyxia or damage the sto~ach. ., the peritoneum, (c) those acc~mparued by protruslOn of the (li) Don't give an aperIent suc~ as castor ~Il. It s , t es t'm es . It will be appreCIated that the, two .latter m bl forms drastic action might force the forel.gn body agal~st the are always serious because they almost lnvaIla y set up delicate walls of the intestines causillg further illJury or peritonitis. . ' h even perforation. . The treatment of a simple wound conSIsts of placmg t e (iii) Don't give" cotton wool" sandWIches. ~he cot~on atient in such a position that the edg~s o~ the wound wool may wrap round the foreign ~ody ~nd by mcreas:ng ~ome together as far as possible and gapm~ IS prevente~. its size impede its passage along the Intestllles, even causillg Thus the edges of a horizont~l wound .w1ll ?e apprOXi- an 0 bs truction. mated if the patient lies on his back ~lt~ his head and (to be continued.) shoulders raised and his knees bent while m the case ?f a vertical wound the best position is ~o have the patIent 1 in cr flat on his back without a pIllow. If nece~sary, Zxp~riments should be made to d scover the most SUItable position. . _ First Aid in Childbirth. The wound itself should be covered wlth a dry t~mporary This film, which was originally. made for the, instruction dressing; it is inadvis~ble to attempt cleans mg. etc., UNRRA relief workers, is now aVallable for showtng to first al except under the instructlons of a doc~o~. , groups and ambulance personnel. It starts with diagram sequences Penetratin cr wounds should be slmlla~ly covered Immediately in border to limit as far as pOSSIble the entran:e showing the anatomy of pregnancy alld the physiology of labour, and goes on to show the materials which should be taken to an emergency of germs. The patient sho~ld then be treated as for general delivery. Then it shows the preparations which must be made: ~he , ' peritonitis pendmg the arnval of a d?ctor. first examination of the mother, note taking, washing, and preparatlOn Wounds accompanied by protrusI~n of. the m~estmes , d h The second part shows in full colour the of dressmgs an couc. , b .' f h Id be treated by makincr the patIent lIe on his back salient points of an entire unaided deltvery from, the. eg1rl!1lllg 0 s i~~ his head and shoulder~ raised and his knees bent, bearing-down pains to the two hours after the child IS born. ,No :rImost, in fact, in Fowler's position, whic? has. the effect detail is omitted, and indeed some stages are shown a second time of relaxing the abdominal muscles. The mtestI~es themclose-up. 'h h' 1 till: selves must be kept moist and warm by cov.enng. them in This 4o-minute 16 rnm. silent film is present~d WIt a SOft ec, e with saline dressings applied as hot a~ the first-alder himse~ h b 1illll11 . ' a and time for question-answermg at the end, making at t e eg o Ali' for hire should be can comfortably bear. Saline conSIsts of ~alt and water up one hour's programme in all. pp cations d (one teaspoonful to the pint); ,the solutlOn should be addressed to Dr. BIlan , __ C d U Montagu Street Lon on, Stllluor ,54, pper , made up with hot, prefera?ly. bOIled, water, a~d flannels or similar material soaked m It. The fomentatlOn should W.I.

Film Review.

FIRST

AID

PRACJTICAL NURSING IN TIlE DOME BY

AGNES E. PAVEY, S.R.N. Diploma In Nursing (Universit y of London)

DIET IN ACUTE ILLNESS (continued) . THE .digestion o~ a meal depends largely upon one's enjoyment of It, and any factor that disturbs one's peace of mind, creates bodily discomfort or introduces an inhart?onious elen:ent can easily destroy appetite. As the tlffie for. servmg meals approaches, anything that upse~s, the p,a~lent-such. as a painful dressing, unwelcome or tUlllg VISItors or dlsturbin a topics of conversation should be avoided. The general atmosphere of the roo~ should be made as pl~as~nt and unhurried as possible. The tray shoul~ be d~lnt1ly prepared, with a clean tray cloth and, napkin, polIshed glass and silver, condiments and anything else that may be required. The tray should be large enough to hold everything needful without an appearance of crowding. If the patient is left-handed, or for a~y reason ~lllable, temporarily, to use his right hand, he wIll appreCIate the thoughtfulness of a nurse who reverses the usual order of equipment on his tray. PREPARING THE PATIENT. Seeing that he must be as ,comfortable as ,possible if he is to do justice to his meal, a patIe?t must be gIven an opportunity to use a bedpan or unnal if these are required, and he should be enabled to feel f~esh and clean by ha:ring l:i~ face and hands sponged and his teeth clean,sed. HIS pos11lOn should be adjusted so that h~ can take hIS food WIth the maximum of comfort. His pIllows should be arranged and, if he is sitting up, his shoulders and chest should be protected from cold, and the ,~ed table and tray should be placed in a convenient pOSitIon. The table upon which the tray is to stand must b~ cleared, except for flowers, and especially should any dIsagreeable artIcle-such as a sputum container-be moved out of sight. S,E R ~Il G THE MEAL. The individual tastes and antlpathies of the patient must be taken into account as far as P?ssible. For .instance, if a patient particularly dislikes vlllegar, eve~ In sauces and salad dressings, a dish may be rendered so dIstasteful to him that he refuses the whole meal unless the nurse makes a point of rememberina his dislike In actually serving the meal, care must b~ taken tha~ cups, t~mblers, and plates are not so full that splashing occurs In carry111g them. Small amounts should be served and a second helping offered if desired. Hot food must be really h~t and be, se~ved on hot plates, cold food being kept chil~ed untIl It is served, the remains of one co~rse beIn~ rem,oved before the next is served. If the patient requIres hIS, food to be cu t up this should be done at once ~o that he IS not k,ept helplessly waiting whilst the meal becomes, cold. SenSItIve patients will often leave a meal uneaten If ~hey cannot manage for themselves rather thar: ask for aSSIstance, or, if they are kept waiti~g any f~ehng of pleasura~le a?ti,cip~tion they may have' had gIves way to an anXIOUS untability that impairs digestion.

~SSISTING THE PATIENT. In feeding a helpless patient the meal should not be taken to the bedside until the nurse is ready to give him her attention, and any appearance of hurry should be avoid,ed. Feeding an adult patient successfully and agreeably IS a ~eal test of nursing ability. The tray s~ould be where the patIent can see it, for the sight of fO,od stimulates the appet~te and gives an opportunity fo~ hIm to suggest the order 111 which he wishes to be fed. It IS ~lways embarrassin~ to need assistance in taking meals and It may ~ake ~ patIent feel that he is giving a lot of trouble. !h1S feelIng n:ay be minimised by ensuring that the clothing, and bed l~nen are protected against soiling and by tucking a napkin under the patient's chin before t~e nurse seats he~self comfortably on a conveniently hi~h stool. The patIen~ may then lose his sense of hurry. Fnendly re,marks contnbute to a pleasant atm0sphere and ~o the feelmg that the nurs~ enjoys g~ving the help that IS needed, but a conversatlOn to which close attention ~ust b~ given is undesirable. Unless a patient is very III he, WIll probably be able to help himself to bread, and he WIll prefer to wipe his mouth for himself. When a feeding cup is used he will soon learn to control the flow by placing his, tongue over the spout, but it will not be necessary for h1m to do this often if the nurse is observant and thoughtful. Trays and equipment should be removed as soon as the meal ~s finished. The patient's mouth is ~hen clea~sed and a dnnk of water is given. His position is then adjusted so that he can rest, or read if this is allowed.

SPE~L~L DIFFICULTIES IN FEEDING TIlE AGED. The maJonty of old people ~ave artificial dentures and,owjng to the changes that occur ~n the, shape of the jaws as age adva?-ce~, these may be Ill-fittIng and so interfere with mastlcatlOn, or even cause ulcers in the mouth that make mastication a painful process. As a result of uncomfortable dentures, old people will often refuse to eat meats or the coarser vegetables, restricting their diet largely to plain ~tarchy ~oods and sweets. In addition, they often have fixed Ideas WIth regard to the foods that they like or dislike, and t~o~e tha.t do or ~o not agree with them, so that they tend to hrrut then selection of foods. It is seldom that an aged person takes too much food and the problem of obesity IS n?t often present, for the obese person and those who habitually over-e,at, seldol,? live to real old age. The dlffic:rlty usually lies In getting an old person to eat sufficient for hIS needs .

,It is very common to find vitamin deficiencies in the dIet of old people, notably of vitamin C and those of the B ~omplex . . The very fact that old people tend to limit theu dletane~ to a comparatively few foodstuffs and to ~ake only small quantities favours a deficient vitamin Intake, and many of the lesser physical disabilitils of the aged may be helped by remedying this deficiency. Digestive

FIRST

AID

disorders, nervousness, irritability and many ill-defined tic:>n difficult ~ell-cooked cereals, fruits and vegetables aches and pains may often be relieved by taking vitamin B, wl~l be apprecIated, but crisp toast might be managed whilst the spongy, bleeding gums and tender muscles in qUlte well. Meat can be minced and other solid foods old age are usually indications of vitamin C deficiency chopped fine. Hot foods are usually welcomed and a hot and can be helped by giving ascorbic acid. Watery eyes, d~ink ,or a mea~ brot~ at the beginning of a meal helps ocular fatigue and chronic conjunctivitis may be due to dlgestlOn by stImulaung the flow of gastric juice. It is lack of vitamin A. The best sources of these vitamins are advisable to give small meals at the usual intervals, but undoubtedly foods, and these are preferable to chemical to give some light noudshment, such as clear broth, fruit preparations, and if adequate amounts of meat, vegetables, or fruit juices, hot milk with Ovaltine or flavoured with raw fruit, milk, eggs and butter are taken daily the mineral coffee or cocoa, malted milk or a cup of tea between the and vitamin requirements will be met, bu t laboratory prepared main meals. Old peopk should be encouraged to take vitamin products should be given if there is doubt, or any moderate exercise according to their capacity, but to take a short period of rest after each meal. It is good for them of the above mentioned symptoms are present. Owing to the slower digestive processes in the aged it to maintain a broad interest in other people and in current is usually desirable to give the largest meal at mid-day affairs, for a completely self-centred old person is very rather than in the evening, and to give a light supper difficul t to feed. several hours before bed-time. All foods should be simply (to be continued.) but attractively prepared. If loss of teeth renders mastica-

FIRE FIGHTING FOR FIRST AlDERS by JOHN WILLIAMSON. (Continued from JulY Issue,)

LIFE SAVING HINTS The fire services are primarily life saving organisations and whilst property is also to be considered, it is of paramount importance that the first person on the scene of the" incident" should ascertain if there is any person in danger of being trapped. Make it your first duty to enquire of anyone likely to know the whereabouts of any occupant if a building is involved. If such is the case the following points will help you to act in a quick, efficient manner and will enable you to avoid panicky and risky action. (1) If you are looking for someone in a smoke filled room you wi1l better be able to enter by soaking a handkerchief, scarf, or sock, etc" and after wringing out surplus water lying same over the nose and mouth. Get down "on a1l fours" keeping your head as low as possible and enter the room cautiously. In this manner it is possible to remain in a smoke fi1led room for some minutes, when to enter upright and without a wet gag would be impossible. (2) Supposing that having entered a room as in (I) you find an unconscious heavy body on the floor; a good way to effect a rescue without standing up is to tie the victim's wrists firmly together and laying the body on its back place your head between the arms until the tied wrists lie in the nape of your neck, Then kneel astride the inert body and crawl out of the room dragging the person beneath you, With a little practice you will find that this is an excellent and quick method and by enabling you to keep the victim's head raised from the floor will save inadvertant injury. (3) If you find that in trying to effect a rescue you are trapped on an upper floor with your injured victim by impassable fire, make for a room farthest from the flames and with a window overlooking open ground or adjacent and accessible roofs. Close all doors behind you in the path of the fire, it will delay its advance, Open a window and attract attention so that no delay is lost in locating you. If the fire is immediately below do not stand in the middle of the floor in case it collapses, If your victim is badly hurt or unconscious and cannot help with his own rescue try the fo1lowing alternatives as the occasion demands, Knot sheets, blankets or any strong material to form a rope and after fL..;:jng one end securely to a bedpo~t, or by attaching to a chair, board, etc., and wedging this across an open window or by tying

to the window sash, tie the other end round the person's trunk securely under the armpits, Remember that the knot must not slip and if you learn to tie a " bow line" you can be sure that your knot will stand the strain without becoming a " slip knot." Now push the victim carefully through the window feet first and take the strain of the rope under your foot and now lower carefully to the ground. Your own exit naturally follows, (4) If the room in which you are trapped is within jumping distance from the ground remember to climb out of the window and hang from the sill before dropping, you will be five to six feet nearer the ground before you drop and will avoid unnecessary injury. (5) If you are ever asked to jump into a jumping sheet or similar device it is well worth remembering that you should not literally "jump," Step out of the window or off the roof quite normally and upright as if you were stepping off a curb. This is perhaps more difficult than it sounds, but will make your fall well controlled and you will land on your feet in the middle of the sheet. There is nothing to fear in this method of escape which though rarely used is quite safe within the limited heights it is practised, (6) I suppose no life saving hints would be complete without reference to the famous "fireman's lift" or "fireman's carry" and it is undoubtedly well worth while to learn to reach proficiency in this method of carrying, as it 'enables you to transport even heavy people safely down ladders, stairs, or even fairly long distances. For those who are not familiar with the method and positions involved, the following is a brief description of the movements. Take the incumbent body and lay it face upwards with arms and legs closed and straight, Stand astride the tlUnk and work your arms under the armpits of the body until yout hands meet and can be clasped together, then heave the body upright and 'w ith a smooch action quickly grasp the person's left wrist in your right han,d and pull the body towards you and at the same time s~oop so that It fa1!s snugly over your right shoulder; then stand upnght. Th~ pers~n s head and arms will be hanging well down your back and With a little practice you will get to know when you have achieved a good balance

(ColltilJlled 011 page 10,)

FIRST

MA RKI 'N G

AID

FIRST In reply to a telephone call the Divisional Surgeon tells members of the team that they should treat and remove patient to his home, and that he will meet them there at. the earliest possible moment. In fact he atnves just as test is finishing, t~kes report ~nd arranges for transfer of pat1ent to hospltal.

SHE ETS

St. John Ambulance Brigade Final Competitions

STAGING

Team Test for th e" D ewar" Challenge Shield INTRODUCTION

You four have met at the Firstead Hotel, Jonsgate, and as you pass through the Dance Hall you see a porter at work on the platform and a kitchen-maid assisting him. Suddenly you hear a crash. You know that the hospital is two miles away and that the authorities on request, will send an ambulance. You have no equipment with you. Act as you see fit. Time limit 15 minutes. Warning at 10 minutes. ACTION

A porter and kitchen-maid are at work on the platform, the former being on a ladder and the latter assisting him. As the team enters the porter falls off the ladder with a crash, pulls down the ladder, and lies flat on his back with right foot everted; and the kitchen-maid falls on extended right hand and sits down holding her right elbow with her left-hand. The patients (or the Hotel Manager) will, if asked, tell the team that there is a stretcher and haversac behind the platform. STAGING

Arrange platform in Dance Hall. Behind it conceal full equipment and near it an ambulance. On a small table near the platform place telephone. The porter is suffering from simple fracture of right thigh and an incised wound on forehead, while the kitchen-maid has sustained a simple fracture of right clavicle and a sprain of left ankle. All injuries to be reproduced on patients. IMMEDrATE ACTION

Mode of approach of members of team Two of whom proceed to each patient Establish at outset both patients conscious .,. ... ... ... And not exposed to further injuries . . . Tactful and consoling words to patients ......... Ask Staff if equipment available (yes)... And if doctor available forthwith (no) Later when injuries have been diagnosed... '" '" ... .. . Arrange telephone call to hospital ... , Report cases and ask for am bulance (S minutes) ... ...

2 2

3 3 3 2 2

EXAMINATION OF PORTER

Note right foot lying on outer side... Ask if in pain (right hip) ; if swelling (yes) ... '" If can lift foot (no) ; if signs of wound (no)... ... '" . .. ... Note wound on forehead; ask variety (incised) ... ... .. . .. . If bleeding (freely) ; kind of bleeding ... ... ... ... (mixed) If signs of fractured skull beneath wound (no) ... '" ... ... Method of excluding injuries elsewhere (none) '" '" '" Ask colour of face (pale); breathing (shallow)

4 4 4 4 3 6 4

Test pulse at wrist (weak); and skin (cool) ... Diagnose simple fracture thigh and wound forehead

TRANSPORT AND AFTER-CARE OF PATIENTS

EXAMINATION OF KITCHEN-MAID

Note patient supporting right elbow ... Ask how she fell (on out-stretched hand) ... Ask if pain (right shoulder); character (severe) Test for irregularity of collarbone (marked) If signs of wound in upper limb (no) . .. Ask if pain elsewhere (left ankle) If able to move ankle (yes, but pain worse) If marked swelling (yes) ; if discoloration (no) Establish signs of shock (not marked) Pulse at wrist, breathing, and colour of face (normal) Diagnose simple fracture clavicle and sprained ankle

2 2

4 2 2 2 2

4 3

Test for changes in condition of patients (none) Decide remove both patients to hospital Method of blanketing and loading stretcher Method of lifting stretcher off platform Method of carrying and lowering stretcher Method of loading ambulance Assisting kitchen-maid to ambulance Genera l observation of patients in transit Proper use of service of Hotel Manager Value of report given to House Surgeon Competency of Leader of Team

Total Deduct penalties, if any ...

Net Total .. .

TREATMENT OF PORTER

4 2

8 6 6

4 4 6 4 4 IS

240

rff70ulJd of Forehead

Keep patient Rat; warn not to move Immediately place pad on wound .. . And apply direct pressure with thumb Later paint with spirit and prepare dressing Which apply well over wound; cover with pad Fix with narrow bandage round head

3 2

4 4

4 2

Support ankle in comfortable position Expose joint; apply firm bandage . .. Wet bandage with cold water; keep wet . Reassure patient; warn her keep quiet Wrap warmly; ask for and give sips of hot tea ... ... '" ...

Team T est for the "Perrot " Challen ge Shield INTRODUCTION

You are members of the J onsgate Nursing Division and are on your way to the beach where you are doing ambulance duty to-day. Two young men (who are not first-aiders) are with you and are carrying haversac and stretcher. As you are turning into Broad Street a motor cyclist passes you; but, before he disappears, you note that his cycle has evidently been involved in a recent smash. You know (I) that the Jonsgate Cottage Hospital is situate two miles away; (2) that its ambulance has taken a patient to London and will not be available for several hours ; and (3) that your Divisional Surgeon is at this moment seeing patients at his house. If you corne across an accident act as you see fit . Time limit 15 m inutes. Warning at 10 minutes.

ACTION

4 4 4 2

4 2 2

4 3 2

TREATMENT OF KITCHEN-MAID

Sprained Ankle

S marks 5 5

Fractured Clavicle

Support upper limb; large pad in armpit St . John sling; broad bandage to body... ... .. . '" '" Check pulse if present; tighten sling

Each Offence

Use of Brigade uniform as covering Unnecessary verbal explanation Redundant questions to Judge... O ther penalties (if any) . ..

Fractured Femur

Steady lower limb; hold ankle and foot ... ... Gently pull foot into line with fellow . . . Figure-8 bandage round ankles and feet... .. . . ... '" .. . Pass bandages under man at chest ; pelvis...... ... Ankles and feet ; thighs above the fracture Thighs below fracture: both legs and knees ... Long splint from armpit to below feet Fix splint with bandages tied in same order . .. . .. ... .. . . .. Loosen clothing- neck, chest, and waist '" Keep head low and turned to one side Wrap warmly--ask for and give sips of hot tea ... .. . '" ... Ask if hot water bottles available (no) Mote reassuring words to patient

REGULATIO N PENALTIES

4 4 4

The patient had just come out of his house when he was knocked down by a motor cycle. He is lying recumbent in the roadway, is fully conscious and complains of pain in right hip and does not realise that his left trouser leg is saturated with blood. H is wife does not know that there has been an accident.

Divide stage into two ~arts-st~eet and house-with front door mtervenmg and opening int.o be~room, which is most untidy and 111. wh1~h place. a teleph~ne. Mark on pattent 1ttegulanty of pel:'lS and varicose veins on left leg, one of which has burst and saturated left trouser leg. IMMEDIATE ACTION

Mode of reading card and of approach Ask if traffic likely in street (no) Consoling and tactful words to patient Ask what happened (cyclist hit me) : .. Ask him if he lives in house opposite (yes)... ... ... ..: And if anyone in house (my Wife) Tell patient that he .must be taken. home Till ambulance aVailable for hosp1tal .. . Ask patient if bedroom ready (no) .. . When injuries diagnosed phone Surgeon ... .... . Report case and ask for mstructlOns (canyon- meet at house) ... ... At early moment release two members And send them to contact wife and tidy bedroom

4 6 6

3 3

Net Total ...

4 4 4 4

3 3 4 6 4 3 4 4 4

4 3 4 4

3 4

Fractured Pelvis 4 4

3 4 4 2

6 4 6 4

3 15

NURSING OF PATIENT

Preliminary Action

Preparation of Bed.

2 2 2

Ask if piece of sackmg available (no) .. . Mattress correctly placed in position .. . Under-blanket smoothly and firmly tucked Under-sheet similarly tucked in position ... ... .... ... Ask if mackintosh sheet avaIlable (no) Place draw sheet correctly prepared .. . Two pillows in slips correctly placed .. . Top sheet tucked under mattress as ... ... ... .. necessary Two light and warm blankets Sl1nllarly placed .. . . .. Light counterpane placed over bed ... ... clothes Correctness of tucking in bed clothes and corners ... ... Method of turning back upper bed clothes ... Place temporary blanket to protect bed ... And hot water bottles (in covers) in bed

2 2

Reception of Patient

Seek co-operation of patient's wife .. . To have hot blanket and hot t~a ready Encouraging words to pattent on arrival . .. ... ... .' .. Tell bearers to place stretcher beSIde bed . ,. . .. .. . . .. To take p~sts on side furthe~ from bed And to lift patient on thelt bended knees ...

Total - --- .

2 2

- -- -

5 marks 5 5

Two members proceed to flat early ... Explain members of Nursing Division Tactful disclosure of accident. .. . .. And comforting words to wife Ask if she feels fit to assist (yes) Method of straightening bedroom Place bed suitable position, easy of access... ... .. . ... ... Have fire lighted and kettle on to boil

When patient lifted, push stretcher under bed Tell bearers to rise, support patient on forearms ... Then to step forward and to place him on bed ... Wrap warmly; watch till Surgeon comes... ... Value of report given to Surgeon Proper use of services of wife and bearers

Each Offence

Use of uniform as covering or pillow...... Unnecessary verbal explanation Redundant questions to Judge ... Other penalties (if any) ... AFTER-CARE AND

4 4 4

REGULA TION PENALTIES

4 4 6

REMOVAL OF PATIENT

Ask if changes in face, breathing, ... . pulse (no) .. . If dressing shows signs of saturatIOn (no) ... .. . ... ... .. . Decide remove patient to his house .. . More consoling words to patient ... Method of testing and blanketing stretcher ... Accuracy of instructions with reference to ... . .. . .. Loading, lifting, and carrying s.tretch~r Careful observation of pat1ent ill transit ... Competency of Leader of Team

Burst Vein

Ask patient if comfortable as found (yes)... ... ... ... .. . Gently attempt to flex lower limbs . . . Ask result (pain in hip much worse) .. . Decide keep lower limbs extended ... Broad bandage round pelvis at hips ... Tight enough to support the parts ...

But not to press broken bone inwards Figure-8 bandage round ankles and feet... ... .. . And broad bandage round both knees Wrap warmly: give sips of cold water

Grand Total Deduct penalties, if any ...

TREATMENT OF PATIENT

Quickly prepare suitable pad... . ... Which projects above ~evel . of skm : .. Place on dres&ing which IS not dISturbed ... .. . Fix firmly with narrow bandage Ask' if bleeding controlled (yes)

EXAUINATION OF PATIENT

Do not alter position of patient yet .... Ask colour of face (pale); breath 109 (shallow) ... ... . Test pulse at wrist (,~eak).; sk~n (col?) Ask patient where 1S pam (nght hlp only) ... ... Discover dampness of clothing and signs of blood Pull up trouser leg and locate burst vein ... ... . .. Ask colour of blood (dark red) How it Rows (steady continuous stream) ... ... .... .... Ask if wound dirty or fore1gn bodtes (no)... .... . Diagnose burst vatlcose vem ... Do not elevate patient'S leg yet Look for constrictions of leg (none) ... Apply suitable sized dressit~g to .vein.:. Ask friend to compress it with his thumb ... ... .. . Note that lower limb appears normal Ask patient if able to lift heel (no) .. , If pain is made worse by such attempts (yes) ... .... ... .... ... Feel for irregulanty of pely1S (marked) Diagnose fracture o~ pel:'l~ ..'. Method of excludmg mJunes elsewhere (none)

AID

2 2

Inter-R ailway Finals The Team Test The competitors were told they v:ere approaching a level-crossing when a dnver of a car passed them going very fast. They heard a train appro.aching in the d.istan.ce and gradually drawlOg near? so~ndlOg Its whistle with a crash occurnng Just as the curtain' of the stage was ra.ised. O~ the stage a set of rails were set Wlt~ the tarl end of a train on them, level crOSSIng smashed, and the driver pinned under the wreckage. A signalman (the judge) was a very interested spectator but he could not leave his box. The injuries were compound frac~re both bones right forearm, wound mIddle of forearm, blood gushing out with bone protruding, simple fracture left thigh crushed between damaged parts of car. The markings were as follows : 2 Rapid approach to railway lines Look right and left for any SIgns of 2 trains... ... ... Call to signalman to control trains by 2 : .. . .. signal or phone 2 Cross quickly to rema111S of car . Speak to patient (patient states he IS badly hurt ; and blood gushes from 2 arm; he is very frightened) Note blood on right sleeve and torn 2 sleeve ... 2 For noting quickly Quickly examine for fracture; note broken bone in wound ... 3 Do not elevate limb, but steady and support ... ... 3 2 And maintain support... . Immediate digital pressure on bleedmg point ... ... . .. 4 2 And maintaining pressure ... Ask signalman ~ he can .help ; and has 2 he any first ald matenal .. . . .. (Signalman states that he ca~ot le~ve his box but he has some kit, which he passes 01:lt to .the team.) . Inquire of dnver 1f .he has any other 2 . .. pain apart fr~m his arm . . . (Patient states his left leg hurts badly.) ate the leg is caught between parts 2 of car .. , ... ... ... . .. Realizing possible damage detailmem2 bet to support ... ... . .. Note pale face and beads of sweat on forehead ... ... ... . .. 3 If asked patient states he feels cold and 2 shivery If examined skin over radial arteries 2 marked" 95 " ... . .. If asked patient states he feels weak 2 and rather giddy .. , ... .. . Cover patient with blankets as far as 2 ... possible

FIRST

10 Inquire if signalman or driver has any bicarbonate of soda... ... . .. (Patient states he is a dyspeptic a.nd carries a small tin of powder which he takes when his stomach feels bad.) j\sk him if it is bicarbonate of soda . . . (Patient states he does not know but prescription is in his pocket.) Fin? p,rescription; note it is "soda b1C. .,. . .. Note also name and address of patient on prescription ... ... . .. Ask signalman if he can get a doctor quickly... .., .. , : .. (Signalman states he has already tned but one is not available immediately.) Ask if there is one on the train (Signalman states" No. It is a goods train. " Prepare alkaline solution level dessertspoonful to pint of water Give as much of solution as patient can take ... (Alternatively, if bicarbonate of soda is not discovered, give water freely.) For giving solution before limb is released Get signalman to telephone for ambulance as condition is urgent (Signalman states ambulance will come.) Ask signalman if any shelter available (Signalman states none near; and as ambulance is coming he is sending on the train.) Layout blankets ready for patient clear of railway lines Release the trapped leg, taking great care to steady it Carefully lift patient out of car and carry to blankets For maintaining pressure on bleeding point and steadying lower limb

3 2

3 3 3

FIRST

AID

Wrap patient in blankets and keep him covered as much as possible . .. Layout dressings on clean triangular bandage ... ... . .. . .. Carefully remove coat, sound side first Expose wound and note no foreign bodies only broken bone in wound Substitute dressing and pad for thumb on bleeding point and maintain pressure Build up dressings and pads round protruding bone in wound and on skin round wound well above level of bone Bandage firmly in position Watch carefully for blood soaking through dressings . .. For care in handling dressings For gentleness in handling injured part Gently straighten the limb and lay it against chest. .. .. . ... . .. Hand just touching opposite shoulder Looped bandage round wris t and tied round neck .. . See that wrist is not constricted Padding between limb and chest where

2 2 2 2

4 2 2 2 2 2

2 2

nec~ssary

Bind firmly to chest by broad bandage Check dressing again for any signs of blood soaking through Replace coat and button over fractured limb ... Examine area of crush in lower left limb ... Find deformity and irregularity middle thigh ... Note there is no wound Note foot i~ everted Diagnose simple fracture of thigh Extend limb and tie ankles and feet with figure-of-eight bandage Pad between limbs where necessary ...

2 2

3 2

2 2

Broad bandage round both knees Bandage above and below fractur,c: Quick examination for further inj uries (No further injuries.) For not raising lower limbs on' account of fracture Inquire for hot water bottles... (Signalman states he has ordinary bottles and hot water available in signal box .) Fill and cover bottles and apply to side of body Ensure patient cannot be burned Inquire if hot drinks available (Signalman states he can provide tea .) Administer frequently... Do not worry patient with too many . questions Ambulance arrives; obtain stretcher, prepare and tes t Correctly blanket, and place near head of patient Lift by rolled blanket method and move over stretcher... Lower patient and wrap up correctly For special care in moving owing to lack of splints Carrying stretcher to ambulance Loading ambulance Check injuries before departure Send member of team with patient in ambulance Collect all first aid material and return it to signalman Ask signalman to telephone message to hospital to say case on way For conduct of case and allotting injuries to members of team Total

3 8

The ability to use this method of rescue is very satisfying to the person who performs it and you can have great fun practicing on your friends. It is an accomplishment that can be of real use on many occasions and I believe that many first-aiders will already be familiar with it.

Helping the Firemen If you :,.te familiar with the scene of a fire you can assist to some extent the prompt rescue of trapped persons and avoid delay in " getting to work."

If you call the fire brigade by using the street alarm system you must wait until the first appliance arrives to tell its personnel where to go . It may seem a long wait, it always does when you are anxious, but

News From All Quarters

2 2

ST. JOHN AMBULANCE BRIGADE. 3 2

2 2 2

3 2

4 4 4 2

2 2 2

2 2 6 200

Fire Fighting for First Aiders (Continued from page 7) as the inert body will feel quite comfortable without holding it in position and will not feel that it is slipping. Having successfully heaved the person to this position all that remains is to put your right arm between the legs hanging in front of you and with it, grasp the right hand of the figure . You now have the body locked in position and your own left arm is free to hold the rounds of a ladder or the rail of a stairway, etc. With an unconscious person this position once attained will prove a very comfortable one, and there is very little risk of the figure slipping, but a person who is conscious tends to wriggle and should be asked to keep absolutely limp as it facilitates safe and quick movement on the rescuer's part.

AID

fire stations are placed in strategic positions nnd answer calls within minutes . When the first appliance arrives it is generally the life-saving " escape" and carries its own supply of water which is usually sufficient for small fires, chimney fires, etc. If it is dark and you know exactly where the nearest hydrant ii situated tell the firemen it will save the~ time if they need more water. The escape has its own wheeled undercarriage and can be wheeled into position providing there is a sufficiently close approach to the window it is necessary to reach, so if the fire is in property surrounded by a wall or fence direct the firemen to the nearest and widest means of entry. If there is a telephone nearby make sure that it can be reached easily (that doors to the room are not locked, etc.), as it may be necessary for the fireman in charge to phone for reinforcements. Many other ways of helping will obviously be a matter of common sense, it must be remembered that one should try and keep away onlookers who will cause serious obstruction. In conclusion I would like to remind readers that if they are called upon to help in extinguishing a fire and do so successfully without calling the brigade to assist, it is still necessary to infonp them that a fire has occurred. You can do this by telephone, personal call or by letter and they will inspect the damage and an official record will be made. You will find this procedure valuable in most cascs where a claim for insurance is subsequently made.

Headquarters !ransport Manager and Mr. J. G. Mackay, ANNUAL CONFERENCE AND DINNER 1n charge of the Ambulance Section. Ald . Kersley said that since the ambulance service OF BRIGADE SURGEONS ~as transferred to the Transport Department The Surgeon-in-Chief has received many 111 September, r946, over II,OOO calls had rcquests that the Annual Conference and been dealt with. Dinner be held this year; consequently arrangements have been made for both these BRACKNELL functions to be held on Saturday and Sunday, During the months May, June and July, September 27 and 28, at the Bonnington Hotel, members of Bracknell ursing Division London. under Div. Supt. Mrs. W. A . Green attended Dist~ictl County/Area Surgeons are asked to adv1.se all Surgeons, including those on the 262 patients, of these IIO were ambulance Executive Staff, of these arrangements, and case~ including 18 in road accidents; II6 forward to the Surgeon-in-Chief, as early as recelVed attention in the First Aid Hut on pOSSIble, the approximate number of Surgeons Ascot Race Course; 30 in the F.A. Hut on who will at~end (r) the full course, and (2) Hawthorne Hill Race Course and 6 were those .who w1ll attend Saturday only, including attended in their own homes. the dl11ner and dance. DIDCOT It is anticipated that the cost for the full On Saturday, July 5th, members of Didcot \Veek-end~ including Conference, Dinner, Ambulance and ursing and Ambulance and Dance, w1th sleeping accommodation, and all meals wll1 not exceed 50S.; and for the !"l'ursing C.ac;Iet Divisions took an active part 111 the Bntlsh Legion Carnival Fete which Saturday Conference, Dinner and Dance was held in the Sports Ground, Didcot. The 25S. Ladies will be especially welcome at th~ Brigade was represented in the Parade by Dinner and Dance. three motor ambulances fully staffed by m~n::~ers of the Ambulance and Nursing Prince of Wales's District D1v1slOns under Supt. W. J. Fisher and ANNUAL INSPECTION Ambulance and Nursing Cadets also took Over five thousand officers, men, nurses part. The First Aid Services were covered by members of all four Divisions. and Cadets were on parade in Hyde Park London, on Sunday, July 20th, at the Annual Inspection by Her Royal Highness the KI TBURY Memb~r~ ?f Kintbury Nursing and Nursing Du.chess . of Kent (Lady Superintendent-inChIef, Pnory for Wales). Her Royal Highness Cadet D1v1slOns recently held a Social in aid who, was .attended by The Lady Herbert was of their funds at the Coronation Hall, Kintbury. received 1n the afternoon by the Chancellor The pr?gramme included country dancing by of the Order (Col. Sir Edwin King), the the Klntbury Folk Dancers and Scottish dancing by Nursing Cadets. The team from Secretary-General (Brigadier W. B. G. Barne) the Secretary (Major - General J. E. T: Hungerford Ambulance Division who had Younger), the Chief Commissioner Brigade WO? the Didcot Shield in the County Comat Hume (Lt.-Genc.ral Sir Henry Pownall), petltlons, came over and gave a First Aid the Deputy Supenntendent-in-Chief (Lady Display. Dunbar-Nasmith). District Commissioner Major A. C. White MAIDE HEAD On Sunday, July 20th, Maidenhead DiviKnC?x was in charge of the parade assisted bc Asslsta~1t .Commissioner Sir George Abbiss ,s ions held their Annual Church Parade and Inspection. The parade was under the and D1stnct Supt. Miss Workman. Largc crowds witnessed the event and after command of Div. Supt. J. Stevens who had the inspecti.on Her Royal Highness was extended an invitation to Divisions from presented with a bouquet of roses from the Bracknell, Cookham, Reading, Twyford and District by Nursing Cadet, Shirley Wills, Bourne End, Bucks., making a total of 130 officers and members. Af(er the parade the of the Romford Nursing Cadet Division. The music was supplied by the City of company assembled for tea at the Civic Restaurant where they were joined by (he London Police Band. . County Commissioner (1\[1'. C. A. Poole), the County President (Sir John Duncan, County of Berkshire K.CB.), the County Superintendent (the Hon. The County Commissioner (Mr. C. A. Mrs. Leslie Gamage) and other members of Poole) waspresent at the Reading Cotporation the County Staff. Transport Depot when eight members of the St. John Ambulance Section of the R.CT. READING Department received awards from the Mayor On Sunday, June 29th, at the Ambulance (Ald. Mrs. A . Cusden). These included Hall, Chatham Street, Reading, the Annual labels, medallions and certificates . With the Inspection of Reading Corps was carried out Mayor wcre Ald. H. V. Kersley, Chairman of by the County Commissioner, who was the !ransport Committee, Inspector Carr, accompanied by the Assistant County ComRead111g Borough Police, Mr. W. J. Evans, missioner, County Superintendcnt the I-Ion.

Mrs. Leslie Gamage and other members of the County Staff. There were 250 on parade under the command of Corps Supt. F. W. Nash. The Inspection was followed by a Church Parade. Mter the Service, the salute at the March Past was taken by the Mayor (Mrs. A. Cusden) at the Town Hall. With her at. t?e saluting base were the Couney ComrrusslOner and members of the County Staff whom she afterwards entertained to tea in the Mayor's Parlour. TBEALE On Sunday, July 13th, at Divisional Headquarter~, Blossom Square, Theale, the Annual InspectlOn of Theale Nursing and Ambulance and Nursl11g Cadet Divisions was carried out by the County Commissioner. There were forty officers and members on parade under the command of Div. Supt. Miss G. Glazier. The Co~missioner, who was accompanied by the Ass1stant County Commissioner the County Superintendent and other me:nbers of the C?unty Staff, gave some practical tests after which he presented \X1ar Service Certificates to members of the Nursing Diyision. He then congratulated Supt. Miss Glazier on her promotion and in his remarks to the Divisions. he stressed t;he very great importance of knOWl11g the Dnll Book and so being always ready to aC.t .in any sudden emergency. Mterwards the v1sitors were eneertained to tea by Area Cadet Officer i\1iss K. Corderoy and members of the Divisions. WI ' DSOR The Annual Inspection of the Royal Windsor Divisions was carried out by the County Commissioner accompanied by Sir John Duncan, K.C.B., the Mayor and J\Iayoress of Windsor, County Superintendent the lIon. Mrs. Leslie Gamage and Other members of the County Staff on July 20(h. The Inspection included two motor ambulances. There were 52 officers and members on parade under the command of Div. Supt. A. F. L. Simmonds. The Commissioner gave practical tests to some of the members and among these was a staged accident in which a boy was lying under a motor vehicle. This test was successfully carried out by j\mbulance Cadets who" treated the patient" and afterwards removed him to safety. The Commissioner then welcomed Sir John Duncan and the Mayor and Mayoress and congratulated the Divisions on their recent work, particularly during the floods, and he expressed his satisfaction with their smartness and general efficiency. He thcn asked Sir John Duncan to present \'f'ar Service Certificates to members of the Ambulance and Nursing Divisions. Afterwards the Mayor thanked the Di\"isions for all they had done for the town. WOOLHA IPTO On Sunday, July 13th, at Divisional Headquarters, Wool hampton and Brimpton ursing Division held their Annual Inspection. This was carried out by the County Commissioner

12 who was accompanied by members of the Cou nty Staff. T he parade was under the command of Div. Supt. Mrs. R. Bowden and included <three N ursing Cadets. Mter giving each member a practical test in First Aid or Home Nursing, the Commissioner expressed his satisfaction with the general efficiency and turn-out of the Division and asked their President, Mr. W. E. C. McIlroy, C.B.E., O.St.]., to present the awards. County of Warwick COVENTRY The City Ambulance and Nursing Divisions, with the Three Spires Nursing Division held a successful Dinncr, Presentation and Concert on Friday, June 20th, at the British Restaurant, Albany Road, Coventry. County Officer J . H. Harris was in the chair, and the guests included Major E. S. Phillips, D.S.O. (County Commissioner) and M iss C. Orton, B.E.M. (County Superintendent) . The toast of "The City and the Three Spires Divisions" was proposed by County Superintendent Miss Orton and replied to by Div. Supt. Mrs. E. Hewitt (City of Coventry Nursing Division). Ambulance Officer B. Parham (Secretary, City of Coventry Ambulance Division) in proposing the toast of "Absent Friends" stated that 20 members of the City of Coventry Division were serving in His Majesty's Forces, and said that most of those members had grown up to the senior division from the Cadets, from which body many of the keenest and most efficient first-aiders developed. The toast of " Our Guests" who included the relatives of many of the members in the Forces, was drunk following a short speech of welcome by Div. Supt. E. Taylor (City of Coventry Division), who paid tribute to the fine service during the war. The County Commissioner and County Superintendent then presented the awards and an entertainment concluded the proceedings. West Ridin g of York shire BRADFORD The Annual Inspection of the Corps was held recently at the Cricket Ground which was kindly loaned for the occasion. The inspecting officer was Assistant Commissioner Whyte-Watson who was accompanied by other officers of the Corps and the Lord Mayor and Lady Mayoress. The parade was in charge of Corps Supt. H. Bray, about 250 men, nurses and Cadets being on parade. Following the parade Dr. Whyte-Watson expressed his pleasure in seeing such a smart turn-out and congratulated them on the work they had done. BRIGHOUSE The Annual Inspection of the Corps was held recently in the Ambulance Hall. About 40 members of the senior Ambulance and Nursing Divisions and their Divisional and Corps Officers and 70 Ambulance and Nursing Cadets, including the Corps band, were on parade. They were inspected by Assistant Commissioner H. Harrison (S.W. Area), W . R. Yorks, accompanied by :.'\t1rs. Balden (Area Cadet Officer), and Mr. Whiteley (Corps President). After the tour of inspection Mrs. Balden addressed the Nursing Cadets. The Assistant Commissioner then addressed the parade. He told them that when he was a private in the ranks, Brighouse was looked up to as the

FIRST

AID

home of F irst Aid, and h oped t hat ere long this would be quite Hu e again; he wanted to see Brighouse the Pride of the West Riding, he was particularly pleased to s~e some of t~e men back from the Forces servtng once agatn with the Brigade. RAILWAYS London and North Eastern SCO TLAND v . ENGLAND AMBULANCE CHALLENGE SHIELD T he L. N. E .R . Ambulance Challenge Shield Competition was held on July IIth in the Headquarters of the St. Andrews Ambulan~e Association, 108 North Street, Glasgow. This Shield was presented in 1927 by the London and North Eastern Railway Company for annual competitions between Ambulance teams representative of the Company in Scotland and England, the idea being to promote friendly rivalry in first aid work between the staff on either side of the Border and so stimulate the Ambu lance movement. The competition is held alternately in Scotland and England and since the inception the Shield has been won nine times by England and five times by Scotland. This year the two teams representing Scotland, namely, Kipps and Porto bello and District were highest in the L.N.E .R. Scottish Railways Ambulance Shield Competition and for England, Nottingham Victoria and March "A" held similar positions in the L.N.E .R . English Competition. The arbiters were D r. A. C. White Knox, L ondon, Individu al Tests, and D r. Thos. F. Greenhill, Glasgow, Team Test. Portobello and D istrict came first with a total of 312 marks. March "A" were second with 271, Kipps third with 269 and Nottingham Victoria fourth with 261. The prizes were presented by Lt.-Col. The Hon. Arthur C. Murray, C.M.G., D.S.O ., Director of the L.N .E.R. and Chairman of the Scottish Area Board. Competitions have been held in six districts of the North Eastern Area as fo llows : Date of No. of District Competition Teams l~inning Team York ... 5th March 6 York Locomotive Midd l es brough 19th 3 Middlesbrough 2 D arlington D arlington 29th Engineers N ewcastle 12th April 2 Tyne D ock 5 Leeds Leeds ... 23rd " D .G.M .O. H u ll 8 Hull D ock .. . 7th May Engineers T he final competition for the Wharton Shield was held at York on May 17th, the judges being D rs. r. N . D unn and G . McD ougall, both of Hull. Mr. C. M. Jenkin J ones, C.B.E., Commander (Brother) St.]., D ivisional G eneral Manager and President of the North Eastern Area, presented the Substitute Shield and Medals to the Tyne D ock team and the Hornsby Challenge Cup to the runners-up, Middlesbrough . The Grou p Competition was held in the Board Room, Marylebone Station, London, on June 4th, the judge being Dr. M. M . Scott, London. T he teams and marks obtained were as follows : -

Marks Obtained. T eal1l Individual. Work Work Total Nottingham Victoria 13 1 139t 27 0 t (G.N. Section) 120 116 236 March "A" (G.E. Section) Tyne Dock . . . 128t lost 234 (N.E. Section) Stairfoot 89i III! 201 (G.c. Section)

SO CIAL EVENTS WELLING and SLADES GREEN Ambulance Classes recently held their Annual Presentation of Awards in conjunction with a Social. O ver 200 persons supported the get-together event which was presided over by Mr. A. J. Green, D istrict Secretary. Everyone thoroughly enjoyed the entertainment and the dancing which was of a high standard . O f the many awards presented special mention was made by the Centre Secretary when he presented Ambulance honours to Mr. E. E. Boorman and Mr. C. H. Wood, Class Secretaries of Welling and Slades Green respectively, when he paid them a tribute for the numerous hours they gave so freely in the organisation work of their Classes. Applause greeted the Special Presentation to Mr. ]. Todd, a retired railwayman who has qualified at 40 first aid examinations and performed 50 yeats' railway service. He also received a fireside companion set as a token of appreciation from his colleagues . THAMES VALLEY The above Class held their Seventh Annual Presentation and Concert at St. Mary's Hall, Twickenham, recently. Dr. W. A. R . Mailer, the Class lecturer, presented the awards.

RESUSCITATION APPARATUS (OXYGEN &- OXYGEN + CO 2) for asphyxia, electric shock, etc.

The RILEY ROCKINC RESUSOITATION STRETCHER

Southern PR ESEN TATION T O GUARD R. W. ADAMS O N, CO ULSDON NORTH To mark the 22 years of his association with the St. John Ambulance Brigade of Coulsdon on his retirement as Divisional Superintendent, Mr. Adamson's colleagues presented him on the occasion of a Social Gathering at St. Andrew's Hall, Coulsdon, with a silver cigarette case and wallet. In handing the tokens of appreciation to Mr. Adamson the Hon. President expressed his regrets on ,his departure and thanked him sincerely for the years of service that he had rendered to the citizens of Coulsdon and to the ambulance personnel generally, and extended his best wishes for his future in other ambulance spheres in which he was interested. Mr. Adamson has been Ambulance Class Secretary at Coulsdon since 1936, and holder of the Company's 7, 14 and 21 year Long Service Awards. CANTERBURY ROSE BO WL COMPETITIO N The annual Class Competition held recently at Canterbury West attracted cleven entries, an increase over last year of four teams. Mr. J. T . Henneker of Ashford adjudicated a test in which the first-aider witnessed a painter fall from a ladder at the entrance to the Station. The incident was effectively staged by Mr. G . Pointer, District Secretary. The winner was Mr. F. Ing, with a score of 67 marks (possible 100) and Mr. R. Howland, runner-up with 63 marks. The Competition was organised by Mr. A. Burgess, Class Secretary.

AID

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AID

FIRS T

FIRST

the f uture to the greater comfort and efficiency of those who labour in this great cau se .

Letters to the Editor.

You rs faithfully, L. S. NORTH.

S.E .25. 5 th Juty, I947·

L ONDON,

The Editor is 110/ responsihle for opinions expressed.

Presenting medals and certificates to su ccessful candidates of the M idd lesex County Nurses' Examination, at Middlesex G uildhall, For many years I have had the honour to belong to the S.].A. B. recently, Mr. Aneu rin Bevan (Minister of Health) said that under the It has however been an honour with l ittle comfort and the reason National H ealth Service the aim would be to p rovide for n urses the for this discomf~rt is the uniform we of the rank and file are expected best possible training to fit them for the varied and responsible posts to wear. they would occu py. Two developments which would help towards achieving this would First let me state what seems to be a general ob jection, i.e., that beastly tight neck-band on the tunic. In specific cases we are instructed be the wider facilities provided by the regionalisation of hospitals and " to undo tight clothing around the neck, chest and waist," it would the fact that the desirability of full student status for the nurse in be a blessing indeed if the first of these principles could be applied training was becomin.g increasingly recognised. Conditions of employment would require adj ustment to encourage to the first-aider's tunic. Next, that hat, that stiff, unbending, headache-producing article, nurses to make wider contacts outside the profession, and he expected that the report of the Nurses' Work ing Party would make suggestion s which leaves the mark of pain on so many perspiring brows . \'lie now come to the water-bottle suspended from its sling, and as to the solution of some of these problems . "Under the new Health Service there will be increasing demand ready on the slightest provocation, to give the poor, unsuspecting for well-trained n u rses," said the Minister. "TAe number of girls patient, a frightful crack on the skull. entering the profession is happily in the increase. Before the war the Finally, that virginal-white haversack, which quickly loses its g low annual intake into general training was between II,OOO and 12,000 after an hour or so of duty, and which uses a considerable portion of whereas recent figures show the rate to be about 14,000. Part-time my wife's meagre soap ration in her efforts to keep it clean. nursing is proving a success in various parts of the country. P artThese then are the main objections; now for some suggestions as time volunteers fit their work into their own times, but it is a great to the brigade uniform of the not too distant future . help when they can share week-end and night shifts with the fullHat-black beret, white band, usual badge. Tunic-officer style, time staff. Nurses in the profession can do much in helping to make \vhite shirt and collar, black tie. Haversack-black, attached to belt the part-time schemes a success . To relieve nursing staff of domestic with clips. Water bottle also attached to belt. Greatcoat dispensed duties, a special recru itment campaign is being held in the London with, cape instead. area and there is an encourag ing increase in the numbers of people I trust the foregoing will commend itself to you and that these or coming forward to d o domestic work in hospitals . European similar improvements will be incorporated in the Brigade uniform of volunteer workers have also helped to ease this problem." DEAR SIR,

Miscellaneous Advertisements.

Advertisem e nts with re mi tta nce sho uld be se nt to First Aid, 46 , Cannon Street, London, E.C . 4 . Rate 3d. per word , minimum 45. 6d. m inimum 6s. Box numbers ls. extra.

25 0 Concert Tickets, 7/6. P osters, Memos, Rubber Stamps. Sam-

ples free. "A" Tices, II, O ak lands Grove, London, W . I 2. H OW to Stop Smoking. Save Money. Safeguard heal th. Thousands cured . Send stamp for Booklet of World Famous Remedy. Stanley Institute Ltd., (D ept. 75) 265, Strand, London. S ADDLEWO R TH Division Annual O pen Ambulance Competition to be held on Saturday September 20th, 1947, at Mechanics Institute, Uppermill. Entries and enquiries to J. D . Bottomley, Chew Valley Road, Greenfield , Oldham. B ARGAIN. Air o r water bed 72 " X 36". As new. Best offer over £7. Skinner, 4, A ppled ram L ane, Ch ichester.

Trade Advts . 4d. per wo r d,

H A RD W I CK Collie ry Ambulance D ivision. Annu al Competition for t he Graham Cup in t he Holmewood Miners Welfare o n Saturday, 30th August, 1947. Apply for entry forms to The Secretary,]' Cocking, " H aslemere, " N orth \Vingfield, Chesterfield .

"Gives clear and constructive advice on selecting and training teams for first aid competitions, and provides useful tips on individual and team behaviour during competitions . . . . . should find a ready public."-Fire Protection.

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Queries and Answers to Correspondents Queries will be dealt with under the following rules : I.-Letters containing Queries 1?71{st be marked on the top left-hand corner of the envelope" QI1C1Y, " and addressed to " First Aid," 46, Cannonstreet, London, E.C. 4. 2.-AII Qucries 11Just be written 011 OIlC sidc of paper only. 3.-All Queries mtlst be accompanied 0 ' a " Query Coupon" cut from the mrrent issue of the Journal, or, in case of Queries frol7l abroad, from a rece1lt issue. 4.-The Textbook to 1]1hich reference !lIa), be made in this' column is the 39th (1937) Edition of the S.].A.A . Mantral of First Aid to the Iniured.

Artificial Respiration

R. B. (Chorley) .- Herell'ith a case r'cport lI'hich has been taken from a cOlltell/porary all/btllallce jOflrnal and II)hicb states tbat tbe first-aider instructed a neighbour 10 apply Fiction to the legs of the patient lvhile his breathing was suspended. ItI the December, 1946, issue oj FIRST Am, hmvever, you gave under the above heading the follmving replY to a correspondent !vho asked if jriction applied to the limbs of patient had aI!)' value !Vhile breathing lvas suspended:" The stimulation derived from rubbing the limbs energetically tml'ards the heart ocmrs only while respiration is iJ1 progress. COllsequClltly in all cases of asphyxia it is we/ess to apply friction to the lill/bs until breathing has been restarted." Such being the facts, I think that a lot of members are going to be misled b)1 the treatment lJihich is said to have been given in the case report ttliless there has been a change ill treatment oj 111hich I am flOt mvare. So I Jlle/coJJle )Iour further cOJJlments.

In the presentation of case reports it is seldom that full details of the condition of the patient are given. In the report to which you refer there is littl~ doubt but that there was some evidence of partial restoration of breathing before friction to patient's limbs was commenced. This being the case, my comment in the December issue of FIRST Am still holds good.-N. Corbet Fletcher. Examination Howler

M. R. (Cannon Street).-In a recent examination I asked a cand1date to give his definition of the human skeleton. I liJas surprised (and at the same time much amused) nJhCII he replied: "The skeletoll is a 1)JC111 lI'ith his it/side out and his outside off I"

Good I Next please I 1 Fractures of Ribs and Thigh S. C. (Birmingham).-WI' rcad lilith much interest your replies to queries month by month ill FIRST Am, and I'Ve ask your indulgence and reply to the follm'Ving query : -

If a patient sustains simple fractures of l'ibs and femur and if the first-aider is single-hal1ded, would it be in order to dispffl1se with the splint jor fractured jemur, to semre both ankles and feet with a figure-8 bandage, to treat the fractured ribs and jinally to apply barldages round both knees and thigh ?

With this combination of injuries the fractured thigh is the more serious condition and demands priority in treatment. If I were the first-aider, therefore, I would treat the fractured thigh with splint and bandages as laid down on pp. 88 and 89 of the Textbook. This done 1 would put the upper limb of the affected side in an ann sling if only

AID

Only a scratch, ., yet 1t s big enough for' infection!

as a signal to the doctor, who takes charge of the case, that there is another injury and with the sure knowledge that the fractured ribs would be well supported by the bandage (B) applied rowld chest and sp lints.-N .c.P.

Swelling of Tissues of Throat

A. M. (Wellington, New Zealand).-Recently we dismssed the problem as to what IPe should do if )}Ie were called to a patient who had s)'}Jallo}1Jed

Cleanse it at once and you'll know it 1S safe ....

sulphuric acid lvith the result that the tissues of his throat nlere slllollen and his breathing impeded. frYe JvotJdered if we should reduce the sUlelling of the throat first or COJlJllle/lce artificial respiratioll. f,f;:7e shall JJlelcolJle ),ot.(r kind ruHllg 011 this problem.

The Textbook (p. 158) tells you that in treatment of a patient suffering from swelling of the tissues of the throat yuu should at once place patient before a [lie if possible, and then apply hot (and frequently renewed) compresses to his throat; and that, this done, you should give certain cold and demulcent drinks, if breathing has not ceased or bas been restored . If, however, this local treatment fails and the obstruction gets worse and causes the patient to be asphyxiated, then you must commence artificial respiration without a second's de1ay.-N.C.F.

Keep MILTON handy to kill the germs and help healing.

Crushed Hand and Fractured Forearm G. C. (Surbiton).-At a recent practice a discussion arose as to the correct treatment of a crush ))Jhich affected the hand alld was a/so accolllpanied by a simple fracture of the forearm. SOllie of us thol/gllt that the 17Jound or wounds of the halld having been dressed, rlle!l padded splints should be applied and the whole treated as for a fractured forearlll, the second bandage keeping the halld at I"CSt JJ'ith thumb enclosed. Others suggested doing up the crushed hand first l}lith t1] '0 padded splints and thm applying the tlPO bandages as for fractured forearm. Your COllllllelits wi/I be !lIlIch appreciated.

The more serious injury and the one which demands preferential treatment is the fractured forearm. Consequently I am of the opinion that the first suggestion as to treatment is the correct one.-N.C.F. Treatment of Insensibility P. N. (Boston) .-On p. 155 oj the Textbook in the General RIdes For Treatment of Insensibility, Rule 9 reads: "Oil return to conscioJlSl7ess water may be given to drink in sipJ. If the pulse is feeble, give hot strong tea or coffee . . ." Does this contra indicate hot tea or coffee if the palient's condition is good and the pulse is strong on his recovery from illsensibility? MearJ,vhile I thank you il1 a11ticipation of your reply. The administration of hot tea or coffee can do no hann to a patient whos~ gene.ral. condition and pulse are both good on his recovery

from lnsenslblhty. These stimulants, however, are urgently indicated when the reverse holds good. Nevertheless, on genera l principles, it is better for first-aiders to follow the instructions of the Textbook which tells them to give sips of cold water to all such cases and then to follow up with sips of hot tea or coffee if the patient's condition is poor.-N.C.P. Humour in First Aid D. S. (East Ham).-At a reeen.' Divisional Practice some one asked what are the stages through l1Jhich a patient suffering from alcoholic poisoning may pass. A 'Pit replied: " J ocose, ]Jerbose, bellicose, IJlorOJe and comatO.re I " Goocl I t"eXl please' I !- N C F.

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FIRST AID Editor: DALE ROBINSON, F.R.S.A., F.S.E.

SEPTEMBER, 1947.

No. 639.-VoL. LIV.

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CONTENTS Editorial A Course in Advanced First Aid

'George B. Ritc~i~d ~li.~? ""akers

1fJ

249

of surgical InstrUrTlSentreet

Buch anan

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Sole makers 0

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Austin have been making ambulances for forty years, and the design of the new 'Welfarer' has been worked out in the light of that experience, by people who understand hospital needs. It is a worthy successor to the famous K2, built in such large numbers for war service.

i.Vumbrr to.-

The short wheelbase makes it easy to manoeuvre ; the specially hinged rear doors and folding step permit quick access to the interior, while there is a convenient extra door on the nearside. Thermostatically-controlled heating and ventilating keeps the air fresh and at an even temperature. ,

• glVes

real protection Elastoplast first aid dressings

The' Wel/m'er' has many alternative

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1,000, 2,000, 3,000

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Editorial keep unbroken. If the burnt skin is stained, e.g., by flavine or gentian violet, or if a hard skin has formed on LAST month we gave some detail s of the new methods it after the application of tannic acid, the doctor will of dealing with severe injuries by burning and often be unable to judge the depth of the burn, and scalding, as outlined by Dr. Leon ard Colebrook, of the therefore, to decide whether an early skin grafting will Birmingham Accident Hospital. This month we continue be beneficial. In this way recovery may be delayed. with his advice as to small burns such as occur very Dr. Colebrook emphasises that before doing anything frequently in kitchens and factories, and which cause only to the burn, the first-aider must wash his hands thoroughly, reddening, without blisters. These are best covered for dryi ng them on a clean towel, and a clean handkerchief three or four days with a piece of clean or sterile linen should be tied round the mouth and nose to trap any because blisters sometimes form after many hours. If dangerous germs which may be in the saliva or nose. painful, the application of lanoline or other skin cream With extensive burns no attempt at first aid should be to such unblistered burns will be found comforting. If you made, except to give small drinks at frequent intervalsare in doubt about the severity of the burn, says Dr. larger drinks are likely to cause vomiting. The patient Colebrook, take the patient to a hospital or a doctor, should be kept warm, but blankets should not be put and do the same if after four or five days the burn is not next to the burn because they are apt to harbour dangerhealing satisfactorily or if it has formed blisters. He tells ous germs. The important thing, as we said last month, us that we should not use bicarbonate of soda or tannic is to get the patient to hospital at once where a transacid jelly or gentian violet or any of t he other remedies fusion can be given. Dr. Colebrook's article is one of the which have been recommended in the past, and gives most interesting on the subject we have recently read, three reasons: Fi rst, cold water from the tap wi II usually and certainly with the large numbel" of injuries from relieve pain better than any of these remedies; secondly, burning and scalding occurring every day, his account of the appl ication of any substance directly to the burn the best methods of first aid is timely. The treatment of without the special facilities which a hospital can provide bu rns has been rad ically changed as the resu It of war involves some risk of conveying infection to the burned experience, and first aid for these injuries has likeWise surface; thirdly, the substance used for first aid will been revised. Unfortunately, the older methods sti II usually have to be removed by the doctor· subsequently remain in countless homes and factor ies. It is a subject treating the burn. Its removal may be painful and may which wi II well repay vigorous propaganda and instruction, result in the breaking of blisters which it is desirable to and in this the first-aider can play an important part.

More About Burns

FIRST

AID

A COURSE IN ADVANCED FIRST AID by

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

EMERGENCIES OF THE D IGESTIVE SYSTEM' Gastric Ulcer Before the hrematemesis occurs, the patient often This is a common complaint and is often the cause of experiences warning symptoms such as giddiness, faintness, what the layman calls indigestion. The ulcer affects the shortness ?f breath and palpit~tions . Later he develops mucous membrane of the stomach gradually extending all the typICal symptoms and slgns of shock. His face is both in surface extent and depth, eating its way through the pale, cold and clammy and his pulse quick and feeble various coats of the organ. The ulcer may be acute or almost to the degree of becoming imperceptible at the chronic. Acute ulcers occur mainly in young women wrist. These symptoms and signs are caused not only by between twenty and thirty years of age; they are usually the shock of the occurrence, but also by the loss of blood small and several may be present at the same time. Chronic which may be anything up to two pints in amount. ulcers are much more common and are usually single; FIRST AIDthey tend to be much larger than the acute variety. (I) Medical Aid. A doctor's services are required The symptoms of a gastric ulcer are generally characterurgently. The most important medical treatment is to istic. The patient complains of a dull aching pain in the pit of the stomach commencing soon after taking a meal. give an injectior: of morphia which by providing complete It usually lasts for about an hour, but is relieved by vomiting rest and relaxatIOn tends to stop the bleeding. (2) Position. The patient must be made to lie flat with jf this occurs. The pain is so persistent and unpleasant that the patient becomes afraid to eat and hence loses his .head low and his feet raised. This position can be attaIned when a patient is lying in bed by removing the weight. pillows and placing supports such as bed-blocks, books, Occasionally, in acute ulcers, typical symptoms are etc., under the casters at the foot of the bed so that it is absent and all that the patient complains of is vague ra~sed to a height of 18 to 24 inches. The patient's body dyspepsia. WIll then slant do.wnwards to.w~rds his head at an angle A gastric ulcer itself is not a first aid condition, but of from 30 to 40 lllches. A slmIlar slant can be obtained first-aiders in charge of ambulance rooms in factories and if the patient has to lie on a stretcher or table. similar institutions will often run into cases' a worker Ambulance attendants and stretcher bearers must rememfor example, may frequently apply for a dose of bicarbonat~ ber that this position must be preserved throughout transof soda or indigestion medicine to relieve his pain and in port of a patient to hospital or elsewhere. Thus he must be this event the first-aider may, after asking a few questions, carried h~ad first ~own stairs, steps, etc., and when the suspect that his patient is suffering from an ulcer. He stretcher IS placed lD the ambulance its foot must immedishould then urge him to seek medical advice. ately be blocked up. This is a point which is very often Far more important and definitely first aid conditions, forgotten even by experienced first-aiders. Several times however, are the complications of a gastric ulcer which have I seen a patient removed from a bed on blocks may arise at any time; these are hrematemesis and carefully placed on a s~milarly slanting stretcher, carried perforation. head first down the sta1rs, through the hall to a waiting ambulance and finally, to my horror, suddenly allowed to Hrematemesis slant feet downwards as he is being lifted into the ambulance. This is the term applied to the vomiting of blood. If A sudden change of position like this, may easily precipitate the ulcer extends either in surface extent or depth, it may another hremorrhage. erode one of the bloodvessels of mucous or submucous (3) Shock. !his ~ncludes a~l the usual general principles coats and thus cause bleeding. There are, of course, other such as ~l.lildoH~g t1gh~ .clothIng, supporting the patient's causes of hrematemesis besides gastric ulcers such as head while he IS VOffilt1ng and supplying warmth by hot varicose veins in the stomach, cancer, etc., but hremorrhage wate~ bottles and extra wraps. Stimulants such as sal from an ulcer is by far the most common. vol~t1le and smelling salts are strictly forbjdden and the The characteristics of hrematemesis are that the blood is patient must be given nothing by the mouth, since fluids dark red in colour, often clotted and mixed with food, would have the effect of disturbing the blood clots which if it has re~a!ned in the stomach for any length of tim~ are forming and aiding the natural arrest of hremorrhage. before .votn,ltlng takes place, it becomes dark brown, Absolute rest is of great importance. Thus it is inadvisrath~r lIke. coffee grounds in appearance since it has been able to ~ake any attempt to undress the patient until the part1ally digested by the gastric juice. doctor gIves the word and when ultimately this is done,

F IR ST

AID

the patient should be instructed. to make no effort ~o help himself but to allow the first-alders to do everythlllg for him. Tactful reassurance in regard to his condition plays an important part in the treatment of almost ~very case. in medical work, but when adopted for a patlent suffenng from hrematemesis, all refel-ence to bJ?od sho~ld be omitted . Usually the patient feels far too 111 to notice that he has vomited blood and mention of the word blood may easily cause him unnecessary alarm. Perforated Gastric Ulcer This occurs when an ulcer gradually eats its way through all the coats of the stomach and finally bursts into the peritoneal cavity. Directly this takes place, partially digested food ~"':J.ters the peritoneum and sets up acute general pentoll1tls. . , . The onset is dramatically sudden, the patient expenenclllg violent abdominal pain, sufficient to cause him to groan and writhe in agony. Accompanying the pain are the usual symptoms and si~ns o~ shock while those of peritonitis follow almost Immediately. The first aid treatment is precisely similar to that already described for acute general peritonitis.

Melaena

Duodenal Ulcer

I-hemorrhage from a duodenal ulcer shows itself as melrena which is the term applied to the passing of black motions from the rectum. The motion is tarry in appearance with a very unpleasant odour. The characteristic appearance of a melrena stool is due to the fact that during its journey throughout the length of the digestive tract, the blood is altered through contact with mucous digestive juices present in the intestine. Symptoms of hremorrhage usually precede melrena. The patient feels giddy and faint, he becomes pale and clammy while his pulse rate is increased and his temperature below normal. At this stage the diagnosis may be in doubt; later, however, he develops a little griping pain in his abdomen and passes the characteristic motions. Various degrees of severity may occur ; in severe cases the patient will collapse, but it is quite possible for a small hremorrhage to pass unrecognised. Thus a young woman working in a factory applied at the ambulance room for a dose of sal-volatile because she was feeling faint. Enquiry disclosed that she had been feeling weak for several days, her chief symptoms being giddiness, shortness of breath and palpitations ; moreover she looked pale~ than normal. When asked if she had noticed any change 1D her bowels, etc., replied, " Funny that you should ask that-they have been black for the last two days."

This is another common cause of dyspepsia. The ulcer generally occurs i~ men over the age o~' 30 and i~ very FIRST AIDsimilar to a gastnc ulcer except tha~ It occurs lD the This is very similar to that for hrematemesis. If the duodenum. The ulcer is usually chron1c, but acute ulcers bleeding has been severe, as shown by the pulse rate and do occur, occasionally as a complication of burns. other general symptoms. and siffns of hremorrhag~, th,~ The patient complains of a dull snawing pain in his patient must be placed 1D the head low, feet ralsed upper abdomen, usu~l~y about three lDche~ abov.e and to position. Treatment for s~ock must be undertaken and the right of Ius umbllicus (navel). The palD beglDs when medical aid obtained. othing may be grven by the mouth his stomach becomes empty generally two to ~our hours and careful observation of the pulse and temperature after a mealor, what is very nearl~ the same th1r:g, about maintained. Any motions that the patient passes should be an hour or so before his next meal IS due. For this reason, preserved for the doctor to inspect. the pain is often attributed ~o hunger. and in ~act is called (to be contintted.) " hunger pain" by many patients. This fallacy IS supported by another characteristic fea~ure of a du.odenal ~lcer namely that the pain is eased by taking food ; lDdeed, It then often NOTICE TO CLASS SECRETARIES. vanishes completely for a few hours. We are now able to print a limited numbe~ of extra In the absence of medical treatment the disease is of a chronic character, dyspepsia continuing ex~ept for short copies of "First Aid." Will Class Secretanes plea~e intervals over a period of years. At any: tlme? however, note that we shall be pleased to supply the J.ournal 1il complications of an urgent nature may anse; If the. ulcer bulk or if members prefer it, they can be regIstered as is of the acute variety, however, they may occur wlthout subscribers and have their copy posted each month. a previous history of indigestion. Copies ordered collectively in do.zet;ts a~e 4~. each and sent post free. The annual subscnptlOn IS 51-' These complications are: perforation and melaena. We would also like to draw your atten~on to the fact that the Editor is always pleased to receIve repor.ts of Perforat ed D u odenal Ulcer your acUvltles. Reports of general interest are publIshed This is precisely similar to a perforated gastric ulcer and as space permits. produces identical symptoms. The ..only . method of distinguishing between the two conditIons IS by ~aref~l consideration of the history of the case, and tl:e patient .IS LOVELY BABY BEAR generally too ill to give an accurate account of hlS ~ys1?epsla. EVERY BODY CAN MAKE IT. Complete It is, however, unnecessary to make more than a provlsIOnal with Eyes, Joints, Diagram & Illustrations. diagnosis because the ~xact si~e of the perforatIon WIll ~e Price 1/4 each Including Tax disclosed at the operatIOn whICh wlll h~ve to be done In EVERYT H ING FOR THE T O YMAKER AMATEUR OR PROFESSIONAL , any case. In the meantime the first aid treatment that G. R U SSELL INMAN, should be undertaken is exactly the same as for a perforated 1-5, Roundhay Terrace, Sheepscar, Leeds, 7. ._ ..... ~.- ' gastric ulcer. >....... "

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FIRST

AID

FIRST

AID

There were about 200 on parade under Thanks to the kind co-operation of Dudley Corps Superintendent Shelley, Carlisle, drawn Education Committee, Brigade Cadets held from the following Ambulance Divisions; their camp at Astley BUlf, StourPOrt. \X'hitehaven, under Supt. Coyles; Carlisle, Acti,-ities included a Church Parade to Astley Supt. J. Leslie; Flimby, Supt. R. Weightman ; Church, physical training, drill and rambles. Workingron, Supt. :\lonon; 11aryport, Supe. The Cadets were from the ~orth \\' orcesterCurwen; Keswick, Supe. EgglestOn; and shire and Dudley and District Corps. from the r..:ursing Divisions as under; \v'hiteThe competition for the "Ollis" Cup ha\Ten, Supt. :\lrs. Spedding; Carlisle, Supe. betWeen the Dudley Ambulance and ~ -ursing ;\1iss Raffles; Temple Sowerby, l\'ursing Cadets was helJ - recently. After a yery B rigade Headquarters Officer ;\1rs. Craig; ;'IIa1)-pon, Supe. ::'Irs. interesting competition the ~ursing Cadets There has been a good response to the E. Todd; Keswick, Supt ..Mrs. Cameron. suggested Surgeons' \'Veek-End Conference, by 2 marks. .. . A fearure of the parade was the presence \\on The audience, \\hlch lOcluded Bngade Dinner and Dance which will take place at of Sr. John Ambulance and ursing Cadets the Bonnington Hotel, London, on September from Carlisle, the boys being in charge of Officers and parents of the Cadets were interested and impressed by the skill shown. 27th and 28th, and its success is now assured. Cadet SUpt. J. Lowthian, while :\Iiss ::'loyra The Cup was presented b): Corps Officer Should there be other Surgeons, who wish Raffles was in charge of the girls. \\.,. Ollis ro Cadet Doreen Ibley, leader of to attend, they are aske~ to ~ommunicate at After County Commissioner Lamberton the winning team. once \yith the Surgeon-tn-Chief so that the had inspected the Ambulance Divisions,. necessary accommodation can be resenTed. County West Riding of Yorkshire Superintendent )'Irs. .Ainscow The problem of hOtel acco.mm?dation in inspected the r..:ursing Divisions and County BR..illFORD CORPS London is still acute, and whilst 1t has been Cadet O fficer Re\-. T. Cross inspected the \\ e much regret that an error crept inro possible to proyide for those Surgeons who CadetS. The whole parade then marched past our report regarding the a<:ti\-itie of th~ a.bo\'e ha\'e already applied, it will be necessary to and the County Commissioner took the salute, Corps last month. The _-1.SSlstam Comrms~lOner close the list in the near future due to the fact after which the parade was addressed by Dr. is Dr. \\. N. \\est-\\atson and nor :-'1r. \\'bytethat no funher rooms are a\-aiiable at the Lamberton \\ho congratulated all on their \\'atson as stated. '\\'e apologise for our Hotel. sman turn-out and said that it was up ro all mistake. R AILWAYS members ro try and bring in new recruit~ to P rince of Wal es's D istrict increase their depleted numbers. He realised Lond on and North Eastern LAMBETH Lambeth Didsion are starring a course the difficulties which DiV'isions were expenenc- ~ORTH EASTER..'\' AREA CE:--';TRE of lectures for men and women on First ing and said that the members had been According to the Centre Secretary's Repon Aid on :\Ionday, 22Qd September. The through a difficult time during the war and for the year ended 30th June, 19+7, IIS lectures, which will be giYen by the Diyisional urged all to (1)- and interest the younger classes were conducted in the Area during Surgeon, will take place each :\londay at generation in this great work. In this con- the 19+6 +7 session. _ . Headquarters of the Di,-ision, Raleigh Park nection he strongly adV'ocated the fo.r::matlon The number of students successtul 10 Church Hall, Brixron Hill. Practices will of Cadet Di,-isions which were ot great passing the examination during the 19+6.p also be held on the same e\·enings. A small benefit to the younger people and also were session \\as 1794. fee of 3S. 6d. ",-ill be charged for the course, a fruitful source of recruiting for the AmbuThis shows an increase of 3 on the 19+5. +6 lance and Nursing Diyisions. . this includes examination and certificate. session. ...-\fter the parade was dismissed tea was ~ew members are required and all interested Ho:-<oURs should write to the Secretary at Di,-isional sen-ed at the Lakeside Tea Gardens. His ;'IIajesry, the King, has be~n graciously Headquarter . pleased ro besrow the Dignity ot Commander County of Hampshire (Brother) from Offic~r (BrOther) upon the CADETS D uke of Connaught District President, C. ),1. Jenkin Jones, Esq., also the Local people who saw the parade of nearly Dignity of Officer (Br?ther) upon C. ~f. ADDISCO:-'1BE Addiscombe Diyision held their annual 200 Cadets on Sunday, August 3rd, when Stedman, Esq., Locomotlve Runru?g SuperlUpresentation of a\\ards recently. They were the County Commissioner, Brig. F. B. Hurn- tendent, and the Dignity of SeITtng B:.?ther presented by the Di,-ision Surgeon, Dr. F. H . dall, )'I.C., took the salute at a march past on )'Ir. John Procror, Hull and :-'Ir. F. WmdeSparling, O.B.E., and all members who were much impressed by thell smartness bank, Hartlepool. recently sat for the annual examination passed and bearing. The Cadets came from all .. and recei,'ed the award of the Brigade. pans of the County, and .~e ~ara~e, CO)'fPETITIO:-;'S It \\as agreed that the District Compeutlons, In addition, oyer thirty members were \yhich included attendance at Dn-lUe ~ ervlce Korth Eastern Area Final, Group and Inte~ presented with a cenificate, sign~d by Their at Romsey Abbey, conducted by the Vicar Railwav, and England '-. Scotland COI?,Pen:-'Iajesties. This certificate was ginn by the (Canon W. H. B. Corban) was one of ~he tions be held under pre-war .cond~n~ns . Red Cross and St. John \\'ar Organisation to outstanding items of a. yery f':lll week which Competitions tOok place in all SIX D1SrnCt~ members ""ho carried out ambulance or they have enjoyed durlUg their annual camp which \yere well attended and proved V'er) at Ridge Farm. firSt aid work throughout the recent war. inStructi ve. _ District Officer E. J. Prew, B.E.;'I1., was Recently the Cadets and ursing Cadets, fr':lm The Final Competition was held. at York present and remarked that the certificates were Andover with other personnel of the Seruor on the 17th ;'IIay before a large. audience and one of the finest a\vards he had eyer seen. It Diyisions and the Cadets' parents, spent a happy at tb~ close ;'IIr. C. ;'If. Jen~ Jones, the certainly ,,-as something that could be handed day at Ryde, Isle of \'\light. Under the super- Divisional General )'lanager, lor.k, presented down in generations to come with great pnde . vision of Cadet Supt. E. .A. Harns and Cadet the Substitute Shield to the wlflillng team Dr. Sparling received a warm welco~e from Officer B. A. Pemble, the part)' started .off from (T\-ne Dock) and the Hornsby Challenge Cup all the members, and stated that dunng next .Audo\-er soon after 7.30 a.m. .Arnvmg at ro' the runners-up (::'Iiddlesbrough). The autumn he \\~oulrl conduct the lectures on Portsmouth, there was a surprise for them as adjudicarors were; Dr. 1. -. Dunn and Dr. firSt aid for the Diyi ion. County O fficer L. P. Botting and )'Irs. Bottl~g, G. :'IcDougall, both of. I:Iull. The Group Competltlon rook place at with their two daughters, who are urs~g C ounty of Cumberland The first Combined Inspection of St. Jo~n Cadets of Basingsroke Di\-ision, were Wa1~g 1Iarylebone tation, London, on the qth for them at the quay, and spent the day With ] une with the following result ; Ambulance Brigade person~el enr ~eld ,tor , Team IlIdi!'idlla! Tolal the countv took place in the FttZ Park, Kesw1ck, the Andoyer party. G.l . Section oton Sunda}-, August loth, when the "\n:bulance, County of Worcester 139~ tino-ham Yictoria) 13 1 Nursing and Cadet Divisions were illspected II6 G .E. Section (;'\Iarch) 120 by County Commi sioner J . Lam.be!ton, CADETS .E. .Area (Tyne A most successful camp for the Nursing Carlisle. Accompanying the Comm1sslOner 105~' Dock) 12 ~ were County Surgeon J. Parker, Go;;forth; Cadets has JUSt been held at Borth, . Wales. County Superintendent :\Irs. ,Ainsco\V, fcmple )'lrs. Lamb, Area Cadet O fficer, was Com- G.c. Section ( mirfoot) ... .., ~9} II 112.10. Sowerby; County Cadet Officer ReL Tom mandant. About 50 Cadets, from all parts of Tyne Dock pur up a good sho"- and It 1S Cross Penrith' Chief Constable P . T. B. the County of \~/orcesters~re, attended the that their indi\ idual \~ork was not Brow~e, Penrith; and Police Inspector Bell, camp which lasted a fortrught . The Cadets reo-retted the same high standard as thell: team work. were under canvas. Keswick.

NEWS FROM ALL QUARTERS.

1,000, 2,000, 3,000 BY

J. W. SCOTT.

N0 doubt, most readers will be familiar with the figures in this title, to the good if you adjust your movements to allow yourself to be but for the benefit of those who may be a little puzzled, it is a sitting back on your heels when you say 3,000, and to be at the end of suggested rhythm of w'ords that may be used to exact some form of your forward movement when you say 2,000, so as to allow a clear timing \yhen applying artificial respiration. It is important that an three thousand to rerurn to your "start" position. In other words, eyen continuity of moyement should be maintained all the while that you allow a three-second period for inspiration, and two seconds for efforts are being made. The question does arise, howeyer, as to the expiration. The usual question here arises, "How long do I keep speed in which the words are spoken or used. Some operators this up for?" Well, the text books are quite clear about this; the habitually speak fast, while others are in a habit of speaking slowly, reply is, " until the patient is fully recovered, or a doctor declares that therefore you haV'e tWO distinct speeds, and if these two extremes all efforts are useless. In other words, "until either the patient or the happen to be working on the same patient, one will probably mar the docror says STOP." work of the other. It is difficult to arriye at a marked pace, but generally In practice or at an examination don't forget to mention that you speaking, if the words are said fast, or slow enough to make each would clear the patient's mouth of foreign bodies and or dentures. word clear in all its syllables, making the D in the thousand sound at (Don't start poking inside the mouth of your mock patient, he may the end of each word, then that can be taken as an average speed. be hungry); but examine and feel thoroughly inside of your real As has been mentioned in the text books, this e,-eness of timing is patient that has been rescued from the water. (The mouth I mean, of most imponant at the time when the patient is showing signs of course). So far I have been dealing with the Schafer method, so I will returning to life and is making effo1'ts himself to gain breathing action. now say a few words on the other method, that of Sylvester. I have It will help him considerably if you can synchronize your movements often wondered why every trainee seems to get the idea firmly £i."\:ed with his efforts. If you are forrunate in haV'ing a helper with you, or in his brain that this method is all but hopeless, and to be looked upon failing that, a member of an audience, if any, get him or her to listen with dread and fear. Personally, I think it equally as efficient as the close to the patient's mourh and nose so as to hear the smallest gasp, Schafer, perhaps a little more tiring for the operaror, but just as or any sign that the patient may giV'e, that indicates that your efforts effecti ve as the Schafer method. It always has been stated that the are succeeding, and then instruct him to signal to you, who may not Schafer is best though, and so I suppose one must not starr some new yet be able to hear from where you are in position, the exact time and thinking now. There is much to be said for the Sylvester action, the instants of these gasps or puffs that the patient may be making, and idea being that of raising the arms outwards and round to an upwards so you can adjust your moV'ements accordingly. position does much for the effect of extending the lung capacity ro its \X'ith regards to the position of the operator, this too is important fullest extent, whereas one has to rely on the diaphragm returning in many ways. It is clearly understOod by all first-aiders that it depends unaided to its position when pressure is released in the Schafer method. a great deal upon the speed in which operations are commenced as to Some say that it is very difficult to hold a patient's tongue out. The the hopes of the patient recovering. \X'e know that the removal of difficulty would lay in trying to hold the tongue out, and perform wet clothing, etc., can be left until the patient is sufficiently recovered, artificial respiration as well. Ce1'tainly it is not a very hard job to covering ",-ith blankets, etc., also may be left until later (if you 'are hold a tongue Out, if the patient is unconscious. If you try it on a friend, single-handed), but in spite of trus urgency for speed, a thought must it is difficult, because he or she has control over their tongue, and is be giyen to your own comfort. It must not be forgotten that you may unconciously holding against you. In any case, as the book says, use have to work on your patient for a long time. (As to how long it may a handkerchief if necessary, but the book does flot say pin the tongue be likely, goodness knows; I have heard of cases of the" nearly out I I I do not know what the views are of my readers this on drm.vned" being brought back to this world after anything up to suggestion, but mine are quite definite, I most certainly would not. eighteen hours and more-I actually know of a case that took nearly If you are single handed, you can easily turn the head to one side, four hours. Records vary wildly). Therefore in as short time as but be quick about ir. And what a lot of fuss some chaps make possible, make yourself comfortable in such a way as to feel that you about turning a patient over from off his tummy. It is the easiest job will not have to moye from your position too shortly after you comin the world, if you remember to grasp the clothing, 1vell around the mence to work on your padent; your knees in line with the patient's patient, not just at his side, but get your arm well round his body, pelvis, and the heel of your hands just above it. Thumbs in line with and with a sharp tug, he will come over. D on't forget to protect the spine, fingers spread out, and then that gentle lowering of your his face as he comes over, because if you have turned him correctly, body forward and downward, lvith ) /Of,lr arms always kept stiff, i.e., if he comes over with a bit of a rush; needless to remind you, always your arms are kept stiff, your patient will only receive half your weight, turn him towards you, not away from you. (R emember this when you whereas if you bend them he gets much more than half, and that is are doing some Home Nursing on your patient in bed, otherwise likely to do damage. (In my first days of training, we were told of one you may merely push him off the opposite side). Having got your uru:ortunate " ~ock " patient, who died as a result of a split kidney, patient to live again, all the warmth possible and rest, in fact all the OWillg to a traillee "diving" on him when at artificial respiration shock treatment that you can manage. practicei· When using the 1,000-2,000 method of timing, it will be

ST. JOHN AMBULANCE BRIGADE.

FIRST

Radio Network for Guernsey. THE resident population of Guernsey is about

45,000 and the Island's ambulance service is provided entirely by the St. John Ambulance Brigade. In order to secure the greatest possible expedition in the handling of calls, the Corps Transport Officer experimented with the use of radio control for the ambulances, and the G.E.C. was asked to instal a V.H.F. radio system. The frequency modulated system now installed adds yet another to the G.E.C.'s long list of V.H.F. network installations, both A.M. and P.M., for police and similar public services at home as well as overseas. In the Guernsey system the four ambulances have direct and continuous contact -:ith the control station, and the service may be further extended 1n the near future as the addition of a sea-rescue launch for cliff accidents at points inaccessible from the land is contemplated. Communication can be maintained to an ambulance or patrol car in any part of the Island, the maximum distance from transmitter to receiver being miles. The important factor in this instance however, is not distance but coverage. The hilly nature of the coastai areas is well known to visitors and can readily be noted from a contour map. Sat~sfactOry communication is, however, obtained in spite of the screerung effects of cliff formation.

Vital time can also be saved by messages from ambulance to Control requesting preparations for an operation, or for the accommodation of a seriously-ill patient. Such information is immediately passed from Control to the Emergency Hospital by telephone. The controlling officer's car is also equipped with radio, so that his constant attendance at headquarters is not necessary. Simplex operation on a frequency of 76.2 Mc/s. is employed. A standard G.E.e. IO watt frequency modulated transmitter-receiver is installed in the headquarters control room, and operated from a desk control unit during normal daytime hours. This unit is a Gecophone instrument fitted with loudspeaker; removal of the handset to answer an incoming call disconnects the loudspeaker and for subsequent communication the telephone handset is used.

One of the F.M. Equipped Ambulances.

Headquarters Aerial.

S~ce c~nt~ct between control and out-stations is maintained at ~ll times, It IS no longer necessary for an ambulance to be held in reserve .at headquarters for emergency purposes. This is, of course a most Important feature of radio control. All vehicles may be out o~ duty and, shoula ~he occasion arise, any of them can be diverted to the. scene ~f an accIdent, or re-directed to any part of the Island where then. serVIces may be required. Therefore a better service can be prOVIded or, alternatively, fewer ambulances will pro 'd . V1 e a gIven service.

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Normally the receiver is operating and the H.T. supply to the transmitter switched off. A press-to-talk switch in the handset is pressed down wh~n it is desired to transmit, connecting the H.T. supply and operating a relay to switch the aerial to the transmitter. At the en~ of transmission, release of this switch again disconnects the transmItter H.T. and restores the aerial connection to the receiver. A second desk control unit is installed in the C .TO's offi ce a d'Jacent . to the control roo~" and for night control the unit may be unplugged and. reco~ected 10 the nearby living quarters_ where points are avallable ill both the livi!J.g-room and bedroom. Extended control is then over 3 00 feet of cable and satisfactory operation is obtained WIthout the need for additional amplification. . For the headquarters station .aerial a standard G E.C. end fed dipole IS. em?loyed. mounted on a nmety foot aerial mast with a 200 foot Pltelb-General concentric cable feeder. The mobile .equipment consists of three units-transmitter, receiver and. power urut-assembled side by side on a common mounting tray. QU.lck release fasteners and multi-core cable connections facilitate mailltenan~e. I~ addition there is a small "glove compartment" control Untt which has the necessary switches for all control purposes and a sn:all loudspeaker to announce incoming calls. The telephone handset IS used for normal transmission and reception. installation was carried out by G .E .C . englDeers . dThe complete . an durlDg the period of installation the local radio retailer who i~ ~o unde~take the maintenance of the equipment was given all necessary InstruCtion. It is certainly gratifying to be able to record once again technical

?rogre~s f~om the Channel I.sI~ds . This installation is outstanding 10 that It g!Ves Guernsey the dIStinction of operating the first Frequency

Modulated.radlO controlled ambulances in the United Kingdom. The County Bngade and all concerned are therefore to be congratulated. Und.ou.btedly the Success of their venture will encourage the adoption of slIl11lar systems elsewhere.

AID

THE NATIONAL BLOO D TRAN SFUSION SERV IC E BY

G. K. SHAW,

I WONDER how many of us, as we go about our daily work, pause to look and think what is behind those familiar posters calling for blood donors. ~'hat does that poster stand for? What kind of an organisation is there at the back of it? What branch of Medical Science has made it what it is to-day? In this talk I want to make an attempt to answer these questions. First of all, the poster represents a chance for the whole nation to contribute to the relief of suffering, a chance for which every man and woman has always longed for! On the other side of the picture it represents new life, fresh encouragement, for the child, perhaps your child, who lies critically ill in hospital, or complete recovery for the man or woman who, a short time ago, would ha\Te been given up as hopeless. All this is possible because of those pioneers in bleod transfusion work, such as Sir \,{/illiam Bayliss, Drs. illoss and Janski, who disco\'ered and classified the various blood groups. Before we go farther let us make ourselves fairly conyersant with these blood groups. \'{'hat are they and of what is their importance as regards to blood transfusion ? In blood we finel two substances, one we will call subsrance "A" and the other, substance" B." Blood is grouped according to which of these substances it contains. Using Dr. ilIoss's method of classification (this is the method generally used in Great Britain), the four main blood groups are as fo11O\;-s ; Group I or "A.B." is so called because it contains barh substance "A" and " B." Group 2 or "A" is so called because it contains only substance

"A." Group 3 or " B " is so called because it contains only substance "B." Group 4 or " 0 " is so called because it does not contain substance "1\" or " B." \'\1hen the classification was in progress it was found that if substance "A" was mixed \;yith blood which only contained substance " B " the blood would clot, and so, for the purpose of blood uansfusion it had to be found out which groups could be n-u,,\ed and the result was as [o11o\.\"s ; A Recipient who is Group can recei, e blood from a Donor who is Group

3 (B),

4 (0)

V\B), 2 (.\), 3 (B), 4 (0), 4 (0) 4 (0), 2 (A) 3 (B)

4 (0)

(AB),

(A),

From the above table it can be seen that each can leceive from his own group and also group 4 (0) which is called the ,. Lm1\'ersal Donor" group. This is because group 4 (0 ) does not contain substance "A" or " B " and will therefore not clot. In addition it \,-ill be noticed that group 1 (AB) can receive blood from any other group as it contains both substances. This group is called the" Gniversal Receiver" group .

F.I.C.A.P.

About 1935 it was discovered that there was yet another factOr to contend witb, this is called the Rb factOr because it was first discm-ered in the Rhesus monkey. People possessing the factor are termed Rh -, the remainder Rh-. If Rh-!- blood is mixed with Rh- it will cause the red cells in the Rh- blood to dissolve. This is one of the causes of miscarriages, as it is quite possible for an Rh T mother to bear an Rh- foetus. The red cells of the foerus are destroyed causing the miscarriage, or the child may be stillborn or suffering from jaundice. 1\:ow let us go into the method used in taking the blood from the donor. The equipment used is a special-shaped, sterile, standardised bottle containing a solution of 25 per cent. citrate and I per cent. glucose to prevent clotting, one sterile-taking set which comprises of a rubber bung with two glas tubes passing through it, one through which the blood flo"\ys and the other acts as an airIet and is closed by a plug of sterile wool. Attached to the first glass rube in the rubber bung, is a length of rubber rubing broken in the centre by a glass inspection rube. At the other end of the rube is the large-bore needle coyered by a sterile tube. Procedure. The donor registers at the reception desk and is handed a label on which is the donor's group, name and address, and two test rubes plugged with sterile wool. One tube is empty and termed " the dry rube," the orher contains normal saline and is called" the wet rube." The donor proceeds to tbe couch where the blood WIll be taken. The site at the internal aspect of the elbow is cleansed, coyered by a sterile clorh with a round hole cut in it and the exposed area covered by gauze. ~ext a sphygmomonometer is placed in position o\-er the brachial region, inflated until the reading stands at 100, and acts as a tourniquet. \'{nen the surgeon arriyes he remoyes the glass cm-er from the needle, the gauze from the site, and gi\-es a local anresthctic, after which the large-bore needle is put into the yein. At this point tbe " sphygmo " pressure is reduced to about go and the taking equipment is fastened intO position with a special clip until the borde is filled, then the needle is remO\-ed and the arm dressed. \\"hen the blood has been giYen, the donor is rested for abom IS minutes and is gi\'en a cup of tea and a biscuit. You may be wondering what has happened to the two test rubes which [he donor brought in with hin1. A specimen of blood is put into each and the " \\"e~ " tube attached to the borde, this ,,-ill be used to cross-group the blood before it is used. The" dry" ' tube is taken to the laboratOry and the group checked . •\1so a " \,'assaman reaction" is done to detect the presence of veneral disease. If the reaction is positi,e the donor is sent for and referred to a special clinic. Distributioll oj Blood. The British Isles is dh'ided intO numerous regions, each of which has a Regional Blood Bank. The region is sllb-divided into areas which has its own blood bank, usually siruated at the local hospital. In each region are mobile blood transfusion units which visit each area in turn. ~. hen the mobile unit has finished a session the local hospital takes what blood it requires, the remaindcr being sent to the Regional Blood Bank by special ,ans.

(Colllinued Oil page I I.)

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PRACTICAL NURSING IN Til E I-l OME BY

AGNES E. PAVEY, S.R.N. D iploma In Nursing (University of Lond on)

rule to record in the written report that a patient has been THE APPLICATION OF HEAT. THE home nurse may often be called upon to give a given a hot water bottle, mentioning the area to which it treatment involving the use of heat either to a part, has been applied. There are several good substitutes for hot water bottles. or to the whole of the body, to apply a poultice or a fomentation to a painful area, or to rub in a liniment. She will One of the best is a bag filled with salt. This can be heated carry out these treatments more confidently and successfully in an oven, and it is particularly good for application to the if she understands what result is desired and how this can lower part of the back in lumbago or sciatica. It holds the heat well and it fits snugly into the hollows of the body. be ensured. Bran bags can also be used, and it will be found that an The effects of heat applied to a given area are: (r) to ordinary brick will retain heat for a considerable time, but increase the blood supply to the superficial tissues and, it needs a fairly thick cover. thereby, relieve congestion or pain in deeper seated structures ; (2) to increase the numbers and activities of ELECTRIC PADS. As with all electrical appliances, the .whit.e blo?d cells in. the area and thus to aid the fight ~hese pads are not easy to obtain at the present time, but agamst mvading bactena, or germs, and to quicken the if they are really needed they might be lent out by a District removal of waste material or the products of inflammation ; Nursing ~s s ~ciation <?r the Red Cross organisation. They and (3) to soften tissues and exudates from them, and to are made ill different SIzes. Those for application to the eye increase drainage from a wound. or the ear may be only a few inches in diameter, whereas Heat may be applied either in a dry or a moist form. the largest sizes may be 24 by r6 inches. They are fitted with D ry h eat is less penetrating than moist heat and as air is a a thermostatic control which operates within a vacuum, poorer conductor of heat than water, dry heat can be used and the insulation of the wires in an asbestos sheath makes at a much hotter temperature than moist heat. The degree short circuiting impossible. Nevertheless, the pads should of h eat that can b~ safel? used, however, is dependent be protected from moisture and the nurse should see that ~pon other f~ctor s m ad~tIon to the form of the applica- her hands are dry before handling them. In cases where tlOn. T~es e lI~clude obeSIty, .oedema and any impairment they are liable to become wet they should be encased in of the cuculatlon. .~ealthy. tissues withstand temperature a wa~e~pr~of c~)Ver. The advantages of an electric pad are changes better than mJured tissues, lnd if the skin is broken that It IS fauly lIght and flexible and can be kept at a uniform temperature. it is important that all materials used should be sterile. The application of heat may be combined with chemical ELECTRIC BLANKETS. These are constructed with agents which act either as antiseptics or as counter-irritants. the same safeguards as electric pads. They are used to The latter redden the skin more quickly than an application combat shock, but also to relieve pain in rheumatism, of .heat alone, ~nd~ because of the similarity of their lumbago, sciatica, neuritis and other conditions wherein actions, the application of heat and of counter-irritants are the application of heat is attended with good results. often described in the same context. RAD IANT HEAT LAMPS AND CRADLES. The HOT WATER BOTTLES. This is the most available lamps are ~sed for treatment to one area only, such as the means applY0g dry heat to a localised area. They are lumber reglOn or a painful joint, whilst the cradle is used used mamly to glVe comfort, but they also relieve pain or for the whole body. The same principles and precautions soothe and relax superficial tissues. Care must be taken apply with both, so that only the use of the cradle needs to avoid burning the patient. A rubber bottle is the most discussion here. When using hot water bottles or electric suitable type. It must be examined for leaks or weak rads or blan~ets , the heat is transmitted mainly by conducplace~ ,. and it must be seen that the washer is in good tlOn,. but radiant heat appliances give off heat by radiation, conditlOn and that the stopper fits tightly. It should not and .infra-red rays from electric bulbs arranged in rows on be filled more than tw~:)-thirds full, .and air must be expelled ~he mner surface of the cradle. Such a cradle may be used before the stopper IS screwed m. The cover should ill the ~reatment of shock, especially after such accidents as completely ~nvelop. the bottle, including the stopper and ~rowrung or severe exposure to cold . They are used also the. har:cile, if oue 1~ present. The temperature should be ill the treatment of any condition wherein heat is a curative mamtamed at a ±a~rly constant level, the bottle being factor, the type of bulb used determining whether only refilled as often as IS necessary. Such importance is now heat rays are. glVen o~ or both heat and actinic rays-the attac~ed t~ the care needed in order to avoid bottle' burns, latter producmg cherrucal changes in the tissues or inhibiting espeCIally ill elderly people, that in most hospitals it is a the growth of bacteria.

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The patient's clothing is removed and he lies between blankets. If the whole surface of the body, with the exception of the head, is to be treated, two cradles will be required. These are placed over the patient and are covered by a blanket and a quilt which are tucked in at the bottom and sides of the bed . A thermometer is suspended either between the two cradles-in which case two folded blankets are used which ov erlap in the middle, or from the top of the cradle neares t to the patient'S head. The temperature at which the treatment is given is ordered by the physician. It may be between r20 and ISO deg . F. It is the nurse's duty to see that it is maintained at the correct level. If the patient's body is to be exposed to the rays, the top of the blanket covering him is tucked around his neck and the res t is drawn out and placed over the top of the cradle. A small towel or a handkerchief is placed under the patient' s chin to avoid irritation from the rough blanket.

The duration of the treatment is usually 2 0 to 30 minutes, during which time the patient should not be left. A cold compress applied to his forehead and sponging or fanning of the face will give comfort and prevent headache, and hot or cold drinks may be given. The patient's colour and pulse rate must be watched. SE SITIVITY. It sh ould be remembered that individual differences, the area treated and the amount of moisture present in the air or on the skin, are factors that influence sensitivity to radiation, and must be taken into account when deciding the intensity and duration of the treatment, in order to av oid burns. The skin may be p owdered, but no greasy preparation should be used following radiant heat treatment. Radiant heat lamps that treat a localised area only need to be used with the same precautions as radiant heat cradles . (to be continued.)

P ractical Points

Patient able to walk from ambulance. Preferred to sit in chair rather than lie on bed. Complained of " stiffness of arms" and pain " at back of neck."

CRUSHE D FINGE R Case.-Workman trapped finger between two heavy castings . There were lacerations of tip and partial removal of nai l of second finger L. Pain was severe and tenderness over distal phalanx so pro nounced that patient was reluctant to allow it to be dressed . Fracture of this phalanx was suspected. Patient was vel-y pale and complain ted of faintness being slightly shocked. H remorrhage was no t such as to cause any alarm . Treatm8nt.-First given drink of warm sweet tea, wound being covered by sterile gauze. \X1ound was then washed in Dettol solution and an acraflavine dressing applied. A generous pad of cotton-wool and bandage completed the dressing. Some time later when patient had recovered from his shock he was sent to hospital, w here crushing of the finger was diagnosed . Practica! Poill/s.- N o hurry in sending patient to hospital. N o finger splint applied, since it appeared that only distal phalanx was inj ured. CHILD WITH LEG IN JU RIE S Casf.- Child run over by milk-float with rubber tyres. Road newly tarred and pebbled . Child \vas picked up by bystander and brought to the amb ulance room at works . History was conflicting, so decided to ignore same. Both leg bones were exposed, muscle was torn and pushed right round to opposite position. T endon appeared torn , bone (tibia) had a small piece taken out long-wise. Foot laying ou twards, b ut did not appear to be fractured, so decided the ligaments were torn. D ozens of pebbles in wound and bleeding freely, suggested anti-tet. in jection. Practical poillts.- D ecided that removal to hospital as soon as possible was essential. Packed wound as thickly as possible and then splin ted same and tied both legs together. Examined fo r further injuries while waiting for ambulance. Fo und none. Child refused drink, but insisted on keep ing his chewing g um, so let him . On admittance to hospital was g iven anti-tct in jection before operation . Diagnosis was as thoug ht w ith the exception that the ankle joint may have been fractured. FRACTURE OF CE RVICAL V E RTE BRAE Case.-t-.fan fell from bicycle. Sustained head wound which was sutu red b y a local doctor. Complained of tendernes s over cerVIcal verteb rae.

X-ray diagnosis showed a fracture of a process (spinous ?) Practical Point.-Patient could and did walk and definitely refused to lie down. Shock was not at all severe.

2/6 has been paid for each of these itelJJs.-Editor.

The Nat ional Blood Transfusion Service (Continl/ed from page 9) A t the local blood bank whole blood is kept for a period of time, usually three to fou r weeks. After this time the surplus is returned to the Regional Blood Bank where the red cells are extracted leaving the straw-coloured fluid known as "Plasma." Some of the plasma is dried and stored in powder form. During the war tons of dried plasma was sent ou t to the battlefields as this was the most convenient way of transporting it. What is the use of these forms of human blood ? Whole blood is used to replace blood lost in accidents, etc., and also in cases of anremia. Plasma (liquid and dried) can be used for many things, the most important being the treatment of shock, and in cases such as cl'Ushing injuries where there is serious loss of body-fluid. The Future of Blood TrallsfllSioll . There have been a number of ideas o n this subject, but when we consider the growing import~nce. ~f blood transfusion and the time taken in grouping, I do not thtnk It IS an absurd suggestion that the blood group should be determined at bi rth and a space provided for same in the Identity Card. . I unders tand the military authorities already have some such system in operation . A nother improvement would be the establishment at the local hospitals of a team trained in blood transfusio~1 work who are re~dy to travel to any pa rt of the area at any time to gl\'e a blood transfUSIOn on the call of the medical practitioner. This team could be made up of the hospital pathologist, a sister and Red Cross and St. J ohn members.

FIRST

AID

FIRST

Letters to tbe Editor. FIRST AID IN SCHOO LS DEAR SIR, You suggest in your leading article that first aid should be taught in schools and that everybody ought to learn some first aid. May I suggest that this is a most questionable ideal ? Already there are too many people who claim to "know" the subject and whose claim is based solely on their having taken a St. John or B.R.C.S. certificate many years ago. These people retain only the haziest knowledge of the subject and their practical experience consists of a little desultory bandaging before their examination. These people learnt some mathematics at school but would modestly deny that they were mathematicians. Yet, with no more foundation in fact, a surprisingly large proportion claim to be first-aiders. Confront them with a case of corrosive poisoning, unconsciousness, or protrusion of abdominal viscera and how would they (and the patient) fare? "Knowing" first aid they have complete confidence in their ability with potentially disastrous results. On the other hand a person with no such pretentions will, in an emergency, do the obvious and right things: call an ambulance and doctor and hand the case over to a practising first-aider if one arrives. I recently posed ten simple questions on the St. John" Black Book" to one such claimant. He was unable to answer one, but confidently assured me that first aid was just based on common sense. I assured him that I had never studied surgery but as that was also based on common sense would he feel safe if I attempted to remove his appendix ? Of course, the ranks of the S.J.A.B. and B.R.C.S . would doubtless be slightly increased by universal tuition in the sub ject; but at what a cost! Again, as to the advisability of the subject being taught in schools, let us remember how many people have a lifelong aversion from Shakespeare through being forced to read him at school; and how many people read Algebra, Biology or Latin in adult life ? No, sir : there are already many inefficient and therefore dangerous first-aiders at large in the community. Let us not add to their numbers but instead wage an active campaign for members for those two organizations in which men and women not only learn but also. maintain their efficiency in first aid. LONDON, S.W.20. Yours faithfully, 27 th July, 1947. F. R. FREWIN. Our correspondent's statement that there are many inefficient and therefore dangerous first-aiders at large surely points to the need for a wider education in first aid. Our view is that universal tuition would give people knowledge and confidence in handling an emergency, we do not suggest that they should go round practising first aid on the strength of a little teaching at school. That persons with no knowledge of first aid always do the right thing in emergencies is open to doubt; we are confident that they are more likely to keep their heads and make themselves useful if they have some knowledge of first aid at their command, and they will appreciate all the more the need for expert help. There are probably some to whom such teaching wou ld be dangerous, but we contend that to the majority it would be an advantage. As to aversion from being forced to study the subject at school, that is largely a matter of teaching, and in our experience most children respond enthusiastically to first aid training. We ourselves at school did worse at mathematics than any other sub ject, and while we do not claim to be mathematicians, yet we picked up enough to know what change to expect when making a purchase. But when the intricacies of Income Tax are involved we call in the expert. That is the benefit of being taught mathematics! However, we invite readers' views on the subject, and particularly ask those who have taught first aid in schools to give us the benefit of their experience.-Editor.

li IQ.,. : ;-,.\" ,;~.~, -.},;~!~"(~A~<:~(;

Uniforrrz by Garrould

AID

: ','

:: : "-"

: ;,~~':~ . .. ...... : '.' . ~

'E f F! C I E NT L Y . ".> ...... E I 'e ~.1 '

•

, '

•

SURGICAL INSTRUMENTS

•

S'URGICAL APPLIANCES

•

FIRST AID eQUIPMENT

'S p\V t ......

The cut. style. and fine workmanship always distinguishes a Garrould Uniform from any other. Great care and attention is given to every detai I. We have such a Wide range of scientifically graded stock sizes that 90 per cent. of our customers are able to obtain a perfect fit.

•

MEDICAL REQUISITES

•

CHEMISTS SUNDR.IES

.~.

S.J.A. DRESS for Officers and Ambulance Sisterl. Made from good quality Sanforized-Sh-unk material. Bodice unlined, Women's sizes 33/-. S,J.A. APRONS for Ambulance Sisters . Made from hardwe aring linen fin is hed apron cloth. Price includes cross. Waists 26 , 28, 30 ins. '. B/ II Waists 32, 34,36, 38 ins. 9/ 11 In Lengths 26 . 28, 30, 32 ins. S.J.A. B LOUSES for Officers and Ambul ance Sisters . In Ivory Tricoline 25/- (4 coupons) . Extra Collar 314 ~ (I oupon). Sizes 13 t, 14, 14 ~ ins. Size 15 ins. 26/-. Extra Collar 3tH. (Civilian coupons must be surrendered for blouses).

120 YEARS'

Even a pin prick can turn septic!

S.J.A. CAP for Ambul a nce Sisters . Embroide red cross on front.

27 x 18 ins. or 28 x 19 ins. 3/3.

All prices are liable to advance without notice. Numerals obtainable (rom headquarters.

S.J. A. REGULATION COAT. Cut and tailored from fully sh~unk and showerproofed material, half lined . An official order for H .Q . to supply us with buttons must be sent with every order.

Women's £5 . 16. II . STOCK

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All grazes, cuts and burns need cleansing at once

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Wm 's- Bust 32, 32, 33, 34, 35, 36, 36, 36, 37, 38, 38,39, 40, 40, 40. Length 44, 46, 44, 46, 'IS, 44, 46, 48, 47, 46, 48, 48, 44, 46, 48.

PADdington 1001.

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Keep MILTON handy to kill the germs and help healing.

in supplying first - class dressings for the medical world.

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Prices of Officers' Uniforms and other items not mentioned in this advertisement sent on request.

S.J.A. HAT for Officers and Ambul a nce Sisters . 18/ -. Box and postage 211. Badges obtainable only from H.Q. Hats stocked in sizes :_ 6;}, 6i , 6lt, 6i, 7, 7~ , 7;}, 7! . Storm Cap 17/ 11 . Box and postage 1/4.

. .:" .

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FIRST

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FIRST

Queries and Answers to Correspondents

S.J.A.B. POSTERS STOCK

QuerieJ I))ill be dealt ll1ith under the following ruleJ : I.-Letters containing QUf11-ies must be marked on the top left-hand corner of the envelope" Query," and addre.fSed to " Fir.rt Aid," 46, CannonJtreet, London, E.C. 4. 2.-AII Querie.r !/Just be l11litten on one side of paper on&. 3.-AII Queries !JIust be accompanied by a " Query Coupon" cut from the current isme of the Journal, or, in case of Queries fro 171 abroad, from a recent issue. 4.-The Textbook to )1Jhich reference may be made in this column is the 39th (r937) Editioll of the S.].A.A. Manual oj First Aid to the Injured.

Wound by Pen Nib

D. H . (Bath) .-Also, how lvotlld )'Otl have treated a la1J, 11)ho accidentallJl pushed the nib of her fountain pen into her finger? There 11)aS ink on the nib. Your tlsual clear ndings on both qtleries will be greatlY appreciated.

The ingredients of writing ink consist of certain derivatives of iron with the addition of colouring agents and a little g um which prevents the liquid flowing too freely. These substances in themselves are not poisonous, and are not likel y to have any harmful effects. Wounds caused by pen nibs, therefore, fall within the category of " punctured wounds" and should be treated as laid down in Chapter IX of the Textbook.-N .c.P.

Size-30 in. x 20 in.

Printing S pace-16 in. x 14 in .

Suitable for Concerts, Meetings, Socials, or any other function . A local printer can fill in the blank space with any required matter.

AID

A HINT TO HELP

SI(IN TROUBLE HEAL QUICKLY

Vomiting with Fractured Jaw A. K. (CheaJle Hulme).-At a recent Divisiollal Practice one member asked why the Textbook all page 71 tells us : " 5. . . . film bead to the sound side . . . " He said he failed to appreciate that allY point l11O!'(ld be gamed by " turning" tbe head) claiming that an "inclination" or "bending" oj the head to tbe sOlilld side could be better understood. We await )'our explanation l/lith interest.

With a fractured jaw there is likely to be a considerable degree of shock in which case the patient would be kept lying on his back in accordance with the instructions on page 44 of the Textbook. Once this is realised by your fellow member he will appreciate that the movement of the head is most definitely a turning and not an inclining or bending one.- . Corbet Fletcher. Fracture of Jaw A. K. (Cheadle IIulme).-Another point raised in discussion at Divisional Practice 1))as lvhether or no it is correct fo believe that, OJving tn the thinness of the tissues cOl'etil1g the 10111er jalV, a fr'acture of that bone is invariabljl COllipound, /lever simple. Your kind help lvill be llIuch appreciated, as it is invariablY, month by month.

It is possible to meet with a simple fracture of the jaw although the compound and complicated varieties are more common, or as the Textbook (page 70) puts it-" irregularity of teeth crevities and bleeding from gums are the usual signs and symptoms."-N.C.F.

I What a gr at ifyin g

S.J.A.A. Classes in War

experience it is to find that the skin no longer irritates, and has become clear and h ealth y aga in. G ermol en e h as hel p ed many a skin sufferer to get rid of his, or her, complaint ... and it is interesting to kno w wh y t his should be so.

E. R . (Swansea).-I halJe been reading )'our Queries and AflJ11 lerS to Correspondents in reference to S.IA.A. Labels and Aledallions, a1ld T should be ve,), grateful if )'OU could clarify the position iJ/ regards to some of our members inc/uding /lI)ISelj. The position is as follol1 Js, taking JJl)lselj as all exomple: I started taking S.J.A.A. instmclion in 1935 and kept at it 1Ip to the present moment.

Tn r940 T had a Label, also in 1946 and 1947 ; but in 1940 1] l e IJ lere told that lve were not allOl1Jed to sitfor an)' examillationfor jilrther Labels, because of the 11lOr. Therefore, members feel very dij·turbed oper the question that there is no practical recognition from the S.].A.A . in regard to the Labels of 1940 to 1945, as they claim tbat tbey did very valuable service as first-aidtrs, very often wider t')ling conditiolls. I hope that you can give me and my fellOJv members some satis/actory answer.

PROTECTIVE

Your query has been passed to the Principal Secretary of the Priory for Wales to whom we are indebted for the following reply: "It is difficult to see how anyone could have been under a misapprehension that St. John Classes were suspended from 1940 to 1945 as the number of students taking courses of instruction in those years far exceeded pre-war records. During the period when, owing to shortage of metal, it was impossible to supply awards to those qualifying for medallions, labels and pendants, token cards were issued; and many thousands of these have been redeemed since bronze and silver-plated 'awards have become obtainablc."-Editor.

PENETRATING

Examination Howler

It is the penetrating power of Germolene which enables it to sink right in through the top skin into the true, hving skin below- and so to reach the tortured nerve endings- which brings such wonderful relief.

M. R. (Cannon Street).~In a recent examination I asked a candidate how she would treat a patiellt lvho had splashed both his eyes with sOllie corrosive alkali. I Ulas flabbergasted ,v/Jen she replied, " I would bathe the I!yes Jl1ith oil of vitnol and lvater (one part in four), and ask patient if the pain had been relieved thereby ! "

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

D. H. (Bath).-When called upon to treat an insect bite I discovered that my alJlfJ/onia bottle lvas empo'. [Would I have done lvrol1g had I used aml7lonia from 1)1)' SllJeI/1J;g salts ?

As the strength of the ammonia in the smelling salts is an unknown quantity it is wiser for you to use the remedies named in the Textbook (page 181) and not to experiment with the ammonia in your bottle of smelling salts in the emergency treatment of insect bites.-N.C.P.

Treatment of Hysteria T. B. (New Cross).-I l1'Oltld be obliged if )'OU n'ould inforlll ?JIe ,vhether or not pressure on the supra-orbital nerve can bring about tbe cessation of a/1 altack of h)'Steria.

If so, do you approve of this method, and does it cOllie l1JithiIJ tbe scope of first aid ? Pressure on the supra-orbital (or any other) nerve can ha\'e no direct effect on an attack of hysteria. The pressure causes intense pail1 and is said to be used sometimes in all-in wrestling in an attempt to distract the attention of an opponent and so to induce relaxation of his efforts. In like manner, pressure on a nerve with its resultant pain may cause a victim of hysteria to think of other things and so give the appearance of a cure. It is, however, not in any wayan improvement or the treatment laid down in the Textbook, and you will be wise if you content yourself with what is taught thercin.-N.C.P.

The purifying effect of Germolene penetrates down in ~ o the sweat pores, htir follicles and sebaceous gland" counteracts th_ activity of skin germs, reduces inflammation, I f you are suffering from skin trouble get a tin of Germolen= today! I 4 & 3 3 incluiing Purchase Tax.

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(je~PTI C

OINTMENT

Three children (aged 3t to 5) bad unearthed a waspr' nest at tbe rear of 01lr houses. The ten·ijying yells of the children who 111ere being badlY sttlng naturall), called our attention. The most serious patient IVas the youngest child oj 3i, lvbo) clad ill a bathing costume and salldals, lVas literallY and absolute(y covered from head to foot 11,i!h lvasps crmvling all over hilll. You could Itot ree the child's hair! His motlth) if he opened it, lvas just entered by hosts of them. Neighbours) parents) first-aiders, were staggered at the sight. But bOll) to treat him? HOlV to get rid of the lMSPS ? Bat them away and )'OU ,vere stullg allover youTJe!f! In the end we tried anything and everythi1lg, including a nearby hose pipe to 11Iash the" beggars" awa)l. The child lvas eventuallY freed and treated for the stings and shock, and after,vardi man)1 oj us lvellt bome to treat our own stil1gs and to do some serious thinking as to hOlv on earth such a terrible plight ought better to be attended to ill the future. I lvotdd lve!c01Jle )lour recommendations. The children were onlY tlva minutes alMy from home, and five minutes to a doctor's house. We used all! But the incident could earil] happen right out in· the country 1'1lhere no or few appliances J])ould be available. I would like ),our recommendations for treatment for getting rid oj the wasps off the patient, and for destrqying the nest afterwards. Nleamvhile, please accept in advance my best wishes for )Iotlr cOI?Ill/ents .

Looped Bandage as Sling C. H. (Newtown).-Can J'ou please gilJe JIIe a ruling on the bandage looped round wrist ill trealment oj fractures of upper limb lvhen splint is not available, as laid dow1l 0/1 page 8 of tbe Supplement to Textbook ? I Sal1) this all aile oj the CD. Instructiollal Films but al/l not sure whether the loop lVas a clove-hitch or a half reef knot tied loosel]) as a single loop allows the hand to slop donln.

Nothing would be gained by using a clove-hitch, and if we bear in mind that a fracture is being treated we shall appreciate that the less the manipulation of the limb the better it will be for the patient. As a fact, you will find that if a turn is taken round the wrist in the form of a loop as taught in the Supplement the hand will not slip.-N.C.F. Humour in First Aid M. B. (Cambridge).-At a recent Divisional Practice a member was asked what he would do if he lvere called to a mall 11.J}0 was sleeping in a ditch and smelling of beer. Without besltation be replied-" I lvould l1'ake him up and ask bim lvhere he got it I "

Good I Next please I !-N.C.F. Compound Fracture of Tibia N. M. (Llanigloes).-In a recent competition the tealJls had to treat a Jllall suffering f1'Om compoul1d fracture of tibia with bone protruding and leg doubled up. 01lr team put up tbe fracture in tbe position as found alld also applied a l'ing pad. Was this treatment correct) because later ollr team was told that thry should have brought the leg into line with its fellow? We have looked up the Textbook and filld that on page 67 it states: "Do 1I0t attempt extension in the case oj a fracture lvhen the bone protrudes." If?'e shaJI be grateful for your comlJlentr.

In the leg there are two bones, anJ if one only is broken it is extremely unlikely that there will be any shortening of the limb. Your examiner, therefore, was quite correct in stating that the injured limb should have been brought into line with its fellow.- N.C.F. Action with Swarm of Wasps B. T. (Birmingham).-Last evening I had to render first aid to a somewhat unusual care) and one ill111hich one had largelY to improvise and act quicklY.

FIRST

AID

FIRST

This case was indeed a difficult one. Fortunately your training in first aid enabled you to remain calm and to render efficient assistance. Had there been a river or pond nearby the most effective treatment would have been momentary but total immersion of the patient. As river or pond were not available, your hose-pipe was the next best thing to use. Another alternative would have been to burn thick paper and so create a pall of smoke in which no insect will remain if it is in any way possible to escape. As to the destruction of the nest, this is a matter for an entomologist and does not come within the scope of first aid. Smoke or fumes from a "smoke" cartridge as supplied to horticulturists provide a safe method. Before, however, this has been inserted and fired, you must look out for the possibility of there being an alternative way of egress for the wasps.-N.C.F.

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ples free. " A "Tices, I I, Oaklands Grove, London, W. I 2. HOW to Stop Smoking. Save Money. Safeguard health. Thousands cured Send stamp for Booklet of World Famous Remedy. Stanley Institute Ltd., (Dept. 75) 265, Strand, London. RUPTURED? FORGET IT! Use Brooks Rupture Appliancethe new dlscov:ery. Wonderful! No lumpy pads, no springs, dura~le, cheap. B.1l1ds and draws parts together quickly. Sent on tnal. Catalogue free. Address: Brooks Appliance Co., Ltd. (7 18A) 80, Chancery Lane, London, W.c.z. (718A) Hilton Chambers, Hilton Street, Stevenson Square, Manchester, r.

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" FIRST AID"

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THE TRAINING OF FIRST AID COMPETITION TEAMS 2nd 2nd

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Their Cause, Treatment and Cure. A few of the Subjects treated: How to Keep Well, First Aid The Principles of Nursing What to Do in Emergencies The Eye, the Ear Influenza, Colds, etc. The Throat, the Nose Measles, Mumps, Catarrh The Chest, the Heart Corns and Warts The Stomach, the Liver Physical Culture The Teeth, the Muscles Treatment for all Skin Diseases Infant Welfare The Lungs, Pleurisy Homoepathy, Neurasthenia Hygiene, Anatomy, Pharmacy 375 Prescriptions, etc., etc. THE YOUNG WIFE will find just the information she requires. MOTHERS who wish their daughters to develop naturally will find exactly the teaching they need. WOMEN OVER 40 will find their difficulties regarding health frankly discussed. PRESCRIPTIONS-375 proved remedies. Hundreds of subjects.

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FIRST

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.'CaMIU PATENT

FIRST AID

"PORTLAND" AMBULANCE

Editor: DALE ROBINSON, F.R.S.A., F. S.E.

GEAR No. 640.-VOL. LIV.

The Gear Illustrated (A.B.C.D.) carries two stretchers on one side of Ambulance, leaving odler 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 .

Shows the top stretcherlowered ready for loading.

OCTOBER, 1947.

Entered at ] [ Stationers' Hall

PRICE FOURPENCE [5/- PER ANNUM, POST FREB]

fJONTENTS Editorial A Course in Advanced First Aid Ambulance Work in the Railways Letters to the Editor -

C. Illustrates the same Gear with the top stretcher frame hinged dow n 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 convalescent cases.

3 4 5 6

Epilepsy, Apoplexy and Hysteria Anatomy and Physiology in First Aid Practical Nursing in the Home Queries and Answers to Correspondents

7 8 12

NOTICE TO READERS. FIR~T AID i~ publis~ed on the 20th of each month.

The Annual Subscription is 59. post free; single copies 4d. . Its alll~ a.nd objects belng the advancement of Ambulance and F irst Aid Work in all branches, the Editor invites Readers to send Articles and R eports on subjects pertamm g to the Movements and also welcomes suggestions for Practical Papers.

Where Ambulances are required to carry four beds two Gears are fitted, one on EITHER SIDE. and the same advantages apply as described above.

Ail Reports. &c., should be addressed to the Editor at the address below, and should reach him before the 8th of each month d t b . d (not necessarily j or publication ) by the name and address of the Correspondent. ,an mus e accompame Subscriptions, Advertisements and other business Communications connected with FIRST AID should be forwarded to the Publishers. DALE, REYNOLDS & CO., LTD., 32, FINSBURY SQUARE LONDON E C 2 Telegraphic Addr=-" Twentll-joUT, F insqua re, London." ' • • •• Telephones-MONarch 1541 /2 .

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Even a splinter can bring trouble ! Sepsis often starts this way. All breaks ln the skin need lnstant cleansing.

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on your handkerchief Inhale freely and prevent infection

Keep MILTON handy to kill the germs and help healing.

Editorial About Ourselves

Advanced Course in First Aid," which are still continuing, attracted wide attention, and we have received many· YEAR ago we announced on this page some improve- letters of appreciation. The new series which commences ments we anticipated making consequent on the with this issue, too-" Anatomy and Physiology in First relaxation of restrict ions governing t he supply of paper, Aid" - has been prepared in response to many Unfortunately, those restrictions were not long relaxed. requests and we feel sure that it will be useful and instructhe chill blast of last winter's fuel crisis shrivelled our tive. In this matter of the selection of articles we have paper supplies once again, and the promise of a bigger been hel ped by the requests and suggestions of readers, journal could not materialise. We wish we could say an d it is always helpful to have their views on the value that future prospects are brighter, but it does not seem (or otherwise 1) of the matter we publ ish. For example, possible in the present economic position that more the letter we published some time ago from a reader paper wil l be readily available. Ind ications are that we suggesting that we might publish something on first aid must be content with a lean journal for some time yet, for animals was followed by a shoal of letters supporting but we can assure readers t hat our plans for expansion the idea. It was a subject which, we confess, had not will not be forgotten, and when the time comes we hope occurred to .us, although there was obviously a need for we shall be able to introduce many new features of some instruction in the matter . As a result of the corinterest to all t hose connected with ambulance work in respondence we were able to include some useful articles all its aspects . But this does not mean that we are putting (in co-operation with the P.D.S.A.. ) which, but for the into abeyance al l our plans for improvement. We mig ht hint from a reader, might never have appeared. We do not be abl e t o grow fat, but it does not mean to say t hat ask readers, therefore, to let us have their ideas and we cann ot be bright and interesting ! The general suggestions , and we thank them for all their co-operation approval w hich greeted th e recen t innovat ion in th e in the past. We offer our warm thanks, also, to those shape of a cover in co lour shows that reade rs have an branch secretaries and others who send us news of local eye for ap pearance, and t his aspect of the journal we are activities . Such items are not the least interesting of the kee ping co nstant ly unde r review. As regards the literary editorial content, and although we cannot as yet give all content s we have in preparation much that we be lieve the space we would like to this valuable feature, yet we will be of int erest t o our readers. In t he last year t he are always glad to hear what our friends in the various art icles "P ract ical Nursing in t he Home" and " An dist ricts (at home and overseas) are doing,

FIRST AID

A COURSE IN ADVANCED FIRST AID BY

A. D. BELILIOS, M.B., B.S. (Lond.) D.P.H. (Eng.) EMERGENCIES OF THE DIGESTIVE SYSTEM abdomen, great care being taken to avoid burns. Colic (4) Don'ts. (i) Don't give castor oil or other aperients TE of the commonest "Varieties of acute abdominal pain is known as colic or, in popular language, except in cases of poisoning by irritants. (ii) Don't give "gripes." It is that kind of pain :which comes and goes ~t food of any kind unless ordered by a doctor. (5) Observation. The pulse should be taken every quarter frequent intervals and from which e,ery reader of this article must ha,e suffered at some time or other in his life- of an hour and the results recorded. The temperature generally associated with ha"Ving eaten green apples or must be taken four hourly. Specimens of vomit and motions passed must be preserved for the doctor to see. taken a strong dose of castor oil. Colic is due to spasm of the in,oluntary muscle of the Particular notice should be taken as to whether the patient passes wind by the rectum. intestines, setting up irregular and excessiye peristalsis. There are many causes of colic. It is usually a symptom Acute Intestinal Obstruction. of gastro-enteritis which is inflammation of the stomach This serious condition occurs when there is an obstrucand intestines. This may result from eating decaying food tion to the free passage of digested foodstuffs, etc., along (ptomaine poisoning), certain fungi, e.g., toad-stools, or the intestines. It may result from disease in which the from taking irritant poisons such as iodine and arsenic. intestines become kinked. In these cases, diarrhoea and vomiting usually accompany The onset is usually sudden. The patient develops the pain ; there may also be a considerable degree of shock. coliey abdominal pain felt chiefly round the navel. This An important exception to the diarrhoea symptom, ne"Ver is accompanied by a desire to open the bowels or to pass to be forgotten by first-aiders who work in factories, occurs wind, neither of which acts are usually possible. in the form of colic due to lead poisoning when there is Vomiting soon follows. At first the contents of the obstinate constipation. stomach are brought up, comprising the last meal. Soon, Gastro-enteritis due to germs-infective gastro-enteritis however, the vomit becomes green in colour since it conas it is called-may occur both in adults and in children. tains bile; finally, it becomes brown, with a most It is then usually accompanied by a raised temperature unpleasant odour, suggestive of a motion and called f::ecal and may be an infectious ailment liable to spread from vomiting. one patient to another. In infancy it may end fatally. A "Variable amount of shock generally occurs at the Other causes of colic include gall-stones, stones in the onset of the disease. kidney, a certain form of appendicitis and intestinal FIRST AIDobstruction. Intestinal obstruction comes into the category of very FIRST AIDurgent cases for which it is essential to send immediately (I) lvledical Aid. Owing to the many causes of colic for medical aid. During the interval, the treatment for between which it may be very difficult even for a doctor colic can be undertaken. to distinguish, it is essential for every patient to obtain Intussusception medical ad"Vice as soon as possible. This is a form of acute obstruction which occurs in A problem that frequently arises in cases of abdominal pain is how urgently the doctor's services are needed. children, generally in infants about twelve months old. Many cases, for example, a perforated gastric ulcer, require It is caused through" telescoping" of a part of the intestine immediate medical aid whatever the time of day or night whereby one portion passes into another. The onset is sudden: the child screams with colic and and the same degree of urgency applies in certain cases of colic. -Usually, however, if diarrhoea is present there is draws its little legs up towards its abdomen to relieve the no immediate danger, but the wisest plan is for the first- pain, attacks of which occur at frequent intervals. Vomiting aider to make personal contact with the doctor by telephone is an early sign but generally does not persist. A characteror otherwise and describe the patient's symptoms as fully istic feature, not always present however, is that the infant as possible. By taking this course, the first-aider will passes a motion which consists largely of blood and slime. The sole first aid treatment is to send immediately for a relieve himself of responsibility and give the doctor an opportunity of deciding for himself ,,-'hether the case is one doctor. of real urgency or one that can wait at any rate for a few Hernia hours. This is what the layman calls a rupture. It takes the (2) Posture. The patient should be encouraged to lie in form of a swelling under the skin situated usually in the whatever position that gives him most ease. Pressure groin. The swelling is caused through the protrusion of usually relieves the pain hence many cases like to lie face some of the contents of the abdomen, intestines or fat, downw~rds with the abdomen pressing against the bed ; through an aperture in the abdominal wall. others like to double themselves up pressing their knees A hernia itself is not really a first aid condition ; usually into the abdomen. it comes on gradually and causes no symptoms apart from (3) Hot Applications. Hot water bottles, an electric inconvenience and worry. Occasionally, however, it heatillg pad or a hot fomentation may be applied to the develops suddenly and so alarms the patient that he seeks

FIRS T the adyice of a first-aider. All that is necessary is to reassure him that the condition is not dangerous and to recommend him to see a doctor. Strangulated Hernia If the contents of a hernia-intestines or fat-have their blood supply obstructed, a serious complication called strangulated hernia results, and produces acute intestinal obstruction. Strangulation may be caused by an extra strain such as coughing or lifting occurring in a patient who is already suffering from a hernia. The patient experiences severe pain in the swelling which soon becomes firm, tender and larger in size. A ,arring degree of shock occurs at the onset and soon afterwards the characteristic symptoms and signs of intestinal obstruction make their appearance. FIRST AID(I) ~Medical Aid. Strangulated hernia comes into the category of very urgent cases and the doctor should be sent for at once. (2) Position. The patient should be made to lie on his back with his knees bent and his head and shoulders raised, with the object of relaxing the abdominal muscles. In addition bed blocks should be placed under the foot of the bed or stretcher. (3) Cold Compresses. These should be applied to the swelling and renewed frequently. These tend to reduce the size of the intestines within the hernia, occasionally to such an extent that they will slip back into the abdomen and thus relieve the strangulation. (4) General Principles. Sips of water may be given but all food should be withheld. The patient should be made comfortable and treated for shock; otherwise the first aid treatment is the same as for acute intestinal obstruction.

AID

Appendicitis Infla~tion of the appendi"'\. is a ycry common disease, resp,?nslble for many deaths each year through failure to call ill a doctor sufficiently quickly. The complaint begins with pain in the upper part of the abdomen or around the na,-el. It is of a dull aching character and gradually moves downwards towards the right side of the lower part of the abdomen where it settles. Occasionally the pain is very acute like severe colic. Ac~om~anying the pain there may be nau ea, "Vomiting, constipation, an increased pulse rate and slight rise of temperature-but it is dangerous to rely on these additional symptoms and signs; in some of the \\"or t cases, the temperature and pul e rate are normal. If the disease is allowed to progress, the appendix becomes ,ery swollen and finally perforates, settinO' up acute peritonitis from which the patient may succumbb. FIRST AID\'\'hile awaiting the arri,al of medical aid, treatment as for peritonitis should be undertaken. Abdominal Injuries Injury to organs \\"ithin the abdomen, such as the Ii,er, spleen and intestines, may occur if the abdomen is crushed as in "run over" accidents or through complicated fractures of the ribs or pel'is. Particularly unpleasant are those injuries caused by gun fire since there may be penetrating wounds of the abdomen accompanied by perforation of the intestines. The symptoms and signs are generally a combination of shock with those of peritonitis and internal h::emorrhage. First aid consists of quick remO\-al to a hospital where medical services are a,ailable. During the inter"Val the patient should be treated on general principles remembering that internal hremorrhage takes priority o,er peritonitis. (to be continued)

Ambulance Work on Railways R AILWAYMEN throughout the Empire have always been among Illinois Central Railroad) publishes artificial respiration instructions in the first to appreciate the value of ambulance work. Railway first aid competitions were instiruted in Great Britain as long ago as 1896, and the ambulance organisation on the British railways has attained a high degree of efficiency, writes a correspondent in the Rhodesia railways magazine. The method of organisation varies a little in detail as between the four main companies, but the system on the London Midland ?nd Scottish Railway may be taken as fairly typical of the others in that the ambulance work is closely allied to the " Labour and Establishment" department, the Chief Officer of that department being Chairman of a central ambulance council comprising heads of departments, medical officers, and representatives from the salaried and wages staffs as well as officers of the St. John Ambulance Brigade. In the United States of America there does not seem to be any organisation comparable to either the St. John Ambulance or the British Red Cross Society so far as first aid work is concerned, though the" safety movement" is very keenly sponsored by various American railway companies which have issued special" safety" regulations which the staff are forbidden to contravene. Some of the companies compete with each other for a " safety" trophy awarded annually to the company with the lowest percentage of reportable injuries to members of the staff. evertheless, accidents do happen among the vast number of railway employees in America but, so far as can be gathered, there is no basic first aid system, though one company (the

its working time table for sections where electric traction is used. Turning to the Yictorian Railways in Australia we find St. John Ambulance work very much to the fore. _\nuual compecitions are held in which a good standard of work is displayed, and a recent innovation has been the provision of a specially-designed mobile " hospital" van for use in the event of a serious train accident. The ambulance organisation on the Yicrorian Railways is under the administrative control of the Chairman of the taff Berterment and Suggestions Board. Closely allied to the firSt aid and ambulance work on these railways is the organisacion on the South African Railways, where there are uniformed units of the St. John iunbulance Brigade. For administrative purposes of the Brigade there is artached to the Railway Health Office, the General Mal1ager holding the appointment of Commissioner. All employees on the South African Railways who undergo a course of training in various subjects at the Railway Training Institute are also instructed in first aid, while lady welfare officers and health foremen are required to hold the St. John Ambulance demonstrator's certificate in both first aid and home nursing. In a handbook published by the South African Railways it is stated the railway staff cc realise that even with the greatest care accidents are always possible and that lives may be saved and much suffering alleviated if those at hand are able to render prompt and efficient first aid."

FIRST

Letters to the Editor. FIRST AID IN SCHOOLS 01lr Editorial, lvir. FreJllin's lettcr alld our subsequent ref/larks seem to have caused considerable controversy and lve have had many letters 011 the su/{jcct. The lIl~jority of correspondents seem to favour the teaching of first aid to children lJ!hiist at school, but sOllie disagree. We publish a seleclion of opinions be/mv.-Editor.

DEAR SIR, Having read your Editorial column in the July issue of FIRST Am, I thought it might be of interest to know that the subject has been taught at this smallmral school for the last four years. I admit that hygiene was on the time table, but I could not resist the clamour for first aid. The older boys and girls were most keen and proved very dexterous, but since the I I plus pupils have been transferred to the modern school the scope has been limited. As an incentive to others I may add that for the last two winters, First Aid Classes have been held in this purely agricultural district, and over twenty have passed the First and Second Examinations. On Bank Holiday two teams had enough courage to compete in an important contest, and as beginners they acquitted themselves creditably. Yours faithfully, COUNTY PRIMARY SCHOOL, D. GLANFFRWD DAVIES, BONT, LLANBRYNMAIR, MON. (Head Teacher). DEAR SIR, I was interested in your Editorial for June where you ad vacated that first aid should be taught in the schools now that the school leaving age is fifteen. It may interest you to know that a short while ago I started first aid competition training for the boys of St. Marks College, Chelsea, where I am on the staff. I claim the following benefits from this type of training-science, hygiene, and dramatisation in competition work which plays a great part in school life developing self expression, and also makes a boy face up to the responsibility of making a decision. In addition it teaches a boy a subject second to none in usefulness, and above all instils the higher ideals of citizenship. I held a competition in June at the school which I believe was the first to be held in any school. The standard of first aid skill displayed by the boys taking part was very high and greatly impressed the spectators. St. Marks' boys are about to train for another competition that will take place shortly. ST. :MARKS COLLEGE SCHOOL, Yours faithfully, S.W.IO. L. J. COOK. DEAR SIR, I am entirely unable to agree with Mr. Frewin's views expressed in his letter under the heading" First Aid in Schools." It seems to me that the principles of first aid could very well be taught to childre'n, omitting all the fancy bandages and difficult medical terms. First aid is not in the least l1lysterious or difficult, or most of us would be unable to grasp it. Surely an average child could be taught tha~ ~ a burn the essential point is to e~clude air; that following an lnjury of some severity the patient must be rested, kept warm and given fluid; that in poisoning, copious draughts of milk or cold water are helpful; that a broken limb may be strapped to either the body or to its fellow ; and in all cases to send for a doctor, the police, or a nurse. Some of us who are memhers of the Brigade tend, in our enthusiasm, to get busy doing something in every case, forgetting that sometimes "masterly inactivity" is the wisest treatment. After all, useless mauling of the patient only increases shock. The Surgeon-in-Chief to the Brigade points out in one of his books that active first aid is

AID called for in only four conditions, viZ' : ha:morrhage, shock, asphyxia and poisoning. Again, the doctor in charge of our local A .R.P. first aid taught that the arrest of ha:morrhage and the treatment of shock had saved more lives than any amount of fancy bandaging. Therefore, I contend that although those of us who are members of the Brigade are required to know more, the little we do know is merely an elaboration and enlargement of Chapter 2 of our Textbook, and the teaching of the principles of first aid in schools can only result in relief in varying degrees, according to knowledge, for those who suffer mishaps. Yours faithfully, 179, GROVE LANE, A. ALLAN KERR. CHEADLE HULME, CHESHIRE. DEAR SIR, I am not at all in favour of teaching first aid in schools and consider that it should be left to such organisations as the Scouts to teach anyone interested. Also there are some alterations I would like to see in the" Brigade" to add some incentive to learn and improve the members' knowledge. Why not first, second and third class first-aiders and only those who are first class to hold N.C.O. ranks? The grading would, of course, mean a stiff examination for those wishing to become first class first-aiders, even more stiff than the Sleath Ghent. If it is considered that this would make too much work for the Surgeons, let them appoint examiners-no examiner to examine within his own area. Chevrons could be done away with and in their place put stripes similar to the R.A.M.C.-one for second class and two for first class. I am sure we should have more members attending classes if the grade system were adopted. What do other readers think? Yours, etc., 75, CUNDY ROAD, E.16. R. HILL. SIR, In my opinion your suggestion that first aid is taught in school is quite sound, provided that it is treated as a serious subject and not as in many cases in the past, as a hobby or a handicraft comparable with, say, home dressmaking or such. You state that many teachers are first-aiders and could give instmcdon in this subject. But could they? I have met with several instances where instruction was confined to reading from the Textbook, with little or no explanation from the instructor who invariably finished off each lesson with a recommendation to be sure to read your book if you want to pass your examination. So, too, with practical work. It usually consists of an endless repetition of splinting and bandaging stereotype fractures and wounds. Except to acquaint myself with the sequence of subjects called for in the examination syllabus, I seldom refer to any textbooks when lecturing on first aid and allied subjects. Let the teaching of first aid be carried out by qualified personnel who really can teach, and do away with standardised questions and answers. Those pupils who take their training seriously can, after gaining their elementary certificates, become student members, and by further study qualify for an Associateship in the Institute of Certified Ambulance Personnel. A qualification worthy of attainment as it places the holder in the top rank of first-aiders and ambulance workers. Yes, sir, if a comprehensive curriculum is drawn up, embracing the present-day scope of first aid, I agree with you, first aid in schools will be of material benefit. Yours faithfully, 17 1 , POWERSCROFT ROAD, L. COLE, F.r.C.A.P. CLAPTON, E.5 .

FIRST

AID

EPILEPSY, APOPLEXY AND HYSTERIA BY

J. W. SCOTT.

A S a result of talking to many first-aiders, also of looking through ~he pulse at the wrist, you can easily notice a quickening of the pulse, many text-books on First Aid, I think you will agree that the subjects of Epilepsy and Apoplexy, also to some extent, Hysteria, seem to be a little neglected, as if they were subjects wrapped in some form of mystery. Quite a lot of first-aiders have delved into other subjects to an extent well beyond what they have seen in most texthooks, but as far as the above subjects are concerned, they seem to have gone just as far as the book tells them, and not a step further. Of Epilepsy, the" Black Book" gives you eleven lines on information, of ApopleA'")', nine lines, and eleven lines cover Hysteria, so perhaps there lies the reason for the limited knowledge of our friends. I would like to enlarge a little on these subjects, because the first two are really serious ailments, and require very careful first aid treatment. With regards to the symptoms of Epilepsy, there is no need for me to dwell on these, as no doubt you know them all, the shrill cry, the fall, etc., except to point out that the patient makes no effort to save himself as he falls, whereas the Hysterical patient neatly always does do so, if he is going to fall. Briefly, an Epileptic fit is a result of a sudden discharge of nervous energy in the cortex of the brain; sometimes it is inborn, but in the majority of cases that are inborn, signs of Epilepsy show before the age of 20. So, unlike a good real gash in the skin, or a neat simple fracture to splint up, we have a complaint in which the patient, until he passes over the alarming stages of contortions and convulsions, is ahsolutely impossible to deal with, apart from protecting his head and other extremities from damage during the spasms. The" book" says that you must place some form of hard gag between the teeth to prevent damage to the tongue and inside of the cheeks. I suppose I have dealt with dozens of these unfortunate people, hut only in cases where I have been fortunate enough to be present at the onset have I been able to get the gag in. Most of you know that these patients seem to have much additional strength during the various stages of the fit, and it is just impossible to get a gag between the clenched teeth. It does save much damage to the tongue if you are able to get it in, though. The fits come on at all times, and apart from the usual signs, the patient may merely act in a vague manner, or just stop what he may be doing, and then continue his actions in a normal manner, quite unaware that anything out of the ordinary has happened at all. These come under the heading of minor fits, but may be the foretunner of the more serious type of Epilepsy. The importance of the sleep that follows the fit or fits as a rule, is very necessary because of the energy that has been used during the great amount of strain whilst in the convulsions. Every encouragement should be given to the patient to have this rest and sleep, not that he will need much encouragement. If it is his first " affair" he should he told to see his doctor as soon as possible; even if it isn't, he still should consult his doctor, although some of the old stagers seem to think it unnecessary, having been already, but in most cases they are waiting for further treatment or perhaps are under a kind of observation or test, to discover the result of some particular treatment. In any case the doctor requires to know exactly how often the fits occur, and to what degree of severity and length of unconsciousness, etc., for the purpose of his records. It is difficult to know the cause of Epilepsy. It may be through an injury, or the after effects of an injury, or merely fright, or anxiety. Insanity in the family is another cause, but just as often no cause can be found at all. While I think of it, if you are with a patient who is having one fit after another, by holding

just before he goes into the next fit. I have personally noticed this on more than one occasion. With regards to Apoplexy (or Intracerebal Ha:morrhage), we seldom find a case of this under the age of forty, and is as a mle caused by physical and/or mental excitement, hlemorrhagic diseases, alcoholism (chronic) or syphilis. The symptoms generally are as follows. The patient may feel giddy and become weak on one side or he may become unconscious and fall, at once. The speech may become indistinct until unconsciousness occurs. Breathing is nearly always laboured and slow, the cheeks puff with each expiration. It is nearly always noticeable that the limbs become paralysed on one side, and that the head or eyes are turned to the opposite side. In most cases a return to consciousness occurs within two or three hours, but the speech may be altered, or maybe indistinct. Even after two or three days, delirium may be present. Mostly the leg recovers before the arm, which sometimes remains powerless or rigid permanently. Treatment consists mainly of rest and apart from early removal to bed, complete rest, and as little movement as possible. Ice or cold may be applied to the head, and heat to the feet. Liquid may be given, on retllrn to consciousness, for which the patient will most likely ask. Of course, send for a doctor, especially if any return to delirium, drowsiness or vomiting occurs. Now for Hysteria. Occurring mostly in young adults-and adultsthis is really a nervous disorder. Treatment, in the" Black Book," consists of avoiding sympathy, speaking firmly to the patient and leaving said patient to herself. That is alright as far as it goes, but it is not always a young girl, and it is not always a case of merely losing command of one's feelings. Patient does not always fancy she is ill when she is really not. (I wonder why we use the word" she.") Primarily, Hysteria must be regarded as a disorder of the nervous system, and your first aid treatment must not, at first, be too drastic, because it is very easy to do much more harm than good. I am quite sure you will soon detect the malingerer, in which case you may start your" firm treatment," whatever that may be. When a patient goes to the extent of warming a thermometer up to show a fever or dashing up a few flights of stairs to get a nice palpitation, then surely that disorder requires a little more than a firm treatment. I would suggest a visit to a doctor or psychiatrist as treatment more fitting to the case. All sorts of things can be placed in the causes list-shock, debility, but mostly emotion, are all helpful to the cause of this disease. If your patient is with another patient, say, in a factory accident, then do your best -to have her, or him, removed, and kept away from the other patient or patients, as they rather tend to make matters worse both for the patients and you. :Mind you, there are more advanced stages of this disease. We have patients that do go insane as a result of a severe bout of Hysteria, and quite demented. But they are rare because they are mostly chronic.

Will Readers and Advertisers please note that our address is now 32, FINSBURY SQUARE, LONDON, E.C.2. Telegrams: Twenty-four Finsquare London. Telephones: MONarch 1541/2.

FIRST

AID

ANATOMY AND PDYSIOLOGY IN FIRST AID

S~l't0nal

The first instalment of a new series by J. WELLS, M.R.C.S., L.R.C.P.

ANTISEPTIC & OINTMENT

I - these articles it is hoped, with the addition of some elementary anatomy and physiology, to make the study of this important subject more definite and interesting to the student. By this method of teaching first aid, the student obtains a mental picture, when taught with the aid of a skeleton ; e.g., the subclavian artery lies on the first rib, at the junction of the inner and middle thirds of a line drawn from the mid sternum to the outer edge of the shoulder joint. This is its anatomical position and can be demonstrated on the skeleton and seen by the students. This position can also be marked on the living model with a skin pencil. As another example, the occipital artery, nerve and vein lie in the occipital triangle. The mastoid portion of the temporal bone is a definite bony mass behind the ear. To apply digital pressure to the right occipital artery, place the left thumb on the mastoid portion of the right temporal bone and drop it downwards and backwards towards the spine. The thumb can then be felt to fall into the occipital triangle. This again is its anatomical position, or again the position of the heart in the thorax, uncovered by lung, can be marked out with the skin pencil' on the living model by the lecturer. This also shows the position of the heart apex beat. If the heart is normal in size and position, the apex beat of the heart is in the fifth left interspace 3t inches from the mid sternum. This again is its anatomical position and by placing the palm of the hand over this area, the apex beat can be felt. If the ear is placed on the chest in this area, the heart sounds c~n be heard. T.he sounds are caused by the opening and closlDg of the mltral valve of the heart this valve being placed between the left auricle and lett ventricle. With this extra knowledge, the first-aider will feel much more certain of his ability to treat his patient correctly and also retain that which ~e is taught. It should always be remembered by the first-alder that first aid has its definite limitations. His duty is to render efficient first aid in cases of accident or sudden illness until a doctor arrives or failing this, to see that the patient has been transpo~ted to the nearest hospital in all serious cases.

Anatomical Position of Body for the Purposes of Description .For the purposes.of description the body should be erect WIth th~ arms hangIng by the sides, the palms of the hands placed lD fro?t. The middle line of the body may be defined by a line through the centr~ of t~e head, vertically downward through the body to a POInt ffildway between the feet. The Skeleton The bony framework on which the human body is moulded. It serves to ;(1) Give shape and firmness to the body. (2) Afford attachment ot the muscles. (3) Protect it?portant organs, e.g., in the skull, the brain and merunges, and important blood-vessels. In the

thorax, the lungs and pleura, the heart and important blood-vessels and nerves, in the pelyis, the bladder, intestine, important blood-vessels and neryes, and in the female, the uterus and oyaries and broad ligaments by which the uterus is suspended. Skull Bones Two groups :(I) Those of the cranium. (2) Those of the face.

AID

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!loa{a( ]JolZe

orbit Occ1jl.zla[ 80ne

17 asfoid Porlion of empora/ Bone

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IOlller Jaw

FIG. I.-The Skull (side view).

BOUNDARIES OF THE CRANIUM.-The right and left parietal bones of the cranium form the vault of the skull ; the frontal bone or brow, forms the forehead, and the occipital bone is situated at the back of the head. On the right and left sides of the head are the right and left t~mporal bones in which can be seen the openings of the nght and left external meatus of the ear, with a short bony canal Ii inches long, leading down to the drum of the ear. THE BASE OF THE SKULL.-If the bony skull is sawn a!ound its circu~erence at the level of the supra-orbital ndge, and then lifted off and the brain removed, the base of the skull can be seen. It is the part inside the skull on which the brain rests, and it is when one of these fragile bones is cracked or fractured that a fracture of the base of the skull occurs. THE BONES OF THE BASE OF THE SKULL ARE : (I) The sphenoid. (2) The ethmoid . (3) The temporals. (4) The occipital. THE BONES OF THE FACE ARE : (I) Two superior maxillary bones, forming the upper jaw, and the greater part of the hard palate, or roof of the mouth. In them are fixed the upper teeth. (2) Two palatal bones, which form the harder part of the palate. (3) Two nasal bones, situated between the sockets of the eyes. (4) Two lachrymal bones, two small bones, very near the nasa~ bones, being separated from them by a narrow portIon of the superior maxillary bones.

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NAVIGATION ON THE ROAD? When the Queen Mary enters a busy port, she aud all the other vessels obey the recognized lights and signals on which safe navigation depends. We, too, obey lights and signals - and rely on them for safety - when we drive or ride or walk on the roads. We are, in fact, "road navigators." Modern traffic simply could not work without a set of rules which we all accept. Why, then, are there still accidents - far too many? Partly because we don't all know and understand the rules and principles Elf Road Navigation. And even if we know them, we forget or ignore them. And partly because some of us don't yet realize that the rules apply to everyone - walkers as well as cyclists and drivers. Any of us can cause an accident in which we or other people get killed or maimed. If we all understood the principles of good Road Navigation (based on the Highway Code) and obeyed thema/l the time, traffic would flow faster and more smoothly. We should all get about more easily and, above all, more safely. By learning to be skiiful Road Navigators, we can help ourselves and everyone else to get home safe and sound.

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(5 ) T wo inferior turbinate bones, which' project into the nasal cavities and are scroll shaped. . (6) One vomer bone, a very thin bone, which separates the nasal cavities . (7) Two malar or cheek bones. These help to form the sockets of the eyes . (8) One inferior maxillary bone or lower jaw-the largest bone in the face. In it are fixed the lower teeth. It is the only movable bone of the skull, at its upper ends it gives off processes, which form joints with the sockets in each temporal bone. T HE BONES WHIC H FORM THE ORBITS OF THE EYE BALLS

skull, and owing to this forming a joint, it allows the nodding movement of the head. Owing to the atlas forming a joint with the axis, it permits of the side to side movements of the head, and the turning of the head backwards, so that when fully turned back, we are enabled to look over the shoulder to which we turn. If these joints were not present the head would be fixed to the spine, and we should then only be able to look straight ahead, nodding and turning of the head being impos sible. If we remember that " AT" in the alphabet comes before " AX,'~ this will remind us that the atlas is the first vertebra. If we draw the finger firmly down the spine from above, we come upon the first most prominent spinous process, ARE : this is the seventh cervical vertebra, therefore the next (r) The sphenoid. spinous process below this is the first dorsal vertebra, and (2) The fro ntal. The upper portion. in this way the vertebrre can be felt and numbered. (3) The lachrymal. The inner portion. There are twelve dorsal or thoracic vertebrce, from each of (4) The superior maxilla. The under portion. which proceed a pair of ribs, numbered from one to twelve The outer portion. (5) T he malar. The Vertebral Column, Back Bone, Spinal Column, on each side. The upper seven pairs are called the true ribs, because they are attached by their terminal cartilages or Spine This is made up of bones called vertebrre. Each vertebra to the breast bone, the sternum, a dagger-shaped bone with the consists of a bo dy or bon y mass in front, from the sides of point downwards, ending in the middl~ line, just above which two bony processes extend backwards, and these the pit of t.he stomach. The named parts of the sternum unite to form the spinal canal, which encloses and protects are the manubrium or handle, the body, and the point the spinal cord. There are 33 vertebra:::, and these are which is cartilagenous. The junction of the manubrium grouped into regions, in each of which they are known by with the body ot the sternum is important, as from this prominence the second rib can be located, and from this, n umbers, counting from above downwards : (r) SEVEN CERVICAL VERTEBRlE I N THE NEc K.- The the other ribs and rib spaces can be counted. The lower e spinous process of the seventh cervical vertebra being the fi:v pairs are calle~ the false ribs; of these the eighth, most prominent. T he first and second cervical vertebrre nlnth and tenth paIrs are attached by cartilage to the rib are given special names. As the first cervical vertebra, above and not direct to the sternum. The eleventh and the atlas articulates with the occipital bone at the base of the twelfth pairs are called floating ribs. These ribs have no cartilagenous end pieces, they are free in front and rre attached to the eleventh and twelfth dorsal vertebrre behind: ~< krst cervicaL verfe6ra

\.. . . . ..,-

(to be continued.)

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~ sevenrh cervical verCe6ra ,.- firs [ dorsal ver[e&ra 6-'~

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\\ {weff!h dorsa! ve,(eur1J

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~ hi-sf lumbar vel'/eora '.

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It/Ill lum/;ar verfeUf'ffi

sacrum

CONFERENCE OF SURGEONS OF THE ST. JOHN AMBULANCE BRIGADE. The first post-war Conference of Surgeons of the St. John Ambulance Brigade was held at the Bonnington Hotel, London, on September 27th and 28th. Dr. N: Corbet Fletcher, O.B.B. (Surgeon-in-Chief) presided at the open.tng session at which the Chief Commissioner (Lt.-General Sir Henry Pownall) gave an address of welcome. ,!he subjects covered during the first afterno on included" The Bngade Peace-Time Set Up" by Major A. C. White Knox (London) and . a talk on "S?o~k: Its causes and effects" by MajorGeneral Su ~eneage OgIlVIe. A special film on the subject, made by the .Canadlan Army Authorities, proved very interesting . .(\. :llnner an~ dance was held in the evening at which the p~lnclpal guest was Rear-A dmiral Sir Cecil Wakeley. Glowing trIbutes were made to the Surgeon-in-Chief by County Surgeon B. Hart who submitted the toast of" The Chairman." . Sunday m~rning session included talks on " Aids to Teaching," gl'{en by vanous doctors," Standard of Marking" by Dr. Edwards and Dr. Nicol, "The Supplement to the Textbook" by Dr. M. M. Scott, "Co-op'erati~n with Local Authorities" by Dr. Gordon Wallace, and dlscusslOns on such matters as Fractured Spine Red Piping on Uniforms, Order Grades, correspondence, etc. AIter luncheon, Dr. A. Leslie Banks, Senior Medical Officer, Ministry of Health, gave a talk on "National Health Service' and this was followed by discussions on Re-examinations of 'Division and Standard of Examination Questions. ' At the close of the Conference, thanks were extended to Dr. Fletcher for his always ready assistance and for presiding over the Conference. . ~ short conference of District and County Surgeons followed at W,hlCh matters brought forth from the main Conference were dIscussed and the appropriate action taken.

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ALLEN'S APPARATUS FOR HOT AIR OR VAPOUR BATHS.

Other requirements are a thermometer to hang inside the cradles, several blankets to cover the wicker cradles and a cold compress for the patient's forehead. Some authorities advocate the use of a long mackintosh over the first blanket in order to prevent the escape of heat, but, as blankets are themselves bad condp.ctors of heat, the temperature of the air within the cradles can usually be raised to the required height without the use of the mackintosh. THE PROCEDURE. The top of the bed is stripped, leav~g the patient covered with one blanket. A long mackintosh and a bath blanket are rolled under him-as for a blanket ba.~h. His personal clothing is then removed, the .cradles are placed over him, taking care that they are restmg on the blanket under the patient and not on the one covering him, which will later be removed. The thermometer is hung from the upper cradle so that it can be

read easily. The Allen's apparatus is arranged in positio? and the lamp is lighted. The air heated by. the flame IS carried, by convection, through the funnel mto the bed. One blanket is placed lengthwise over the cradles and the other two are arranged with the length across the bed so that they can be tucked in firmly at the sides. The top of the blanket that is next to the patient is then tucked around his neck, the rest of it being drawn up from under the cradles and placed over the blanket covering them, leav0g the skin of the whole ot the body exposed to the hot alt. The heat of the bed will then rise graClually, taking about twenty minutes to reach 140 degrees. F., by which time the patient should be perspiring freely. It is essential that air should circulate freely around the patient's body so that the tc:mperature should not rise unduly. The nurse should, therefore, see that no two skin surfaces are in contact. The arms should be a little away from the body and the legs should be separated. The cold compress is then applied to the forehead. During the bath the cold compress must be changed frequently, and if the face is perspiring it should be sponged with tepid water and dried with a towel. Unless instructions to the contrary have been given, the patient should have warm drinks as frequently as he wishes. The duration of the treatment is usually 20 to 30 minutes. The patient must not be left whilst the bath is in progress and careful watch must be kept upon his colour and his pulse, the latter being taken over the temporal artery. For a first treatment it may be ordered that the temperature of the bath should not exceed 120 degrees F. Much depends upon the extent to which the sweat glands are stimulated, but if the skin does not begin to act by the time that the temperature of the bath reaches 120 degrees F., the treatment may be terminated. AFTER TREATMENT. At the end of the prescribed time the lamp is extinguished and the apparatus removed. The blankets are untucked from the bottom of the bed and the cradles drawn out, allowing the hot blankets to fall upon the patient. It he is benefiting trom the treatment and his pulse and respiration are satisfactory, he may be allowed to rest for a further half an hour, during which time perspiration will be continued. He is then quickly sponged with hot water and dried with a bath towel, using a fair amount ot triction. This is better than merely rubbing him down with warm towels because the treatment aims at removing waste products by means ot the skin, and these must be 7vashed off rather than rubbed off. The blanket and mackintosh are removed from under the patient, his night attire is replaced and his bed is made up in the usual manner; after this the patient will often sleep for a time. HOT DRY PACKS. These are used for the same purposes as hot air baths and they may also be given to prevent the development of a " chill" after. any experience that involves prolonged exposure to wet or cold; in which

RESUSCITATION APPARATUS

AGNES E. PAVEY, S.R.N. Diploma tn Nursing THE APPLICATION OF HEAT-(continued) HOT AIR BATHS, These may be prescribed for patients with renal, or kidne.r dise~s,e in order to promote sweating, or for rheumatIc condWons, !hey are thought to be better, in renal cases, than a radIant heat cradle because they allow a free circulation of air, so that perspiration is more readily evaporated, A higher temperature can, therefore, be tolerated, and the patient can be quite comfortable in a hot air bath given at 140 to 150 degrees F., especially if his, skin c~n be kept, dry. Also, it is possible to give a hot alI bath 1n a rural dlstnct where electricity is not available, using an Allen's apparatus, the heat being produced by a spirit or an oil lamp. Allen's apparatus was designed, primarily, for the giving of vapour baths, It consists of a stove with a rectangular chimney terminating in a large "spreader" which is hung over the opening at the bott<?m. of the lower of tw? wicker cradles. There is a kettle WIthin the stove, but this is discarded when the apparatus is used for producing hot air instead of vapour. The oil or spirit container fits into a tray which forms the base of the stove. The apparatus is made in sections and is usually supplied in a thick wooden box which forms a stand for the assembled stove and chimney, and is the correct height for use with the standard hospi tal bed, although it may be a little too high for an ordinary home bed. A bucket of sand should be in the room, for use in case of fire.

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case the pack may be preceded by a hot bath. They may to prevent headache. The nurse remains with the patient envelop the whole body, but occasionally they are ordered throughout the treatment and takes his pulse trequently for one part only, when the region. treated is us.ually .from over the temporal artery. His colour must be carerully the waist to the hips, with the object of reliev~g kidney watched. If he becomes blue or unduly flushed and restcongestion. Hot packs are somewhat less efficIent than less he must be removed from the pack even if the preshot air or radiant heat baths, but they have an advantage cribed time has not expired. in that no special apparatus is needed and they can, thereAt the conclusion of the treatment the blankets and the fore, be given in an ordinary house. patient's gown are removed. The latter is probably a THE PROCEDURE. The essential requirements are little damp from the induced sweating. A warm, dry blanket two to four extra blankets, six hot water bottles or their should be ready to cover the patient, who is then sponged substitutes, a cold compress for_ the forehead, a small with hot water, dried briskly and a clean warm gown is towel and a hot drink. If possible, two nurses or members put on. The cold compress is removed, the face is sponged of the household should work together. The patient is and the hair is brushed. The top of the bed is then made clad in a flannel gown and the blankets are thoroughly up. It must be remembered that as a result of these treatwarmed. They are unfolded and placed one on top of ments with dry heat the patient'~ temperature is raised another and are rolled lengthways to the centre. The before he commences to perspire and it is essential that upper bed-clothes are removed, the p~tient is turned ?n he should be allowed to cool gradually in order to avoid his side and the rolled-up blankets are lnserted under him chill. in the same manner as clean bottom sheets. The sides of THE NURSE'S REPORT. In her report on patients the blankets are folded over the patient and the lower part who have been given hot air baths or hot packs the nurse is turned up over the feet, avoiding pressure .on the toes. should state the time at which the treatment commenced, The top is mitred down over the shoulders In much the when the patient began to perspire, the temperature of the same way as upper sheets or blankets are mitred at the air in contact with the patient if a hot air bath was given, corners, a straight fold of blanket then passing across the the duration of the treatment, the degree of perspiration neck. The small towel is placed under the chin in order and the length of time it continued after the apparatus was to prevent irritation from the blankets. The hot bottles removed. The amount of urine passed during or after the are placed outside the blankets, three on each side, and t~e treatment should be recorded, and so also should the counterpane is replaced if desired. The cold compress 1S nurse's general observation on the condition of the patient, applied to the forehead and a hot drink is given. The including his pulse and colour and whether he slept patient may be left in the pack tor an hour to an hour and a quietly after the treatment. half, the cold compress being changed sufficiently often (to be continued.)

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QUERIES and ANSWERS COUPON To be cut out and enclosed with all Queries. October, 1947.

Our Thanks to "N.C.F." Once again it is our pleasant duty to render thanks on behalf of our readers and ourselves to FIRST Am's Honorary Medical Correspondent, Dr. N. Corbet Fletcher, O.B.E. The well-known initials" N .C.F." are the recognised authority on all queries connected with first aid not only in this country but in the Dominions. We know at least that the advice, which he has given on this page during the past thirty-two years has been of inestimable value to our readers. Each answer' which he has contributed has contained more than wide knowledge and large experience because it has reflected sound common-sense, good humour and a kindly nature. Good advice he gives in plenty; but, more than that, he always shows a gen.linely friendly interest in all our problems. We are sure that all readers of this most popular feature will join with us in this appreciation of the Doctor's services, and in the hope that he may long continue to disentangle our" Readers' Queries."EDITOR.

Treatment of Cramp E. H. (Bradford).-At a recent class we entered into a disClissioli as to the best treatment for cramh wbicb ended 11 i i/bout any agreed treatme1lt being decided upon. It was therefore decided that 11'e should seek )'OU1' opinion 01/ the Illalter and )'our repfy will he eagerfy O1vaited ry all of us. Cramp is an involuntary and painful spasm of a voluntary muscle or group of muscles; and it usually occurs as the result of sudden muscular contraction. Relief may sometimes be effected by grasping the affected muscle (or muscles) and rubbing briskly with hand or towel and sometimes by vigorous movement of the musc1es.-N. Corbet Fletcher. Examination Howler O. B. (Exeter).-In a recent examination I asked a candidate hOJv he 11)o{{ld treat a boy ,vho had pushed a pea into his ear. Without hesitatioJl the candidate replied promptl),-" I would stand the boy 011 his head and shake him to disengage the foreign bodJl." Good J Next please! J-N.C.P. Methods of Artificial Respiration A. P. (Clacton-on-Sea).-As we) the members oj a Seaside Divisiol1) may he called to assist on our beaches in cases of drOJvning) 11Jould you please inform us which of the two methods, Schafer or Rocking method is the most efficient? Thank)lou for an earfy repfy. Either method, if properly applied, would, in my opinion, be equally effective. Bearing in mind however that you would not have the official rocking stretcher at your Beach Hut and that it would not

LOVELY BABY BEAR

Queries and Answers to Correspondents Queries will he dealt with under the following rules : I.-Letters containing Queries must be marked on the top left-hand corner of the envelope" Query," and addressed to " First Aid," 32, Finsbury Square, London, E.C.2. 2.-AII Queries must be written on one side of the paper onfy. 3·--AII Queries must be accompanied by a "Query Coupon" cut from the current issue of the Journal, or, in case of Queries from abroad, from a recent issue. 4·-The Textbook to which reference may be made in this column is the 39 th (1937) Edition of the S.J.A.A. Manual of First Aid to the Injured.

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be easy to improvise this apparatus, you would, in my opinion, be In reply to your second question, fluid in the stomach is not regarded well advised to make all your members proficient in the Schafer method. as part of the body Ruid. Consequently, the act of vomiting this fluid Incidentally, it is generally agreed that the Rocking method (which cannot increase the shock which is already present. -N.C.F. has been adopted for use in the Navy) should only be practised by a Treatment of Wounds trained squad of rescuers.-N.C.F. A. K. (Manchester).-RecCltt& there bave been man)' queries based on the Flushed Face with Compression Supplement to the T extbook. Here is a further one. P. . (Berwick).-Recent{y ,,)e Jvere discussing compression of the brain and On page 25 of the Supplement ll'e read: "If blood still soaks thmugh the question arose as to 11lh)1 lvith this condition the face of the patient is the dressing and pads, appb' further dl'essings and pads on top with a flushed. As 11le C01i1d not agree about the cause, lve decided to ask you to fresh bandage, but do not remove the original ones." tell us. lHl'amllhile, our best thanks for your anSJver. Jvfy difficulty) sir, is this: Wh)' place a dressing (l1)hich cannot CO!lle With compression of the brain there is increased pressure within into contact lJ/ith tne lvotmd) on top of a bandage the surgical cleanliness the skull. This affects the vaso-motor centre in the medulla and causes if l1)hich llIay be in doubt? Pads and further bandages, Jles; but 11111)1 dilation of all blood vessels, including those of face and trunk. Conwaste a perfectly good dressing? sequently there is flushing of the face and loss of heat from the body I await your helpful reply 11lith interest. which \ve seek to minimise by wrapping patient warmly with blankets The lesson of the Supplement is that firm pressure w ill control or other similar covering.-N.C.F. practically all bleeding wounds. The dressing, therefore, is gently Fractures of Both Thighs packed into the wound and supported by a pad and bandage. If these T. A . (Finchley).- Please tell tiS h01V we should treat a patient who is suffering dressings should become saturated with blood, they are not to be froll! sill/pie fractNrcs of both tNghs. removed, because, soaked with blood, this will cause further and When they have to treat this combination of fractures, first-aiders beneficial pressure. So all that is required is to apply more pressure should modify the treatment laid down in the Textbook (pp . 88 and by purting on another dressing and pad and by holding these in 89) by applying two long splints, each reaching from armpit to beyond position with a fresh bandage. foot on either side of the body. This done they should control the Your objection to the use of a clean dressing puzzles me, because splints as indicated in the Textbook.-N.C.F. I know that no good first-aider would deliberately choose a dirty one! Arm Sling with Fractured Ribs Further, what the members of the Revision Committee evidently had in P. S. (Slough).-Please tell me if we should use the large arm sling in a case mind was that you would have a supply of dressings and pads in of fractured ribs 11,hen the patient is reCtimbent. your haversack (or ambulance room) and that it would be better to The muscles of the arm and ribs are so interwoven that the slightest use these rather than to waste time looking for other material.-N.C.F. moyement of the arm may pull on the ribs. Consequently, just as in Humour in First Aid splinting a fracture, we apply the upper bandage to control the upper A. B. (Hampstead).-I have read )'our "Examination Homlers" ever fragment, so in this case, even when the patient is recumbent, we use since )Iou st~rted this montbl)! feature if tbe QuelY Column mva)! hack a large arm sling which helps to keep the ribs at rest by controlling in I923 ; and I wonder if the follo),ving stor)ll/Jill be interesting to readers the muscles attached to ribs and humerus.-N.C.F. of" First Aid." Swelling of Tissues of Throat Ata recent road accident tmo Brigade members chanced to be present A. H. (Dagenham).-W·ould )Iou please explain ,vhy in the treatment of a and ' rendered first aid. Tbe patient sudden& recovered consciouslless} patient suffering from swelling of tissues if throat. (Textbook, p. 158) overheard the first-aiders talking and picked tip the IJ/ord "arterial." 1l'e·are told to place'patiellt in front if the fire ? Then to their amusement be suddenly exclaimed- cc Arterial! Am I The effect of heat is to enlarge the blood vessels in the immediate on the arterial road? If so, I am going the wrong way to Illy bOllle ! " vicinity. By placing our patient therefore in front of the fire, we Good! Next Please! !-N.C.F. cause dilation of the superficial bloodvessels w hich will relieve the Lay Instructor Certificate painful local condition. Further, the patient will breathe warm air C. D. (Catford).-IPill )'OU please inforlll me if there is StIch a thing as a which is not so likely to cause local irritation of the swollen tissues S.].A.B. First Aid Instructor's Certificate. I have always understood of the throat and to promote coughing, as would cold air.-N.C.F. that our Divisional Surgeon was the instructor-I lvas told) b01llever} Artificial Respiration at Divisional Practice the other nigbt that tbis mas not so. NIeamvhile} R. W. (Hayle).-One if the members if this Division revived a fellOlv from my best thanks. drOll'ning recentl),- He applied Schafer's method until the pulse became During the late war and until quite recently arrangements were quite strong and the breathing normal. Then he decided to move patient in operation whereby lay persons, on taking the Lay Instructor from the beach to the nearest house-carr'ying b)' human agency. On the Certificate, were allowed to give lectures in first aid when a doctor wal' the patient kept sayillg-" I'm feeling sick "-" I Jvish I could be was not available. T o-day, however, when a Lay InstrLlctor belongs sick." He II'as retclling. No medical aid 2vas available, and our member to a Division of the Brigade, he has no locus standi because the Divisional "'as in a dilelJllJ/a . We sbou/d like to kn01v if he should have made the Surgeon is responsible for the instruction of the members.-N.C.F. patient sick and if the patient lvouJd have felt better or worse if he had? Prevention of Accidents Also if our melllber bad made tbe patient vomit would loss of fluid have P. R . (Henfield).- I would like to suggest that an additional chapter 011 increased bis shock? If?'e mlJait lvitb interest )lour comments and thank " Prevention of Accidents» should be added to the Textbook and that )'OU. all D ivisional Superintendents of the Brigade should be asked to make When victims are immersed in water, a quantity of the fluid (poss ibly returns periodically of all accidents in tbeir areas, preferab& by lIeJ1)spaper dirty) may be swallowed apart from that which may be taken into the Ctlttings and possib& classified. lungs. During the period of partial or complete insensibility the water Brigade H eadquarters would then be able to collate such statistics and in the stomach will have no effect; but, when the victim regains to publish figures showing. the chief !JIpes of accidellts and the precautions consciousness, it may have an irritating action on the stomach and necessar)1 to avoid them. cause patient to vomit. The prevention of accidents is not a subject which could be detailed It would be incorrect for a first-aider to induce vomiting; but, if in the Textbook. Neither is it the responsibility of first-aiders to this occurs naturally, the possibility is that the patient would have felt organise propaganda for the prevention of accidents. In point of better. fact this is the duty of the local authorities and the police.- N. C.P.

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CON TE NT S Editorial A Cou rse in Advanced First Aid The Surgeons' Conference The Meclicine Chest -

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News from all Quarters Practical Nursing in the Home Anatomy and Physiology in First Aid Queries and Answers to Correspondents

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NOTICE TO READERS. FIRST AID is published on the 20th of each month.

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The Spirit of Service. IT has been well sai d (by whom, we· confess we have forgotten) that "Show me a pit disaster and I'll show you men," and the axiom might we ll be extended to all those accidents and disasters which befall us in our daily lives. We refer specifically to the recent unhappyrail accidents which have shocked the nation, but which, terrible though they were, provided in the courage and self-sacrifice shown by ordinary men and women who unhesitatingly answered the call to help and succour their fellow-beings in d istress, an inspiration to all who hold as a fervent bel ief the Spirit of Service. We read of doctors, nurses and flrst-aiders, working without I-espite in the relief of the injured, of men toiling without regard for themselves to rescue victims trapped beneath the debris, of householders tearing up their precious sheets an d linen for bandages, and freely giving up their more precious rations for the comfort of the distressed. These things are taken for granted by those who perform them, they are sometimes taken for granted by those who read about them. But in these times when we hear so much tal k of frustration and despondency. when the spi I-i t of endurance, courage and sacrifice which brought us triumphantly through the war, seems to be swallowed Lip in the morass of our economic ill s, it is well for us to

remember that in the deeds of ordinary men and women caught up in some perilous emergency, thiS spirit still shines like a star to guide us. It is found, too, in the more trivial emergencies of evel-yday life, in the less spectacular accidents in home, factory, and on the road, which do not occupy the headlines, but nevertheless bring much misery an d suffering in their train, the alleviation of which is the constant aim of hundl-eds of public-spirited men and women working quietly and anonymously, asking no I-ewal-d except the gratitude of their fellow men. The emphasis to-day, as we all know, is on the activities of the "spivs" and "drones"; and their shameless preying on the community seems actually to excite admiration in some quarters. It would be better for our morale in these difficult times if we gave more thought to those whose unselfish devotion to the public well-being is everyday evidenced, for example, in the care and attention of the injured. Those untiring men and women who, wearing the white or red crosses, symbols of the chivalry of the Old Krights, give their leisure and energy to the rei ief of suffering, do not work in the limelight, and indeed do not wish to, but their zealous efforts are an example to all. Now and again some national disaster brings them into the public eye, but every day their work goes on . May we never lose sight of this grand spirit!

FIRST

AID

A COURSE IN ADVANCED FIRST AID BY

A. D. BELILIOS, M.B., B.S. (Lond.) D.P.H. (Eng.) EMERGENCIES OF THE DIGESTIVE SYSTEM AN important abdominal emergency which so far has not been discussed in this series of articles is internal hxmorrhage. This is the term applied to bleeding within the body without any blood being visible externally; for this reason it is sometimes called concealed hxmorrhage. Some readers may be surprised that the subject was not dealt with under emergencies of the circulatory system. Actually this course would have been more correct academically, but it is more practical to describe it here since it most commonly occurs within the abdomen. Internal hxmorrhage may be caused by injury or disease. Thus it may occur as a complication of broken ribs which on the right side have injured the liver or, on the left, the spleen. Similarly a fractured pelvis may be complicated by damage to one of the important blood-vessels in this region. An important cause is any injury involving crushing of the abdomen such as the" run over" accident; in this event organs liberally supplied with blood-vessels (vascular organs), may be ruptured; for example, the spleen, liver or kidneys. So far as disease is concerned, internal hxmorrhage may occur from the sudden rupture of blood-vessels within the abdomen. A common example is provided by the condition called ruptured ectopic pregnancy which may develop if a pregnancy occurs in an unusual place-in the fallopian tube instead of in the uterus. The symptoms and signs of internal hxmorrhage are fair.ly characteri~tic. ~f the condition is caused by an aCCIdent, the patient falls to recover from the initial shock and the features of internal h::emorrhage gradually develop. If, ~owever, the bleeding is caused by disease, it usually begl11s suddenly. The patient complains of agonizing pain in the abdomen feels giddy and faint. His skin is cold and clammy and th~ temperature subnormal. He breaks out into a sweat. His colou~ becomes pale, ~his pallor affecting particularly the face, hps and ~ge~ nails ; later there may be cyanosis. T~e pulse IS qu~ck and feeble, soon becoming imperc~ptlble at the Wrlst, e:ren the cardiac impulse may be difficult to. feel. The ?mpor~anc~ of taking the pulse f~equently m any case m which Internal h::emorrhage is hable. to ?ccur cannot b.e too strongly emphasized. If each exa~atIon shows an 111creased rate it is very suspicious . that 111ternal bleeding is taking place. In most cases the patient partially recovers consciousness after ~ short interval. H~s subsequent remarks and general b~havI0ur 1l!ay supply lm1?ortant ,clues to the diagnosis. FIrst there IS the fear. of Impending death; the patient often declares drama~lcally that he is going to die and frequently repeats this sta 'ement, a fear which is well founded unless he receives prompt treatment, . ~xtreme s:10rtness. of breath supplies another characterIStic fe~ture called au-hunger. Not only does the patient ~ompla~ tha.t ~e cannot breathe properly and that there is ~sufficlent au In .the room, but he also begins to fight for hIS breath, thrOWIng off the wraps with which he has been

covered for the treatment of shock, clutching at his throat and attempting to undo his collar and tie, etc. Restlessness is a valuable diagnostic sign. It may be almost impossible to keep the patient lying down, as he s~ould be; he. is contin~ously trying to sit up and then lYIng down agal11 or mov111g about from side to side of the bed or stretcher. Thirst causes the patient to implore the first-aider to giv.e h~ dr~nks, a request which must always be refused. This thirst IS caused by the rapid loss of fluid from the circulation. ~inally, i? the absence of treatment, the patient complams of d.lffine.ss of vision and ringing in his ears. He g~aduall'y s111.ks 111to a coma with gasping respirations and dies. F1!st-~lders ofter: ask how long a patient can live hen s:uffenng from .111ternal hxmorrhage. The answer IS that It depends entuely on the severity of the case. If a large. blood-vessel has ruptured as occurs rarely when the aorta IS damaged, death may be almost instantaneous. On the other hand, if the hxmorrhage is less severe he may live for some hours. ' FIRST AID(r) Medical. Aid. Everything depends on quick medical treat~ent which almost invariably involves an operation to dIscover the blood-vessel that is bleeding and seal it off.. Unless a doctor can be obtained immediately, the patient sho.uld be r~moyed by ambulance to a hospital where surgIcal attentIon IS available. (2) Posture. The" head low and feet raised" position must be ado12ted as for shock and maintained throughout transport. It IS da~g~rous to chang~ this position suddenly. (3). General J>.nnczples. These 111clude undoing tight clothing, supply111g extra wraps and warmth. Inhalations of oxygen may aid breathing. The patient should be kept as still as possible. . (4) MasterlY Inactivity. Any treatment which tends to ~ncre~se the .rate or strength of the heart beat is most InadVIsable S111ce it can only result in the loss of more b~o?d fro~ the c~rculation. The use of smelling salts, glV111g flUIds or stlmulants such as alcohol or sal-volatile are therefore definitely contra-indicated.

Hremorrhage from the Rectum The passing of dark tarry motions called melxna has already been described. .It r~sults from h::emorrhage in t~e upper part of the digestIve tract and must be dist111gmshed from ha::morrhage from the rectum when ordinary blood is passed. . .Unaltere~ bleeding from the rectum may result from tr:lury ~r disea?e. Thus the rectuJ? .itself may be injured eIther from a ?ire.ct cause such as sItt111g on a spikey object or as a comphcatlOn of a fractur~d pelvis. The bleeding is not usually severe and no speCIal treatment is called for except to .keep the patient resting until medical advice has been obta111ed. If an obvious wound is present it must of course be treated on general principles.

FIRST Far more important is bleeding from the rectum caused by disease. It is not really a first aid condition, but it is so common that any first-aider in charge of an ambulance department in a factory or other institution is bound to meet a case in the course of his routine duties. The bleeding is not usually profuse, generally it is slight in quantity and may only occur occasionally. It is not for the first-aider to recommend any treatment whatever, indeed, it would be most improper for him to do so; it would be just as serious a " howler" as being unable to stop bleeding from the wound. Nevertheless, he can give his patient a most valuable piece of advice, namely, to go and see his own doctor without delay. Moreover, this advice must be given firmly without hesitation and the good first-aider will make a point of seeing his patient again within the course of a few days to make sure that his advice has been followed. Bleeding from the rectum may be due to piles. It may, however, be one of the first signs of cancer of the bowel. Everyone knows that cancer, wherever it occurs, is a most unpleasant disease. Many people think that it is always fatal, but fortunately many cases are quite amenable to treatment provided they are taken in time. The trouble is that so often the warning signs of cancer are ignored by the patient and before medical advice is sought the disease has been allowed to progress to a stage when it bas become incurable. Nowadays most patients suffering from h::emorrhage from the rectum suspect it may be due to cancer and for this very reason many will not consult a doctor because they are afraid that he will confirm their suspicion. Hence they try to carryon their lives hoping against hope that their suspicions are ill-founded and that the bleeding will cease spontaneously. Very often, however, they will confide in the first-aider who then has a golden opportunity

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of giving advice which may save life. Tonsillitis Most of the emergencies of the digestive system which have been described are comparatively rare; they W~re ch<?sen .becaus~ they are s~ri.o~s ailments for which prompt act~on IS. reqUIred .. T.onsillitls,. howev~r, is not usually a senous aIlment nor IS It a first aid condition ; nevertheless it must be indud~d in this ~eries of a.rtides since it is very common and patIents suffermg from It frequently continue at work and apply at the ambulance room for treatment. Tonsillitis i.s inflammatio~ of the tonsils caused by a ger~. ~ts. chIef symptom IS a ~ore throat, the pain of whIch IS mcreased by swallow111g. Generally there is tenderness at the side of the neck just below the angle of the jaw where there are glands which become enlarged. In all but the minor cases there are the typical symp~oms and signs of fever, namely headache, aches in the limbs and b.tckache, together with shivering, sweating and a rise of temperature. If the throat be examined, the tonsils will be seen to be red, swollen and inflamed; later, in many cases, small white spots make their appearance, enlarging and coalescing as the disease progresses. Tonsillitis is a mildly infectious ailment; it may, however, be the first sign of scarlet fever. Moreover, it can be difficult to distinguish from diphtheria, a disease that can be fatal. Once more, therefore, the first-aider should adopt a " do-nothing" policy. He should not even advise a gargle. The patient must be referred to his own doctor for diagnosis and treatment. By adopting a firm line of action in refusing to have anything to do with the case the first-aider will prevent the patient from procrastinating in seeking medical advice.

(to be continued.)

The Surgeons' Conference WE referred briefly last month to the first post-war Conference of Su(geons of the St. John Ambulance Brigade which was held at the Bonnington Hotel, London, on September 27th and 28th. A fuller report has now reached us and we are able to give the following details. The Surgeon-in-Chief. Dr. N. Corbet Fletcher, presided, and at the opening session the Chief Commissioner. Lieut.-General Sir Henry Pownall, gave an address of welcome. He said mat he had seen quite a lot of the work in the Brigade, and he was impressed with the amount of assistance which the lay members got from the members of the medical profession . "Without your belp," he declared, " we could not exist, without it we should prove ourselves inefficient, you are essential to us." The Chief Commissioner added thac 3,750 members of the medical profession were helping them every day and every week in the year. Replying to the Address, the Surgeon-in Chief said it was the fourth Conference that had taken place since he had occupied the post. It was a great pleasure, he went on. to revive the Conferences. The Brigade had always rather tended to treat its surgeons as figureheads. The Brigade wanted no passengers. "There is a tendency ro forget the fact that ,ve all in the Brigade work for nothing," Dr. Corbet Fletcher continued, "and this fact should be driven home whenever the general public are being addressed."

Speaking of the duties of Surgeons, the Surgeon-in-Chief said that there was a magnificent circle of them doing splendid work for which they alone were responsible, and for which the Brigade was intensely thankful. He concluded: "Once again I am happy to welcome you, and I thank you each and all for the support which you have given me throughout my term of office." He then called upon Major A. C. White Knox, Commissioner No. I District, to give a talk on " The Brigade Peace-time Set-up," and this was followed by a talk by Major-General Sir Heneage Ogilvie, Guys Hospital, on " Shock-Its Causes and Effects." The dinner and dance which was held in the evening has already been reported in our columns. Many tributes were paid to the Surgeonin-Chief, and among those present were Rear-Admiral Sir Cecil Wakeley; Brigadier W. B. G. Barne; Secretary-General of the Order, Sir Clive Liddell; Director of Ambulance, Mr. R. S. Handley; Hon. Surgeon, Middlesex Hospital, Mr. F. W. Lindgreen; Major P. G. Darvil-Smith, Brigade Secretary; County Commissioner F. Edwards, Shropshire; and County Surgeon B. Hart, W.R. Yorkshire. Resuming on Sunday morning, the Conference first of all considered " Aids to Teaching." Dr. Hoby, Kent, gave details of the use of the Quiz, and Dr. D. J. Nicol, Birmingbam, demonstrated plaster casts for competitions and similar work. A letter from Dr. Natham, London, was read in connection with obtaining from hospital authorities

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reports of cases which St. John members took to hospital. A joint talk followed by County Commissioner Edwards and Dr. Nicol on "The Standards of Marking," and there was a good discussion. The opinion of the Conference was that some directive should be issued for the use of Surgeons of the Brigade undertaking competition judging, so that they would be in agreement with each other. " The Supplement of the Textbook" was the next talk, contributed by Dr. M. M. Scott, London, a member of the Textbook Revision Committee. He explained why the Supplement had been issued, and the manner in which it had been prepared, and spoke, also, on the work now being undertaken by the Revision Committee. Dr. Gordon Wallace, Dorset, talked on " The Co-operation of the Brigade with Local Authorities," and other topics discussed were red

piping on uniforms, and O rder grades on correspondence. The view was unanimously expressed that red piping should be worn by all surgeons of the Brigade, executive or administrative, and that they should all place their grades in the O rder on their notepaper. At the afternoon session a talk on the National Health Service was given by Dr. A . Leslie Bankes, Senior Medical Officer, Ministry of Health, and other matters dealt with were Re-examinations of Divisions (Dr. Stoker, London) and Standard of Examinations (Dr. B. Steele, London). The Conference concluded with an expression of thanks by Dr. Corbet Fletcher to all those who had attended, and a vote of thanks to the Surgeon-in-Chief, proposed by Dr. H. Powell, County Commissioner, Somerset, and supported by Dr. Gladys Wilkinson, Cheshire.

M edicine Chest By FRA K BERRY. THIS is the first of a series of articles compiled to explain to first aid Acacia Gum and ambulance workers the nature and uses of some of the many This material oozes from the stem and branches of certain trees drugs and chemicals with which they become acquainted during their native to i \.ftica, and after drying and puriflcation, becomes a\ailablc duties. in small irregular lumps, or as a fine white powder. Emphasis will be placed on materials actually used in practice, but The gum is used extensively in manufacture of many pills, pastilles, brief comments will also be made on the more important medicinal lozenges and emulsions. It is used medicinally on account of its agents. demulcent or soothing properties and forms an ingredient in many The notes will be arranged in alphabetical order, elassified according cough syrups and linctuses. to drug names and will conclude with some general comments on the Some saline solutions administered by intravenous injection for more usual forms in which medicinal substances are issued for use. treatment of shock contain Acacia Gum. Acids These will be dealt \.vith under the names of the individual acids, Acriflavine and R elated Antiseptics ('.g., Acetic, Hydrochloric, Nitric, etc. Y cars ago, research workers who had injected coloured substances Acetic Acid into living animals, noticed that certain body tissues became deeply This is an acid obtained by the dry distillation of wood. It is present stained, while others remained absolutely uncoloured. This selective to the extent of about 5 per cent. in vinegar and is an ingredient in staining action suggested that some dyestuffs might have the power of many liniments and embrocations. Pure or glacial acetic acid is a staining and killing the living germs of disease without adversely colourless, strongly-smelling liquid often used as a caustic for removing affecting the body cells of the patient. Development of this idea led corns and warts but its use in this connection is not without danger. to the discovery of many valuable antiseptic dyestuffs now frequently The strong acid would act as a corrosive poison if taken internally and used in hospital practice. treatment should be in accordance with standard Textbook inst1llctions. Acriflavine is derived from one of the constituents of coal tar and Aconite is prepared as an orange-red powder which dissolves easily in eithcr The Aconite plant, known also as Wolfsbane or Monkshood and ' water or alcohol. grown in many English country gardens, is one of the most pois;nous It is a powerful, safe antiseptic which maintains high activity even in plants growing in this country. The fresh root has been eaten in presence of blood and serum, and is particularly recommended for mistake for horse-radish with rapidly fatal results. Tincture of Aconite, in small doses, is given internally to relicvc prompt application to wounds soon after infliction. Its presence destroys invading germs before they have time to multiply, likelihood many feverish conditions and local inflammations such as feverish cold laryngitis, and tonsillitis. Aconite is frequently used externally fo; of sepsis being thereby greatly reduced, and natural healing encouraged. relief of rheumatism and neuralgia; A.B.C. Liniment (Liniment of Aconite, Belladonna and Chloroform) often being prescribed for this purpose. All Aconite preparations are intensely poisonous. Symptoms of poisoning include a characteristic tingling of the mouth, lips and tongue; numbness of the skin; and marked collapse; death often ~ccurring sue! -1enly after some slight exertion such as endeavouring to SIt up. Treatment of poisoning should be in accordance with the general rules quoted in the standard Textbook, but noting particularly that the patient should be kept lying down, and that jf artificial respiration becomes necessary, it should be continued over a long period.

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Acriflavine is most frequently used in the form of a lotion containing per cent. (I in 1,000) Acriflavine together with Sodium Chloride (salt), and an emulsion containing 0.1 per cent. Acriflavine with Liquid Paraffin.

0.1

Neutral Acriflavine, also known as EuBavine, is a modified form of Acriflavine, which, being almost devoid of irritant properties can be used in stronger solutions. EuAavine gauze and lint which contain 0.1 per cent. Euflavinc,form the basis of many antiseptic and burn dressings . It is also issued in form of lozenges and chocolate-flavoured tablets for disinfection of mouth and throat, and in specially-coated oral tablets for use as an intemal antiseptic, especially in cases of chronic infections of the urinary tract.

Owing to the chemical changes which occur when certain substances are mixed together Acriflavine should not be used in conjunction with either Corrosive Sublimate, Carbolic Acid, Eusol, Chloramine or other similar antiseptics. Proflavine, a dyestuff closely allied to the acriflavines, is an extremely powerful antiseptic which, being free from all irritant properties is frequently applied direct to wounds as a fine powder, either undiluted or mixed with one of the sulpha drugs and is also extensively employed in ophthalmic and brain surgery. With brilliant green and gentian violet it forms an ingredient in the Triple Dye solution often used in hospital treatment of burns. For con venience in preparing solutions of these flavine antiseptics, special solution tablets are manufactured containing the exact amount of antiseptic needed to make a stated amount of solution of given strength. Solution Tablels Proflalline, o.Sri grains ; One tablet dissolved in 2 fluid ounces of distilled water gives a solution containing 0.1 per cent. (1 in 1,000) Proflavine. Solll/ion Tablets Acriflavine, I.75 grains ; One tablet dissolved in 4 fluid ounces of dis illed water gives a solution containing 0.1 per cent. (I in 1,000) Acriflayine. Obviously, by varying the number of tablets 2nd volume of water used, varied amounts and strength5 of lotion can be prepared. Thus, using the I.75 grain tablets ;I tablet in 8 fluid ounces water yields S fluid ounces 0.05 per cent. lotion (1 in 2,000). 2 tablets iu 8 fluid ounces water yields 8 fluid ounces 0 . 1 per cent. lotion (1 in r ,000). 1 tablet in 2 fluid ounces water yields 2 fluid ounces 0.2 per cent. lotion (I in 500). The use of these special solution tablets for preparing antiseptic lotions saves the great deal of time which would otherwise be required for weighing out the powdered flavine needed. While the use of these coloured antiseptics is advantageous in that the exact area which has been treated is easily distinguished, the yellow stain imparted to skin and clothing is often undesirable. To remove Acriflavine stain3 from the hands rub carefully with a little dilute acid such as 3 per cent. Hydrochloric Acid. Stained linen should be washed as soon as possible, for exposure to air tends to make such stains permanent. Any mark remaining after washing can often be removed by applying soap direct to the stained spots and then well rinsing. Some non-staining antiseptics belonging to this chemical group have been recently introduced, the most promising being a substance called s-aminoacridine.

(to be continued)

Review Ad van ced Industrial First Aid by R . A. TREVETH1CK, lI1.B., Ch.B. Rotherham ; Henry Garnett & Co. Ltd. This book has been written, not as a primary book for those taking up first aid but for those who have already acquired some knowledge of anatomy, the application of bandages, etc., etc. Its main theme is simplicity combined with speed. Elaborate first aid destroys its own objective which is to get a patient to hospital or doctor in a condition at least as good as when treatment began. Consequently treatment must be easily remembered, simply and quickly applied, and the patient must be removed to hospital by the best available means.

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UniJorrrt by Garrould The cu t. style. an d fine workmanship always distingui shes a Garro uld Uni for m from any other. Great care and attent ion is given t o every detail. We have su ch a wide ra nge of SC ientifically graded stock sizes that 90 per ce nt. of o ur customers are able t o obtain a perfect fit. Prices of Offic ers' Uniforms and other items not mentioned in this advertisement sent on request. S.J.A. D R E SS for Officers and Ambulance Sisters. Made from good quality Sanforized-Shrunk material. Bodice unlined . Women' s sizes 33/-. S.J . A. APRONS for Ambulance Sisters. Made fro m hardwearing linen finished a pron cloth. Price includes cross. Waists 26, 28, 30 ins. .. B/ II Waists 32, 34,36 . 38 ins. 9/ 11 In lengths 26 , 28, 3D, 32 ins. S . J . A . B LO US ES for Officers and Ambulance Sisters. In Ivory Tri. coline 28/ 11 (4 coupons). Extra Collar 39 (I roupon). Sizes 13t, 14, 14}ins. Size 15 ins. 29 'II. Extra Collar 3 9. (Civilian coupons must be rendered for blouses). S .J.A. HAT for Officers and Ambulance Sisters. IB/-. Box and postage 211. Badges obtainable only from H.Q. Hats stocked in sizes :6t, 6~, 61, 6s, 7, 7t, Storm Cap 17/ 11. Box and postage 114.

S . J.A. C AP for Ambulance Sisters. 27 x IB ins. o r 2B x 19 ins. 3, 3. Embroidered cross on front.

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News From All Qu arters In welcoming the next speaker, Acting sponsored by Miss Ellen Partner, dancing on THE ST. JOHN AMBULANCE Chief Officer Ambulance Cadets G. Guthrie- the lawn by floodlight, after which the Cadet Moir, M.A., the Chairman extended the Band Beat the Retreat. During the afternoon BRIGADE. Area's congratulations on his recent appoint- a presentation was made to Mr. Eppstein. Prince of Wales's District EAST LONDON DIVISION The passing of David Stitcher, Divisional Superintendent, has robbed the Division of a great and invaluable leader. Born in March, 1884, he first became interested in the Brigade at the Jubilee Celebrations of Her Late Majesty Queen Victoria, when for the first time in its history members took their positions in front of the crowd and not at the back as had been the practice till then. Joining in 1902, he soon obtained Certificates in Home Nursing, Hygiene and Sanitation. Promoted Corporal in 1910, Sergeant 19II, SjSergeant 1919, Ambulance Officer 1927 and Superintendent in 1928. Always on the look out to promote the welfare of the Brigade and first aid, he was responsible for the formation of the No. 76 Nursing, No. 182 Ambulance, No. C23 and No. CN22 Amb ul ance and Nursing Cadet Divisions. In 193I he introduced an N.C.O. Class of Instruction, which was followed by a similar class at Headquarters, with great success. In 1936 he qualified as an A.R.P. Lecturer and Examiner and thereafter was responsible for the setting up of many classes of instruction in the subject, in the Borough of Stepney, at clubs, firms and organisa tions. At the outbreak of war he was mainly responsible for the training and set-up of stretcher parties and first aid post in public shelters in Stepney, work for which Dr. F. R. O'Shiel, M.O.H. for the Borough, has paid great tribute to on many occasions. He was a member of the St. John & B.R.C.S. J oint War Organisation throughout the war years, and recently was associated with Stepney's Road Safety Organisation, as well as a member of the Hospitallers Club. EASTERN AREA CADET OFFICERS' CONFERENCE Thirty-eight Officers, and potential Officers, were present at the first Eastern Area Cadet Officers' Training Conference, held on September 28th at Southend-on-Sea. Area Cadet Officer H. F. Mulligan was in the chair to welcome the speakers and delegates. Area Cadet Officer Miss Parrott opened the Conference with an interesting talk on Brigade Forms for Cadets. As a result of this talk, ani the many questions that followed, numerous points of doubt were clarified. Following lunch at the " Hope" Hotel, Area Cadet Officer H. F. Mulligan discoursed on " Badge Subjects." He then went on to give advice on the authorities best to deal w~th when arranging lectures and examinatlons on the many subjects in the Cadet curriculum.

ment, which he (the Chairman) felt sure augered well for the future of Cadets. The Chief Officer's most invigorating talk on " The Future of the Cadets" was the highlight of the Conference, and left all the delegates with a feeling of well being for the organisation's future. The Chief Officer was followed by District Staff Officer Haines talking on "Competitions," whose point was that a Division trained to competition standard would be well disciplined and its members always acquit themselves well in emergency. At the close of the Conference, following tea, D.S.O. Haines and Lady District Officer Miss Moore expressed their pleasure at being invited to attend tbe Conference. County of Berkshire The County Commissioner (Mr. C. A. Poole) accompanied by the Han. Mrs. Leslie Gamage, the County Superintendent, and other members of the County Staff carried out the Annual Inspection of the following Divisions on September I4th. At Finchampstead, Finchampstead Nursing and Nursing Cadet Divisions ; at Bracknell, Bracknell Ambulance and Nursing Divisions, Ascot Nursing, Ambulance and Nursing Cadet Divisions and Wokingham Ambulance Division. A County Nursing Cadet Competition was recently held at the Ambulance Hall, Chatham Street, Reading. The trophy, which was the Byland Cup, was won by the team from Reading South Nursing Cadet Division. This team entered for the Regional Competition held at Slough on October 25th, the winners entering the National Cadet Competitions held in London during this month. DIDCOT The number of transport duties covered by Didcot Ambulance Division during August exceeded those of any previous month. Eighty-one calls were answered and a total of 2,286 miles run by the two ambulances. READING On Monday, September 8th, at the Ambulance Hall, Chatham Street, Reading, the County Commissioner presented the Grand Prior Badge to Cadet Sgt. David Fowler of Reading Town "A" Ambulance Cadet Division. In doing so, the Commissioner congratulated Cadet Sgt. Fowler, wishing him luck when he joins the R.A.F. in the very near future. On Saturday, September I3th, members of Reading Town "A" Ambulance Cadet Division held a successful Garden Fete at Quarry House, Tilehurst (by kind permission of Mr. John Eppstein). Side-shows were well patronised and much amusement was caused by the antics of the circus composed entirely of Cadets. The programme included a concert

Nine members of Reading South Nursing Cadet Division recently took their Preliminary Home Nursing Examination, the result of which was 100 per cent. pass. The examiner on this occasion was Sister Howart, S.R.N., . S.C.M. WHITLEY On Thursday, October 9th, at Whitley Community Centre, members of Whitley Nursing Division under Div. Supt. Mrs. A. Clark, held an "Open Evening" at which demonstrations were given of "St. John at Work." The proceedings were opened by the County Commissioner who appealed for recruits to help carryon the good work already started in the district. Anyone, he said, under 65, able and willing to work for the good of others, would be welcome. The programme included demonstrations by members of Reading Town "A" Ambulance Cadet Division . WINDSOR At the Road Safety Carnival held at the Alexandra Gardens, Windsor, on September 20th, members of the Royal Windsor Divisions staged a mock accident invol ving a car, a cyclist and two boys playing ball in the street. During the demonstration, which was watched by some 1,500 people, Div. Supt. A. F. L. Simmonds gave a running commentary, explaining each step of the first aid work as it took place. The scene was so realistic that several members of the audience fainted I County of Cheshire The new headquarters of the Birkenhead Corps were opened by L ord Leverhulme on Saturday, September 27th. Also present at the ceremony were the County Commissioner Capt. P. Reay, Corps Supt. Woodward and Coros Officer Pollock. Mter the official operung Lord Leverhulme inspected the new ambulance recently presented to the Corps. County of Leicester On Friday, September 26th, members of the Co-operative Ambulance Division competed for the "Dr. Garrett" Cup awarded for individual efficiency. The Divisional Surgeon, Dr. E. B. Garrett, was the judge. The test was based on an actual accident to which the Surgeon was called. Corporal S. A. J. Smith, who has held the Cup on two previous occasions, was adjudged the winner, Pte. E. Remmington being placed second. In presenting the Cup, Dr. Garrett expressed his appreciation of the work done by the competitors. West Riding of Yorkshire (South-Western Area) BRIGHOUSE CORPS At the recent Health Exhibition held in the showrooms of the Gas Company, Brighouse,

one of the stalls was taken over by Brigade members. The stall was effectively draped with the flag of St. John; many posters and items of equipment were displayed and much literature was freely distributed. Many enquiries were received from members of the public and it is to be hoped that the week's exhibition may encourage several new members to the Ambulance and Nursing Divisions.

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LYE bars, 77 25-years' bars, 33 30-years' bars, 16 The Annual Dinner of Lye Ambulance 35-years' bats, 10 +o-years' bars. Division was held recently in the Divisional Great Western Headquarters, Ambulance Hall, Chapel Street. Cl\ROIFF Among those present were Corps President Mr. L. Lewis, Class Inslructor, presided at J. A . Harris, Corps Supt. J. H. Watkins, Corps Officer H. G. Mills, Mr. H. Perks the presentation of awards held recently, and the presentations were made by Mr. H. II. (Div. President), Mr. Round (Div. VicePresident), Dr. Martin (Div. Surgeon), Div . Swift, Divisional Superintendent. Others Supt. T. H. Pardoe, Transport Officer H. present included the lecturer, Dr. Bence and SADDLEWORTH Barlow and Amb. Officer H. Cooper. Quite 1\1rs. Bence, 111'. A ]. Robinson and ,\[r, Eleven teams from various parts of LancaJ. H. Page, Assistant Divisional Superintenshire and Yorkshire competed in the fifth a number of representatives of local firms dents, Mr. P. W. E. Longhurst, District Annual Ambulance Competition promoted were also present in addition to ,Mr. P. H. 1\1anager, Hotels Department, and l\ft. B. Schofield, ex-Asst. Commissioner, and a large by members of this Division recently. Board, Divisiona l Ambulance Secretary. An The winning team was Dewsbury West number of members of the Division. Mter a meal the Divisional President gave enjoyable musical entertainment was provided. Riding Police, Horwich L.M.S. Works Machine Shop being only half a point behind. the" Loyal Toast." This was followed by HEREFORD Dr. D. G. Tullis, who has for man)' years the presentation of awards and Certificates Batley were third. Of the women's teams, Manchester L.M.S. by the Corps President to members. The been adjudicator in the Divisional ComLadies were first, Huddersfield Central toast "Lye Division" was proposed by petitions in the Chester, Gloucester and Nursing Division "A" Second and Horwich Mr. J. Watkins and responded to by Div. Worcester Divisions, has kindly presented a trophy for a competition between the teari1s Supt. Pardoe. L.M.S. Ladies third. competing in these three di"isions. The An enjoyable concert then followed. Over 100 men and 30 women took part in trophy will be awarded to the team from the the individual tests, the local cup being ROWLEY REGIS· Chester, Gloucester or Worcester Division awarded to A. Blacker, Greenfield. The members of this Division, together with gaining the highest number of marks in the The keen members of the Saddleworth Division are open to receive notice of any their wives, met at the Civic Restaurant, Semi-Final Competition. Mace Street, Old Hill, recently for a reunion EWTON ABBOT competitions they may enter. supper. l\Ir. A. W. H. Christison, Divisional The Chairman for the evening was the Locomotiye Superintendent, presided at the County of Worcester President of the Division, Mr. 1. Collins. presentation of awards to the ~e\'·ton Abbot The Annual Inspection of the Northern Mter an enjoyable meal, served by the class and the awards were presented by l\Irs. Area of the County of Worcester was held members of the staff of the Civic Restaurant, Christison. The Chairman also presented a l\lr. Collins proposed the Royal Toast \l.nd cup to 11r. Sweetland of Taumon, who had recently at Bingley's Ground, Old Hill. The Inspecting Officer was County Com- then expressed his appreciation at another of gained the highest individual marks in the missioner Dr. F. L. Newton, Commander these functions so well remembered from competitions of the Exeter and Plymouth Order of St. John, assisted by County Supt. pre-war days, and hoped it would be the fore- Divis ions. Dr. Porter and County Cadet Officer :iYlrs. runner of many such events. 1ft. R. A.. Newson, Chief Mechanical He spoke highly of the work of the St. Engineer's Department, who 'was Divisional Robinson. County Secretary l\liss H. M. Walton was responsible for the examination John Organisation, and said in order to Ambulance Secretary until he joined the of the books and records of the Corps Divi- appreciate to the full work done, one had to Forces in 1943, has again taken oyer this sions. The Area Commander was Asst. experience the help that could be given, and post. Since 1945 the duties have been ably Commissioner T. C. Lench with County as such an experience had been his, he could carried out by "\lr. H. J. Potter, Goods not speak too highly of this work. Sergeant Major Preece as Adjutant. Department, Taunton, who has now left the The war ended, but the needs of humanity district. The North Worcestershire Corps paraded at Haden Hill Park with Messrs. T. W. Lench's still went on, and the work of the St. J ohn Southern band and Dudley & District Corps at Nether- Ambulance Brigade was needed just as much PORTS..\10UTH ton Park with Birmingham Cadet Ambulance now as at any other time. Presentation of Awards for Portsmouth and Band. Both Corps marched to the parade District Ambulance Class "\vas held in the STOURBRIDGE ground. Ambulance Room recently and made by l\Ir. 1\1iss C. D. Whittingham, Div. Supt. Corney, Goods Agent, who congratulated The Mayor of Rowley Regis, :iYliss E. C. Jeakes, President of the Southern Area Nursing Division, passed away October 18th. the recipients on qualifying and for. unde:Nursing Corps, and several Divisional The funeral took place at the Stourbridge taking such excellent work. He prorrused hIS support to funher the movement. Mr. W'est, Presidents and Vice-Presidents were present Cemetery on Wednesday, October' 22nd. The Guard of Honour was made up of Station n{aster, referred to the efforts of :\11'. for the Inspection. Mter the Inspection, displays of tactical officers and members of the Brigade. Chedzey, Class Secreta1Y· Mr. Chedzey, on behalf of the Class, marching and physical training were given expressed his thanks to Mr. Corney and l\Ir. by the Cadets under their instructors. RAILWAYS West for giving their valuable time to make HILL AND CAKEMORE London & North-Eastern the evening such a success. A Harvest Bring and Buy Sale was held in The staff of the N orth-Eastern Area Centre ASHFORD the Girls' Hall, Secondary and Modern School, Over 300 Ambulance men and \vomen and Hill Top, Hill and Cakemore recently, in of the St. John .Ambulance Associati<;)!1 are having a busy time. They are prepanng to their families and friends attended the Concert aid of the funds of the Nursing Division. and Social arranged by the },.shford Works The function was opened by the Rev. / '>.. distribute medals and bars to L.N .E.R. Beaven, Vicar of Blackheath, who gave a servants who ha ve won them but who, and Motive Power ~\mbulance Classes, held owing to the restriction in the use of precious at the County Hotel, .l\'shford, recently. The suitable address for the occasion. Divisional Superintendent Wise Dye wel- metal, have up to now been given Certificates Centre Secretary presided in the unavoidable absence of Mr. J. H. Chitty, \X'elfare Officer, . . comed all friends and thanked them for their only. Staff who have passed fifteen examl11aUons at the presentation ceremony. Before calling support of the Division, especially in view of the growing Cadet Division now being are eligible for a gold medal and if t~ey up 1\lr. J. t. Bell, Works '\.lana&"er, w present continue to pass examinations they receIve the awards, Mr. Trott paid tnbute to J:?rs. supported by the Division. Gray and Hodgson for so kindly lecturmg Certificates were presented to the five a bar for each succeeding five years. As the gold position i~ not li.kely to. improve, to the Classes and spoke of the tremendous members of the Division in respect to work done at the first aid test during the war years. it has been decided to Issue SlIver gIlt medals service rendered to the mo,"ement and to the and bars, and in a few months' time these Class members by Mr. ]. T. Henneker and These were presented by Miss N. Ashton. Afterwards the gifts, which had been gl :ren will be aYailable for the staff who ha\Te become r.h. H. Bowes, Class Secretaries. Referen~e was made to the 7,000 odd cases treated. In very liberally, were sold and a mock aucUon entitled to them. During the period 1941 to 1947 inclusive the Ashford area during 19.t7 to date, which was conducted by l\1r. Harry Roberts, to reflect with credit upon the seryice rendered whom thanks were due for his untiring efforts the North-Eastern Area staff have gained the by the first-aiders to their raih'ay colleagues. following awards: 488 medals, 176 20-years' in getting money from. the visitors.

FIRST

AID

FIRS T

AID

PRACTICAL NURSING IN THE DOME BY

AGNES E. PAVEY, S.R.N. Diploma 111 Nursing (University of London) The Uses of Moist Heat organs, the pulse rate is increased but the tension is lowered MOIST heat may be applied to the whole of the body- and the patient may become faint, but if the muscles had excluding the head, or to a selected or limited part. previously been in spasm or were contracting sufficiently The simplest form of generalised. moist heat i~ the ordinary to cause pain, a hot bath will frequently have a beneficial bath of from ten to twenty rrunutes duratlOn. If some effect. For example, infantile convulsions or intestinal antiseptic or other substance is added to the water it will colic may be relieved in this way. The changes in the be known as a medicated bath. Other forms of generalised circulation aids the elimination of accumulated waste moist heat are vapour baths and hot wet packs; but these products in over-used muscles, tendons, ligaments and procedures involve a somewhat complicated technique and joints, and this, together with the soothing effect upon the usually a fully trained nurse would be sent to carry them nervous system, results in the relief of pain in these out. Local applicatiom include fomentations or com- structures . presses, stupes and poultices. Medicated Baths HOT BATHS. These may be ordered (r) to promote Medicated baths are given (r) to relieve skin irritation, sleep, (2) to stimulate skin excretion, (3) to relax muscle (2) to overcome parasitic skin diseases, (3) to reduce spa<;m and prevent or relie,'e conv,ulsions, or (4) to relieve inflammation, (4) to remove crusts or scabs, or (5) to paw in tense muscles, tendons or ligaments. The effects of relieve the pain of chronic rheumatism. Among the a hot bath will depend upon the degree of the heat, the commonest are the following : duration of the bath and the cQndition of the patient. OATMEAL BATH. This is one of the most available Por sedatilJe effect in il1somnia the bath should be given at, of the emollient baths. One or two pounds of oatmeal is or slightly below, body temperature. This produces no put into a muslin bag and is boiled in half a gallon of water. marked change in the circulation, but it surrounds the The water is then added to the bath, which is about twobodv with a medium that shields the skin from external thirds full and contains about 30 gallons of water. The stim'uli such as irritation of the nerve endings by air, oatmeal bag mar be used as a sponge. clothing pressure and changes in temperature. Thus the BRAN BATH. This is prepared in exactly the same whole nervous system is rested and the patient becomes wa y as an oatmeal bath but using two pounds of bran. drowsy. If the temperature of the path can be maintained STARCH BA Tf 1. Half to one pound of starch is mixed at a definite level and the patient can be made comfortable- with cold water to a paste, which is then added to the for example, by providing a rubber cushion as a head rest- bath. With a second method, boiling water is poured he may he allowed to remain in the water for half an hour over the paste to make a mucilage and this is added to the or more, after which he returns to a warmed bed and will bath. A starch bath is more expensive than either oatmeal probably fall asleep quite quickly. Such a bath is often or bran and, at the present time, starch is almost impossible beneficial to a child with chores, or "St. Vitus dance." to procure. In these cases the child is so highly nervous that it is BORAX BATH. Half a pound of powdered borax necessary to prevent and allay fear. He must be supported is added to the bath. It will dissolve readily in the water, in the bath, his head resting on the nurse's left arm, her so that no previous mixing is required. forearm passing diagonally under his shoulders. He must SODA BICARBONA TE BATH. This is prepared never be allowed to feel that he is slipping or is in danger in the same way as a borax bath, using the same quantity. of getting water into his ears. If water at a lower tem- It is an alkaline bath and it not only relieves itching, but it perature than that of the body is used, a bath towel may be aids the removal of crusts and scabs. It is sometimes placed under the child so that his naked skin does not ordered for the relief of stiffness and pain in chronic touch the cooler porcelain of the bath. If it is necessary to rheumatism. In these cases, washing soda may be subadd hot water in order to maintain the temperature of the stituted for the soda bicarbonate. bath, this must be run in slowly, the nurse's arm being ALUM BATH. This is astringent as well as soothing between the stream of hot water and the child's body. and is used when there is a moist exudate from the affected \'\lhen given to promote skin excretion the temperature of skin. Half a pound of alum is added to a 3D-gallon bath. the bath should be from roo to IrO degs. F. The immediate ACID BATH. The commonest acid used is vinegar, effect of immersion is to contract superficial blood-vessels, one cupful of household vinegar being added to a plain forcing the blood into internal vessels . This stimulates water or a starch bath. Its main use is to overcome itching. the production of heat within the body, the heart's action SULPHUR BATHS. Two to four ounces of sulis increased and the rush of blood to the head may result phurated potash is dissolved in a small amount of boiling in headache unless this is counteracted by applying a cold water and is then added to the bath. It has been used compress to the forehead or to the nape of the neck. As particularly in the treatment of scabies, but it is less often a result of the heat production, the skin vessels dilate and ordered since the benzyl benzoate treatment was introperspiration is increased. The greater volume of blood in duced. \'{1hen used strong enough to kill the parasite it the skin lessens the amount in muscles and in internal may cause dermatitis. A sulphur bath of half the strength

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THE TRAINING OF FIRST AID COMPETITION TEAMS 2nd 2nd By

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Mr. Boyce-Mears advises most ~0t?petently on the building of the team, on tr~1n1ng for c<;>mpetition work, :vha~ to expe~t 111 the test, dIagnosis and exanunatlOn rout11le and completes the booklet with a very useful and informative specimen of an average judge's mark sheet.

CHANCERY

LANE,

W. C. 2

FIRS T

suggested for scabies has sometimes proved of benefit in MUSTARD BATH. This is useful in infantile conacne, gout and rheumatism. vulsions. The bath should be prepared at 100 to 105 HYPERTONIC SALINE BA T H. This may be degs. F., mixing a tablespoonful of mustard to a smooth ordered in the treatment of septic skin conditions. Three paste and adding it to three gallons of water. The child is pounds of rock salt is added to a 30-gallon bath. Hypertonic held in the bath on the nurse's arm for three to five minutes saline stimulates the circulation and increases muscle tone. only, a cold compress being placed on his forehead. If his By its action on the skin it produces a sensation of warmth, skin becomes a rosy pink or the inner surtace of the nurse's so that a saline bath can be given at a temperature a few arm begins to tingle the baby should be taken out at once. degrees lower than an ordinary bath. Its duration is usually ~e is dried quickly with a warm towel and is then placed about ten minutes, after which the patient should be dried m a warmed cot. A mustard bath is sometimes given for on a rough towel, the friction counteracting any te~dency its sedative effect in chorea. The temperature of the water to chill. should not then exceed 90 degs. F. and not more than one PERMANGANATE BATH. A few crystals of per- tablespoon of m,":stard should. be used to each five gallons manganate of potash are dissolved in hot water. The of water. The child may stay m the bath for half an hour if physician usually specifies the exact amount to be used, he shows no untoward reaction. On return to a warmed but care must be taken to see that the crystals are com- bed he will probably sleep quietly for some time. pletely dissolved or burns may occur. Permanganate baths In the treatment of colds and chills, four to six ounces of are useful in pustular skin infections, when they act as mustard is us~~ for a 30-gallon bath, but correspondingly oxidising agents. smaller quantItles for a foot bath only. The temperature IODINE BATH. This is used to stimulate slow-healina should not exceed 95 degs. F. tor the mustard acts as a ulcers and it may be given to a localised area-as a sit~ chemical irritant, stimulating the circulation in the skin bath for an extensive bedsore, or a leg bath for varicose vessels. In these cases the patient may remain in the bath ulcers.. ~he quantity l!se~ is two tablespoons of Liquor for 20 to 30 minutes. Iodo Mltls (2 per cent. lOdine) to every six gallons of water. (to be continued.)

ANATOMY AND PHYSIOLOGY IN FIRST AlB by J. WELLS, M.R.C.S., L.R.C.P. The Bones of the Upper Limbs are :_ (I ) The Clavicle (collar bone). (2) The Scapula (shoulder blade). (3) The Hume"rus. (4) The Radius . (5) The Ulna. (6) The Carpal Bones (wrist bones). (7) The Meta Carpal Bones. (8) The Phalanges. The Collar Bones or Clavicles.-At their outer ends form part of the shoulder joint, and at their inner ends are attached to the sternum. The Scapulae or Shoulder Blades, right or left, lie at the ul?per and out~r part of the back of the chest, and also help wlth the cla v1cle and humerus in forming the shoulder joint. The spine and edges of the scapula can be felt on the living human being. The Humerus) the Upper Arm Bone, right and left reaches from the shoulder .to. the elbow, and at the elbow, helps to form the elbow lOlnt, together with the ulna. The Fore A rms, right and left, each have two bones. The outer bone, the radius being on the thumb side and the ulna on the inner or little finger side of the forearm. The Carpal Bones form the wrist, and are eight small bones arranged In two rows of four bones each. The M eta Carpal Bo~es (that is meta beyond the carpus), are ~ve bones extendtng from the wrist to the knuckles formlng the framework of the hand and support the phalanges or finger bones. The Phalang,?s or finger bones are three to each finger and two to the thumb. The Pelvis Is a basin-like mass of bone, consisting of :_ (I) Two Innominate Bones, right and left.

FIRST

AID

(2) The S~crum, consisting of the five sacral vertbr~, which forms the back of the pelvis. The innominate Bones Each consist of : (I) The Ilium Bones, right and left. (2) The Ischium Bones, right and left. (3) The Pubic Bones, right and left. There is .also a deep socket, the acetabtt/uJ1l, on each side of the pelvls, for the heads of the right and left femurs in the formation of the hip joints. ' The Crest of the Ilium, :vhich can be felt along its entire length, e?ds ~ front, with a bony point which is called the an~~nor (m front), superior (above) spine of the crest of th~ llium, and this point is ~mportant,.in surface markings of this part of the body. This bony p0111t can be felt easily on the living body. Bones of the Lower Limbs

(I) The Femur (thigh bone), right and left, is the longest and strongest bone in the body. It extends from the hip joint to the knee joint. This bone demonstrates ' t~e. different ~arts into which long bones can be divlded ; that 1S, the head, neck, shaft and lower end. :r~e lower end of the femur helps to form the knee lOlnt, together with the tibia and patella. (2) Y,he Patella (~ee cap) is a fiat, thick, triangular plece ?f bone, s1tuated on the front of the knee joint. RU11111ng over the patella is the conjoined tendon of th~ ~xt~nsor mu.scles of the front of the thigh, and this l~ 111serted lnto the tubercle oj the tibia, a bony proffilnence on the front of the tibia. This tendon can be felt as a thick cord, just below the lower border of the patella. On sudden contraction of the

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FIRST

extensor muscles of the' thigh, the patella is sometimes fractured by this tendon suddenly pressing on it. If the legs are fully extended, with the feet resting on the floor, the free movements of the patellre can easily be felt. The Bones of the Leg (r) The Tibia (shin bone). (2) The Fibula (brooch bone). The Tibia extends from the knee to the ankle, in both of which joints it plays an important part. Its edges can be felt under the skin along the inner sides of the leg, immediately below the skin, the prominent border forming the shin. On the top of the head of the tibia lie the internal and external semilunar cartilages. On sudden twists and sprains these cartilages are sometimes loosened and misplaced, owing to the fine ligaments w.hich bind them to the head of the tibia becoming ruptured. This accident is common in football players and athletes.

FIRST

The Fibula) lies on the outer side of the tibia. The head of the bone can be easily felt. It is attached to the tibia like the pin is attached to a brooch, hence its name. It does not enter into the knee joint, but its lower end forms the outer part of the ankle joint. Owing to the fibula being fixed to the tibia above and below you do not get the movements of supination and pronation, which take place in the forearm. In the forearm the ulna articulates with the lower end of the humerus and the radius is not fixed at the elbow, but at the wrist the radius articulates with the wrist joint and the ulna does not. Owing to this the bones of the forearm can rotate on each other and are, therefore, able to perform the movements of supination and pronation in the forearm, whereas in the leg these movements are absent, owing to the fibula being fixed above and below. The ankle joint is formed by the lower ends of the tibia and fibula above and the astragalus below. (fo be confirmed.)

AWARDS

Letters to the Editor.

SIR, I am a regular reader of FIRST AID and a member of out local St. John's Brigade. Recently, members of the Brigade were awarded certificates signed by their Majesties, for ambulance and first aid work carried out through the war, I enquired if I was entitled to one, I was told I was not as I did no first aid work during the war. What about the first aid work the catering staff of the ex-Empress of Asia did ? They volunteered to stay behind at the General Hospital before and after capitulation of Singapore, they rendered valuable assistance under most trying conditions. A few of them carried out Erst aid and hospital work from the day of capitulation right up to VJ day. Would you or would you not call that first aid work carried out during the war ? Catering Staff, Yours faithfully, Ex-Empress of Asia. DISAPPOINTED FIRST AIDER.

EMERGENCY TREATMENT

OF SKIN INJURIES

S_____

SIR,

I note on page 6 of the current issue of FIRST Am you refer to F.I.C.A.P. Although a regular reader 1 have not noticed reference to this Association before. Will you please inform me of the meaning of the letters and send particulars of membership. Yours faithfully, R. E. WALES. The letters stand for" Fellow of the Institute of Certified Ambulance Personnel." The address of the Institute's Secretary is 61, Cheapside, London, E.C.2. You should write there for full particulars.-Editor.

queries and Answers to Correspondents Queries will be dealt with under the following rules :_ I.-Letters containing Queries mUff be marked on the top lefl-hand corner of the envelope" Query," and addressed to " First Aid," 32, Finsbury Square, London, E.C.2 , 2.-AII QuerieJ must be written on one side of the paper only. 3·-AII Quericf must be accompanied b.! a "Query Coupon" cut from the current lSs,!e of the Journal, or, In case of Queries from abroad, from a recent ISsue. 4·-The Textbook to which reference may be made in this column is the 39 th (1937) Edition of the S.J.A.A. Manllal of First Aid to the

Injured.

Treatment of Shock K. B. CSheffield).-Recently a young girl in our lvorks had alJ electric shock from a small machine which she was l1)orking. Her hand was slightly burned and she waf suffering from shock. Our first aid man'lvaf not 011 the firm at th: time. So another )'oung lJIan got buJy te/ling the other girli to give her some cold sweet tea and 1vas attending to her needf. 1 just mentioned that fhe should have hot sweet tea and be kept l'var!l1. Whereupon he turned round and said he had learned that in the R.A.F. and he k.new ,vhat he )pas doing.

Later 011 he callie to me and told me 1I0t to be so emphatic as he had learned about shock in the R.A.F. and I1 IOltld back thelll agaillst alQlbocfJ, Of course 1 told him that I /Jad lIel'er heard of afJ)'lhing cold being ginlJ to a perSOli sufferilJgfrolJl shock and left it at that. 1 hape been a member of St. John a felv )lea1's nOli) and have ah1 l a)'f been lold to give lI'arll/th 10 stich a person. Thinking aboNt a// this affair aJtenva1'df I began to 11'01l&r if thif mati nas right and he had been tallght to give cold Sll'eet /('a as an emergency during the ,var. I shall be pleased to hear 11)hai )lOti think about it and thank J'OII in anticipation of al1 earry repry.

To me it would seem that your fellow worker used the term" cold" rather in the sense that the tea should not be given" hot." This, of course, is strictly in accordance with Rule 8 on page 29 of the Supple~ent to the Textbook, which tells you to give large quantities of warm, weak, sweet tea." N.C.F. Examination Howler E. H. (Liverpool).-In a recent examination a candidate )Vas fold to compress the subclavian artery. If?'hen he IJJaS doing his test, the doclor asked: " Agaimt 1J1hat bone do .yOII rOil/press Ihir arle1')' ?" The candidate

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Miscellaneous Advertisements. Advertisements with remittance should be sent to First Aid, 32, Finsbury Square, London, E.C.2. Rate 3d. per word, minimum 4$. 6d. Trade Advts. 4d. per word. minimum 6s. Box numbers 15. extra.

BE Wise. Get that extra Wear and Appearance from your Shoes. Send for a pair of Vic Shoe Trees 8/- including post. Cash gladly refunded if not satisfactory. CLAYTON Leather Crafts, Sutton in Ashfield, Nottingham. Concert Tickets, 7/6. Posters, Memos, Rubber Stamps. Sam0 ples free. "A" Tices, II, Oaklands Grove, London, W.I2. HOW to Stop Smoking. Save Money. Safeguard health. Thousands cured. Send stamp for Booklet of World Famous Remedy. Stanley Institute Ltd., (Dept. 75) 265, Strand, London. RUPTURED? FORGET IT! Use Brooks Rupture Appliancethe new discovery. Wonderful! No lumpy pads, no springs, durable, cheap. Binds and draws parts together quickly. Sent on trial. Catalogue free. Address: Brooks Appliance Co., Ltd. C7I8A) SO, Chancery Lane, London, W.C.2. C7ISA) Hilton Chambers, Hilton Street, Stevenson Square, Manchester, 1. Standing Bear, Monkey and Rabbit. Complete patterns, Instructions and materials. 2/6 each inc. tax. Inrnans, Roundhay Tee., Leeds 7.

15"

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PENETRATING It is the penetrating power of Germolene which ~nables it to sink right in through the top skin into the true, livinu skin below-and so to reach the tortured nerve endings-which brings such wonderful relief.

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QUERIES and ANSWERS COUPON To be cut out and enclosed with all Queries. November, 1947.

OINTMENT

FIRS T

1/'a,r JlalpabtJ /Jerpkyed. So the dorlor, haring il1 l1Iind the .rtor), oj the origin o( ]I'oll,all/rolll a nb, tried to be helpJul and said: "just thiilk oj Lrc :.. III//l/ediatPl)' the calldidate replied : " Oh! I know 111)11'! It IS" ldmJt's _,lppl, ! "

Good ' ~cxr plea ~ : :- -.C.F, Fracture of Base of Skull p. , '. I\Iorpcthj.-Please tell me if it If possible Jor a padent) JI'hoff' J ace h pale, b,.eathi'~p. .rhall07l' alld pulse Jeeble alld quick) to be suJferingJrol!! a (rae!!/!' if the barf oj the skull accompanied by escape of blood or clear fluid Jrom the ear.

Yes.- '.C.F. Roller Bandage O. R. (Beccles). -Can ),Of{ tell 11lC 12'hy illstructiolls Jor app(ying the roller bandage are 1I0t lJIduded in the 5.;'llabus oj Instruction in First Aid? During the recent 1/'01' J spent abot" tn'o ),ears doing Jull-time first aid 011 d~tJ{'rent buildillg works afld aerodromes;

and in my estimation I used roller balldages jor one triangular bandage! I t seems to me that a good kJloJl'ledge of rollfl' bandaging u'ottld be helpJul to all Jirst-aiders. I aJra;/ )'0111' rep!;' and again thank you Jor the invaluable help derizled .. from )'Oflr Query' COillJJI11 ill the past. 1,000

~\hhough not included in the Syllabus of Instruction, a description

of the rollcr bandage and its application is reproduced from the H ome of the First Aid Textbook. I t is, therefore, possible for all first-aiders to learn how to apply the roller bandage. In this connection the advice that all keen first-aiders should take the Home i'\ursing Course and Certificate is thoroughly sound. The reason for these instructions not being included in the Syllabus of I nstmcrion in First Aid is that a first-aider is taught how to deal \\'ith emergencies for which little, if any, equipment is available and for which the triangular bandage (which can be quickly improvised) is the most useful bandage for controlling dressings and splints. •. C.F. ~ea~ of F racture O. S. (\\'eli;ngroCl, _ (' v Zealand).-I am .rurprised at the nUllIber of lIew

AID

The terms are synonymous and express the same condition, " break" bcing a word of j\nglo-Saxon origin and " fracture" a word of Larin origin. It is a popular error among lay persons to regard a fracture (which is the technical term) as more serious than a break (which is the colloquial term).-N.C.F. H umour in First Aid

E. II. (Liverpool).-So/J/e Parsee girls llJere taking their examination Jor first aid ccrtificater. One noas asked h01I1 she would treat a foreign body in '!J'e. She hl'Silated and seemed confused. The examiner tried to be helpJul alld said: "Collie 011 ! I am sure that you know II/hat to do ! " To this the candidate replied : "Yes) btlt unfortunatelY I do not h70)V 711hat kind oj bail' brush a came! uses I "

Good!

ext please!! N .C.P. H remorrhage and Asphyxia E. P. (Charlton).-Ifl a recent conversation lIIith a Jel101v Jirst-aider (who is a member oj another Dil'ision), the question arose as fo which should lake

AID

the arrest of h:emotrhage ,-..-ould occupy a brief space of time, this shou ld be giyen firs t attention and follo\,-ed by artificial respiration 011 the second patiem at the earl iest oppormnity.- .C.F. Transport Down Narrow Stairs E. B. (Fraddon).-II1 the course oj a discussion (7vhich took place il1 our .Llmbf(laflce Room) OJ] methods of getting cases d0 I1-'11 lIarr0711 rural slaircases lI'ith a carl)'iflg sheet, our instructor staled that, if f aced with the lIeceSSlf)' of taking a patient (ll'iJo Jl'as sujfpring f rom J rac/tlred Jemur) dOil'fl 'f/rrow, tllisted stairs, hc would just tie the limbs together and appfy splint after he had the case on the grollnd floor. I feel that) if this is a 17'ise cOllrse to adopt) it IVotlld be as weff to take the patiellt straight 0" as it 711as n'ithout ll'aiting to splint the limb p rovided that a stretcher lI'as or'ai/able 011 the ground floor . I shall great(), appreciate your cOll/ments 011 this problem.

THE HOUSE

Splints and bandages are used to pre,em movements of fracrures during transport and the use of both is universally recommended . Even though it may not be practicable to apply splints previous to the transport d own narrow stairs of patients suffering from fractu res, it must be remembered that this is only one part of the journey to hospital. Consequently, splints should, in my opinion, be applied after patient has been moved to ground floor or placed on stretcher.- .C.F.

FOR

Crush Injuries

~ursing Textbook in .l\ppendix 4

.r/"dettls Il'ho callf/O; accept the definitIOn oj "fracture " as given on page 6J oj Ihe Tl'xtbook and who affirm that a Jracture is more serious than a break. Please tellllle if I am correct ill .rtating that the two terms are S)'IJOI!)·JJIOf(S.

FIRST

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The futu re holds something good for us aiL

Articulated & Disarticulated HALF SKELETONS, Etc. Etc.

Those seeking a professional career can avail themselves of the opportunity of preparing for the futu re by study ing the art of Scientific Massage with the oldest training centre of its kind in Great Britain.

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If First Aid is a subject in which you are interested, then you will re adi ly understand the value of SWEDIS H MASSAGE and how it can ass ist in healing the sufferer.

D . K . (Ferryhill).-At a recmt Call/petition one oj tbe individual practical tests conceTfled a man pinlled dOJrn by a heal)' weight 011 the thigh. T he examiner's instruction ]J'as that the patient could not move the ,veight but that the first-aider could. One opinioll in our tealll is that the Jirst-aider was justified in promptly removing the weight (" Removing the cause of I fYuT.Y") before rendering Jurther aid Ivhich included the admillistration oj fhe alkaline solution in accordance 711ith the Supplement to Textbook) page 7, paragraph 8. The other opinion agrees with the judge in accepting literally the abol'e instmc/ion that " tb fluid .: ](I!{ld be given if pr.ssiblc uefore the limb is refeaed" and car'J'ing tbis out before removing the weight. Your adllice will be welcomed.

Although the Supplement to Textbook does not mention the time factor with crush injuries, the administration of weak alkaline solution is called for only when the weight has been on the limb for a period and has resulted in death of the tissues below the weight. In the case which you quote, since the first-aider could lift the weight and presumably was on the spot quickly, these serious results would not be present---especially as the weight could be moved easily and the pressure had not had time to produce its harmful effects. T he treatment of the case quoted, therefore, is to remove the weight without loss of time and then to proceed in accordance with the instructions of the T extbook.-N.C.P. Fractures of Upper Limb D . K. (Ferryhill).-On page 8 oj the Supplement to T extbook (Stfpplementary paragraph to General Rules Jor Treatment oj Fracture) is " A general method fo r dealing with aflJ' fracture if the Upper Limb," and opinion

l Human Osteology, Anatomy, etc.,

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prioril), if Ihe first-aider is single-hallded-h(lJmorrhage, f rom which the patient IS liable to bleed to death) or complete absence of breathing. 'Pe Oilla;t )'Ollr rep(), wilh milch illterest and ask)'ou to accept our best thanks.

But in the case of fracture of bones oj the Jorearm or wrist lIIe think that securillg the limb 011 the chest b)' means oj a bandage looped around t he IlJrist, etc., 71/0uld tend to calise aggravation oj Ihe it!/ury and at least would not be comJortabie. Your advice is aUJaited 12Jitb interest.

You do not make it clear in your query whether the conditions named are supposed to be present in one or two patients . In the former case there would not be severe h:emorrhage if the patient were asphyxiated; anu you would not know the variety and extent of the h:emorrhage until breathing had been re-established. You should, therefore, commence artificial respiration and watch the wound for onset or recurrence of bleeding. Should, however, two patients be involved, both are in a serious condition ; but, as the treatmen t for

You r query gives the impression that you have no t given full consideration to the third paragraph on page 8 of the Supplement to Textbook, and so fail to realise that the instruction to which you refer applies on ly to cases of fracture" for ]phich splints are not available." If, therefore, the proper equipment is not available, you are forced to use the bod y as a splint; and if properly applied, the looped bandage round the wrist would cause neither aggravation nor discomfort, N.C.F.

AID.

ami_noa IOI..-ed for Senior Students. .. Without doubt the book will be 0/ great

_vice in the training 0/ thO$e lor whom it i, desis,,,,l.-Briti.h Medical Journal.

in our team accepts this as a sound improvised treatment where the fracture occtlr.r abOl'i1 the elbow.

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contains steri~ vaccine filtrates (antivirus) of all the common strains of STAPHYLOCOCC I, STREPTOCOCCI and 8. PYOCYANEUS in a lanoline-zin <-ld >t Plyol base . SPECIFIC AGAINST the micro-or,anisms causin, abscesses, boils, eczema, dermatit is, erYSipelas, hzmorrhoids , impetieo. ulcHs and all inflammatory cuta neo us affettlons , ANTIPEOL LIQUID for infections of the ear, septic cavities and suppuratin, wounds.

,./"'-WE illustrate a conversion recently executed for the St.lves Division /

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Size-30 in. x 20 in.

(Size 2 ft . 2 ins . by 3 ft. 4 ins.) Complete Set of 1 9 sheets on tough cartridge paper with Roller, 63/- net, postage I Od . ; or Mounted on Linen, 90/- net, postage I / I d.

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Be prepared for an emergency and keep Cuticura Brand Ointment in your First Aid Kit. It brings instant soothing relief to cuts, burns, skin lacerations-prevents spread ofinfection, quickly heals. Obtainable at .~ Chemists and Stores.,

. rut~~ura \..! OINTMENT

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MANUALS OF FIRST AID By N. CORBET FLETCHER, O.B.E., M.B •• B.C., M.A. (Cantab.), M.R.C.S.

AIDS

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.. Col. Sir Jam~ Cantlie contributu an introduction and We endoru hi, good o/linion of the boo'k."-Lancet. .

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"PORTLAND"

Editor: DALE ROBINSON, F.R.S.A., F.S.E.

AMBULANCE GEAR The Gear Illustrated (A .B.C.D.) carries two stretchers on one s ide of Ambulan ce, leaving othe r side cl ear for si tt ing pat ients .

No. 642.-VOL. LIV.

Entered at ] Hall r Stationl'1's'

DECEMBER, 1947.

The UP AND DOWN act ion is quick an d easy for loading or unload ing.

PRICE FOURPENCE [5/. PER ANNUM, POST FREE]

CONTENTS

A . Shows the two stretchers in position.

Editorial A Course in Advanced F irst Aid The M edicine Chest A New Weapon against Tuberculosis

B. Shows the top stretcher lowered ready for loading. C . Illustrates the same Gear with the top stretcher frame hinged dOW1t for use when only one stretcher case is carried. D. ShOW5 the same position as in" C" only with cushions and back rest Ji !led for con valescen ( cases.

News from all Quarters Practical Nursing in the Home Anatomy and Physiology in First Aid Queries and Answers to Correspondents

8 10 II

N OTICE TO READE RS. The Annual Subscription is 55. post free; single copies 4d.

FIRST AID is published on the 20th of each m onth.

Whe re Ambu lances are requ ired to carry fou r beds two Gears are fitted, one on EI rHER SIDE, and the same advan t ages apply as described above .

. Its aim. a.nd objects being the advancement of Ambulan~e and First Aid Work in all branche •• the Editor invites Readers to .end Articles and Reports on subJects pertaining to the Movements and also welcomes suggestions for Practical Papers. All R~ports. &c .•. sh?uld be addre ..ed to the Editor at the address below, and should reach him before the 8th of each month. and must be .«companied

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American Red Cross Activities

facilities offered. But it is interesting to note that our

American Red Cross is seeking to extend its activities right into the home. The war greatly enhanced the American organisation's already considerable reputation, and now the peace-time programme is aimed at havi ng at least one person in every household trai ned in the care of the sick. while other activities will be concerned with the prevention of iII ness and accidents. As part of this ambitious programme, health and safety courses are planned, and will embrace nutrition, first aid, home nursing and accident prevention. They will be available to every section of the community, and special cou rses are to be started in ru ral areas, deal ing with types of accidents encountered on farms. Apparently medical amenities and facilities in the rural areas are sparse, and the organisation are placing special stress on the extension of home nursing in these districts, while the special courses will make the farming community familiar with farm accidents and the necessary preventative precautions. This is an excellent programme, and the results produced will, of course, depend on the use the public make of the

brought out in the recent correspondence in these columns on the question of teaching first aid in schools, it is not everyone in this country who is of the opinion that first aid shou Id be taught to all and sundry. Without re-opening that discussion, it may be said that conditions are quite probably different in the United States. We believe we are correct in saying that there is a greater awareness among the people there-especially in the more remote districts -of the need for some knowledge of first aid, no doubt it is something handed down from pioneer days when every man was his own doctor and surgeon. Consequently, the Americans are more likely to take kindly to instruction on these matters, while in this country, more often than not, it would be considered a great bore. However, with 6,000 people ki lied every year in their homes in this country, we feel that some such vigorous programme as the American Red Cross are undertaking. could not fail to be beneficial in tackling this problem of home accidents.

cousins consider it worth while to make these AN Ame rican contemporary gives us news that the American courses available to the general public. As was well

Septonal cleanses and heals woun ds with amazing rap idity. Prevents and ar r est~ inflammation . A safeguard against blood-poisoning . Possesses ex traord inary styptic properties. In liqU id form Septonal is supp li ed in 16 oz. bottles at 3/-, quart 6/-. ~ gallon 9/6 and 1 gallo n bottles at 17/ - per bottle , and in co ncentrated form in 2 oz. bottles , for making up 1 gallo n, at 14/- per bottle. Septonal Antiseptic Ointment This ointment is most useful for bo ils, minor in juries and sk in troubles . Ava ilable in i lb . jars at 2/3. ~ lb . 4/· and 1 lb. 7/6 per jar. Make sure you include Septonal in your ambulance outfits. We hold stocks of Surgical Bandages Dressings, Lint, Cotton Wool and all First-Aid requisites.

_ _ __

COUGHS & SNEEZES

Be on the .. safe " side-Septonal will meet every First·Ai d need .

PEN~JROL

THE I. D. L. INDUSTRIALS LTD.

~',S~"!ARl~"t:t

1, ST. NICHOLAS BUILDINGS, NEWCASTLE-ON-TYNE, 1.

2/3 Inclu di ng Tax A t a ll C he m ists

INHALANT ,.~'"-.

PEiNETROL

on your handkerchief Inhal'e freely and prevent infection

FIRST

AID

FIRS T

A COURSE IN ADVANCED FIRST AID

Pregnancy

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

First Aid in Maternity Cases FIRST aid in childbirth has been sadly ne&"lected in first aid training. It is, however, a very. Importa~t subject, particularly in these days when the b1rth-ra~e IS high and there is a lamentable shortage of nurses tramed in maternity work. . It is not at all unusual for a woman to gIve birth to a baby before the arrival of professional assistance; sometimes indeed births occur in ambulances, first aid rooms, shop; and other places far from suitable for the well-being of the mother or her newly-born child. The emergency does not usually occur with the firs~ or second baby of a family because the mother has suffiClent \,'arning of the approaching arrival ~o enable h~r to send for assistance, or to go to the hospital or nursmg home ",here she has booked up; but sometimes a mother will ignore the \varning symptoms until it is too late to obtain profeSSIOnal help. The more common emergency, h.owever, occurs when a woman has alr~ady had several babIes ; she may, on a subsequent occasion, give birth so rapidly that she has no opportunity to obtain assistance; this is called « precipitate hirth or labour." It is obvious, therefore, that every first-aider should possess some knowledge of first aid in maternity cases for he mal· find himself involved in either of the two groups of emergencies described above; in addition he may ba\'e to deal with a miscarriage which will be referred to in a later article. The chief reason for keeping the first-aider in comparati\·e ignorance on the maternity work is that it is such a specialised subject both for doctors and nurses; faulty treatment at any time during case-taking may cause the most disastrous consequences to the mother and child. For this reason, it is illegal for anyone, except a medical practitioner to undertake maternity work in England, unless she possesses a special qualification, State Certified Midwife (S.C1L), recognised by the Ministry of Health. Hence 110 first-aider should ever attend a maternity case except in (l/2 extreme emergency; in aJry event, he should send immediatety for qualified assistance. To understand the correct procedure to adopt at a confinement, the first-aider must first gain an elementary knowledge of the anatomy and physiology of the female generative organs, the course of pregnancy and the actual process of childbirth.

The Female Generative Organs These are situated within the pelvis, and are thus well protected from injury. They comprise the uterus (womb), ovaries, fallopi~n tubes and vagina. The uterus is a hollow, muscular organ lying between the rectum and the bladder. It is shaped rather like a pear with its broad end, called the fundus, directed upwards, and its neck, the cervix, directed downwards where it opens into the vagina. The inside, or cavity of the uterus,

enters the uterus and imbeds itself in the endometrium where it begins to grow rapidly to form an infant.

\'qithin a few weeks of conception, the first signs of a human form are visible while aiter two months, the head trunk and limbs are well developed. The growing infant, or foetus as it is terme~, obtains its nourishment from its mother. A sponge-like mass, almost circular in shape, develops on the inner wall of the uterus; it is called the placenta or after-birth and is well supplied with blo~d der.ived fro~ t.he blood-stream of the mother. A thick Jelly-lIke cord Joms the placenta to the navel of the child; this is known as umbilical cord and carries bloodvessels which convey blood containing food, etc., from the placenta to and from the c~i~d. The growing foetus is protected from mJury by a la~ge bag of liquid (popularly kno.wn .as "th~ waters ") which surrounds it. Further protectIon IS supphed by the muscles of the mother's abdominal wall.

VAGINA

The Female Generative Organs. Half of the uterus has been exposed to show its interior leading through the neck of the womb (cervix) into the vagina. IIltlstration reprod/tced from" The Handbook of Firsl Aid al/d Bandagillg," Beldios, ,\lull'all)' and Arllls/rol/g, bJI courteS)' of Balliere, nlldall C-N Co.,,\,.

is lined by a special kind of mucous membrane called the endometrium. The ovaries are two oval organs about the size of large almonds, they are situated one on either side of the pelvis. Each ovary contai~1s many thousands of minute " eggs" termed ova; these lie in little bag-like cavities (sacs) on the surface of the organ. Every month, one of the ova undergoes further development and is discharged from the surface; it is then capable, if fertilised, of growing rapidly to produce a child. So far as is known one ovum only is discharged on the I 5th, I6th or I7th day before the onset of each menstral period. Some women, however, produce two or three ova each month. The fallopian tubes, two in number, begin in close proximity to each ovary and end by opening into the cavity of the uterus. They are about four inches in length and have the important function of guiding the ova into the uteros. The vagina is the passage which leads from the uterus to the external skin where it opens at what is called the vulva. Fertilisation The male reproductive fluid, known as the semen, contains enormous numbers of spermatozoa which are minute cells carrying tail-like projections. \Xlhen deposited in the vagina, they make their way to the uterus and up the fallopian tubes. If, during the journey, one ot the spermatazoa meets an ovum, fertilization takes place and the two cells fuse together. The fertilised ovum then

UM5ILKAl

COr<.O

PQOTIC LIQUID

AID

Abnormal positions are very common but are usually recognised by the doctor or midwife during the course of ante-natal examinations. The well-known "breach" occurs when the buttocks are directed downwards and the head upwards. Pregnancy lasts for forty weeks at the end of \vhich time the foetus has grown to its full size, weighing on the average 7 lb. and measuring about 20 inches in length. Approaching Confinement The process of giving birth to a baby is called labour. It is important that every first-aider should know the symptoms and signs which indicate that labour has actually begun. False alarms are not a~ all uncommon but there are also, occasionally, cases in which the patient does not recognise that her confinement has commenced; sometimes she erroneously attributes her pains to indigestion or some similar cause. The signs of labour are (0) Pains, (b) the Show. (a) The Pains are caused by the action of the muscles of the uterus. They are first felt in the back and lo\"rer part of the abdomen. Initially they are feeble and infrequent, but they gradually grow more severe and more frequent. A characteristic feature is their regularity. At the onset the interval between pains may be as long as half-an-hour, but gradually, as progress is made, this interyal becomes shorter. (b) The Show is a discharge of blood and mucus (slime). It does not, however, always occur. Course of Labour Labour is usually described as consisting of three stages. The first stage is monotonous because the mother does not feel that any obvious progress is being made. It generally lasts for quite a long time, on the ayerage I6 hours for a first baby, and 10 hours for a subsequent, but there can be marked variations in time. During the first stage, considerable preparatio.ns for the birth are taking place. The bag of waters IS pressed downwards by the muscular actions of the uterus in such a manner that the neck of the womb is made gradually bigger and bigger (dilated). Ultimately it becomes. l~rge enough for the head of the foetus to pass through It lnto the vagina. This stage is at an end when the neck of the womb has been dilated to its maximum extent. During the .first stage of labour th~ patie.nt is usually entirely comfortable between th~ pams; mdeed? untIl they become very frequent, she :vill ge~erally lrefer to be up and about, except that she will req.uue to .Lea.n ~orward and support herself, or to sit down while each paln IS on. As dilatation of the neck of the uterus proceeds, the patient has .an increasing desire to empty the bowels and bladder this resultlng from the pressure on these two the head of the foetus which is gradually organs descending. The second stage of labour is usually heralded by the rupture of the bag of waters :vhich shows itself by a sudden gush of fluid from ~he vaglna. From now onwards the patient must be kept 1ll bed and should not be le~t alone .. The pains now become more severe .and different m character. They are regular in time, occunng every two or three minutes. \'<:'ith each pain, the mother .holds .her breath and" bears down," bracing her feet) pu~ling agalnst something with her hands and straining hard In her effort to propel the baby from the uterus. Cltimately the whole process becomes involuntary.

The Foetus in the Uterus just before birth. Illustration reproduced from "The Handbook of First Aid & Balldaging," Bclilios, Allllpar!), and Armstrong, by Courtesy of Ballierc, Til/dall & Cox.

The foetus lies in the uterus in a curled up position. In normal cases, its head is directed downwards into the pelvis while its buttocks lie in the upper 'part of the abdomen; its back is on the le~t and 11s lunbs ?n. the right, on which side the mother notices the greatest kicking.

FIRS T

Each pain has the effect of forcing the foetus a little further down the pelvis; soon its head makes its appearance at the vulva. At first only the top of the scalp can be seen and this disappears again as each pain passes off. Gradually, however, more and more of the scalp becomes visible as the vulva becomes sufficiently stretched to allow the baby's head to emerge. When the head ceases to recede during the intervals between pains, it is said to be " crowned" and the birth of the baby is imminent. At first the head is born; then, after a short interval and with the next pain, the remainder of the baby arrives. There is usually a slight gush of blood and liquid immediately after the birth. The second stage of labour lasts on the average two hours.

FIRST

AID The third stage begins with the birth of the child and lasts until the placenta is expelled. For a few minutes after the arrival of the infant, the tired mother rests quietly free from pain. Soon, however, further muscular actions of the uterus, usually insufficient to cause perceptible pain, separate the placenta from the uterus, and force it into the vagina from which it may be spontaneously expelled. During and immediately after expulsion of the placenta there is a considerable loss of blood, the average amount being four ounces. The third stage of labour lasts on the average 20 minutes at the end of which the patient is usually tired out and cold even to the extent of shivering. (to be continued.)

The Medicine Chest By FRANK BERRY, PH.,C. Adrenaline

as Absolute Alcohol, and is then a colourless, volatile, inflammable

A DRENALJ E is the active principle of the suprarenal gbnds, liquid with a characteristic smell and a burning taste . those small glands simated one abo,'e each kidney. Administration of Adrenaline brings about effects similar to those induced by stimulation of the sympathetic nervous system, as for example, hair sranding on end, acceleration and strengrhening of the heart beat and increasing release into the blood stream of the carbohydrates stored in the liver. For this last reason, Adrenaline should not be administered to diabetic patients unless to counteract insulin overdosage. In cases of sudden heart failme, injection of Adrenaline solution ditect into the cavity of the right auricle has often restored cardiac activity and rhythm. Adrenaline is generally used in the form of a 1 in T,OOO solution, and this solution, which also contains salt and preservative, should be kept in small, well -closed containers and stored in a cool place away from light. Adrenaline has a powerful constricting effect on blood vessels and for this reason is frequently applied locally ~o check capillary bleeding from superficial wounds, from tooth sockets after extractions and from the nose. It is often incorporated in local anresthetic solutions in order to prevent undue spread and absorption of anresthetic and to yield a relatively bloodless area for subsequent operative procedure, being particularly valuable for operations on nose, throat or eve. It is very useful in treatment of hay fever, asthma and ~any allergic conditions and is ineluded in the formula of many nasal sprays and inhalants. In the form of ointment or suppositOries Adrenaline is used in treatment of h~morrhoids and inflamed conditions of anus and rectum.

Alcohol Under this heading, several closely-related preparations having Alcohol as their essential constituent, will be considered. The name Alcohol is given by chemists to many series of substances having a similar type of chemical structure, but when used without further designation in connection with medicine, it is presumed to refer to the specific substance more accurately described as Ethvl Alcohol. . Ethyl Alcohol IS produced by the fermentation of sugary solutions and can be separated and purified by distillation processes. Many strengths and qualities of Alcohol are used in medical work and in manufacture of medicil1es such as vegetable extracts and tinctures. When completely pure and free from all traces of moisture it is known

Proof Spirit contains 57 per cent. by volume of pure Ethyl Alcohol, and is so called because an old test of its strength consisted in pouring the Alcohol over gunpowder, and if on subsequently applyin g a li ght, the gunpowder became ignited, the Alcohol was said to " stand the proof." Spirits are termed so many degrees over or under proof, according to the amount of distilled water which must be added to or subtracted from roo volumes of the sample in order to yield a spirit of proof strength. Rectified Spirit or Spirit of Wine, contains 90 per cent. by volume of pure Ethyl Alcohol and corresponds to approximately 58 over proof. Alcohol is popularly regarded as a stimulant, but in actual fact, it has a purely deprcssant effect on the central nervous system. The higher centres of intellect, reason and inhibition, located in the frontal lobes of the cerebrum, are the first to be affected when Alcohol i~ taken in excess, and this explains the impairment of reason and iudgmem, the abolition of self-criticism and the increase of assurance and confidence which generally follows such indulgence. AlcohOl dilates the blood capillaries in the skin and by thus increasing the blood supply to the body surface, leads to a sensation of warmth, but it should always be borne in mind that there is, in consequence, a greater liability to chill, and continued exposure to cold must be carefully guarded against. Alcohol or other spirit should never be administered unless by instnlction of a doctor; the only two occasions when a first-aider is authorised LO gi ve Alcohol, are cases of Prussic Acid poisoning and after bites by rabid animals. In cases of Alcohol poisoning, treat according to standard Textbook instructions, paying particular attention to promotion of bodily warmth; always remembering that accurate diagnosis of these cases is complicated, and cc drunk or dying" is difficult to differentiate. Methyl Alcohol is the name of an Alcohol present in Wood Naphtha or Wood Spirit, obtained either by destillctive distillation of wood or by synthetic processes. Ethyl Alcohol is denatured and rendered unnt for internal use by addition of a suitable pJ"Oportiol1 of this Wood Naphtha and is then known as Methylated Spirit. There are several types of Methylated Spirit in use, the chief being ; Mineralised Methylated Spirits This is the otdinary blue-coloured Methylated Spirits sold commet·cially. It consists of Ethyl Alcohol mixed with 9.5 per

AID

cent. Wood Naphtha and 0.5 per cent. Crude Pyridine, with the Alcohol, but being eliminated from the body very slowly, the toxic addition of a proportion of Petroleum or Mineral Naphtha and a effects are more prolonged and more dangerous. little Methyl Violet D ye. Symptoms of poisoning include, lowering of body tempetature, O wing to the presence of the Mineral Naphtha and Pyridine, convulsions, vomiting, dilation of pupils and serious visual disturthis product does not give a clear solution when diluted with bances which may lead to permanent blindness. As little as one fluid water. ounce has caused death and this practice of Methylated Spirit drinking, This grade of spirit is unsuitable for medicinal use as the Pyridine cannot be too strongly condemned. in it may cause a type of dermatitis. Treatment of poisoning should be as for Alcohol poisoning with Tndustrial l11ethylated Spirits, also kn01vn as Industrol particular attention to rapid elimination of the offending substance This is prepared by mixing 95 parts of 95 per cent. Ethyl Alcohol from the body. with 5 parts Wood Naphtha and is a colourless volatile liquid The special varieties of :M ethylated Spirits mentioned above, are which gives a clear solution when diluted with water. It is used used for sterilising surgical instruments and the patients' skin prior extensively in the manufacture of medicinal products but should not be employed in preparation of Iodine solutions owing to the to operative procedure, preparations containing 70 per cent. Ethyl Alcohol having the maximum bactericidal effect, stronger Alcohol chemical reaction which takes place between Iodine and the being less efficiem. Acetone present in the spirit, leading to the formation of extremely Instruments must not be stored for prolonged periods in diluted irritating vapours. Alcohol or msting may occur. Ind1lstrial lVlethylated Spints (Acetone free) Surgical Spirit is of value in preventing bed·sores and the oil it This is a purer product which has been freed from Acetone and contains helps to obviate cracking of the skin. For this purpose, after may be safely used in preparation of Iodine solutions. washing and carefully drying the skin, some of the spirit should be Surgical Spirit, aL.o knonJn as Spirit Chirurgicalir There are several formulas approved for this purpose but all poured into the hand, applied to the area concerned and rubbed gently consist essentially of Industrial Methylated Spirit containing about with a circular movement until rhe skin is quite dry. Diluted Alcohol is present in many evaporating lotions used in 2.5 per cent. Castor Oil in addition to the special denaturants. These denatured spirits are not intended for internal use, but treatment of bmises and sprains and is often used to form a cold unfortunately, many misguided individuals reson to Methylated compress by soaking folded lint in the lotion or spirit and applying to the required part. Spirit drinking with disastrous results. (to be continued.) Methylated Spirits do not produce drunkenness as quickly as Ethyl

A New Weapon against Tuberculosis THE MOBILE MASS X RAY UNIT. On the left as we enter are the developing and washing tanks com· recently paid a visit to the ambulance \\'orkshops of W E Pilchers at Wimbledon to see the nrst of a fleet of mobIle umts pletely heat controlled by thermostat, here too are the darkroom .Mess~s.

for mass radiography. This prototype is certainly a very fine achievement and is the result of many months of planning and sheer hard work for all concerned. The result is well worth every minute of the time spent in perfecting the appliance. The mobile unit is a heavy van into which has been built a complete and up-to-date darkroom carrying with it the entire portable X-ray apparatus complete with equipment for exposing, processing and projecting the 35 mm. and larger film that is normally used. ot an inch of room has been wasted, in fact the biggest problem must have been to fit all this equipment into such a small space. Arriving at the site for the X-ray tests, in this case a factory, the side of the unit is lowered by an internal built-in winch, and becomes a gangway down which the X-ray apparatus and control unit are wheeled into the premises to be set up ready for use. Th.is intricate and costly mechanism has been made foolproof and despite the extreme technicalities of X-ray machinery the control panel makes it a simple " press the button " affair, that is, to the expert radiographer of course; we hesitate to think of what state of confusion the layman would reach if confronted with the job. To return to the mobile unit we find that the side has now been raised into place and we can enter, via the driver's cabin, what has now become a perfect darkroom . The van is completely insulated and the big alternator built into the tail is now running from power supplied by the motor engine and is creating the electric current for this film processing room. Refrigerator and heating units keep the temperature within one degree of accuracy and the thermometer registers a steady 63 degrees.

clock, water faucets and drainage sumps, all closely packed yet so well designed that manipulation of the film offers no problems. At the rear of the cabin are the heating and freezing units and the electric cabinet into which the processed films are hung for drying. On the right, built·in cabinets hold the items of equipment for work. Film wi.nders and holders, cutters, chemicals, the projector and camera when not in use, sheaths for the larger film, etc., all have their exact position for storage. Even a section of the wall through which we entered has its built-in cabinets holding the expensi\'e X-ray tubes, etc. The driver's cabin itself contains the ammeters and other instruments and indicators controlling the electric current that is being generated. The combination of this travelling darkroom and the portable X-ray unit means that hundreds of X-ray photographs can be taken, processed, projected on a screen and enlarged films be ma~e .of any individual 35 mm. exposure showing suspicious characteristics, all within a few hours. It means that no matter where this senriee is needed it can be set up entirely independent of electricity supplies if necessary. It means that the most advanced method of diagnosing certain forms of tuberculosis is brought to the public in the shortest possible time and with it the ultimate saving of countless liv~s. We feel sure that our readers will recognise the value of thIS enter· prise and the valuable edition to the early diagnosis of ~be:culosis that it represents. By this time the first mobile X·ray u~tt WIll be 111 the hands of the L ondon County Council for whom It was buIlt, and will have started its acti,'e career. This is the first of many and we hope that these units \\Till soon become a common sight in our midst, eventually enabling rhe entire population to be X-rayed. First-aiders will realise only too well the \"alue of early treatment.

FIRST

AID

News From All Quarters JIII/iors: 1St, Ipswich; 2nd, Grays; 3rd, Unit look place on Sunday, October 26th, at THE ST. JOHN AMBULANCE Swanage. Trophies : Championship Woodley Airfield. The members, under their (" Dunbar- asmith" Cup); Ipswich; officer, Miss Susie George, were inspected by BRIGADE. Individual Tests (" Cunard" Cup) : Warwick the Deputy Superintendent-in-Chief, Lady Town. Dunbar-Nasmith, who was accompanied by Headquarters. The "Tweedale" Trophy for the team the County President, Major-Genet·al Sir J ohn gaining the highest number of marks in the Duncan, K.e.B. ; the County Vice-President, Dr. W . C. Bentall It is \vith deep regret that we record the Home Nursing Section was won by Warwick Lady Loraine; the County Commissioner, passing of Dr. \VI. e. Bentall, O.BE., K.St.J., Town Junior Team, whilst South Wigs ton Mr. e. A. Poole; the County Surgeon, Dr. A . on No,"ember 16th. Dr. Bentall started his gained the Bcdmaking Trophy. Altogether Buchanan Barbour, O .B.E.; the County Superintendent, the Hon. Mrs. Leslie Gamage; career in the Brigade as a District Staff Officer 38 teams competed. the Brigade Secretary, Major P. G. Darvilin ~o. 4 District, he afterwards became Prince of Wales's District Smich, C.B.E.; and the County Officer for Assistant Commissioner for that District; On Saturday, the 15th o'vember, 1947, later he moyed to o. 8 District. He was the 6rst post-war Conference of County Air (Berks), Mrs. M. S. 1. Mils. At the march past the salute was taken by appointed j\ssistant Surgeon-in-Chief in 1936 Surgeons was held at o. I District Headand became AR.P. Staff Officer to the Chief quarters under the Chairmanship of Dr. I'vL 11. Lady Dunbar-Nasmith and the parade was led Commissioner shortly before the war. He Scott, District Surgeon. There was a good by Reading Town " ~\." Ambulance Cadet was a Knight of the Order and a member of attendance, and the occasion was honoured Band. The members of the Unit, some twenty in the Chapter General. by the presence of the District Commissionernumber from Nursing Divisions all over the Dr. . Corbet Fletcher, O.B.E. (Surgeon-in- Major A. e. White Knox, O.B.E., M.e. Chief) writes the following appreciation : Following the introduction of his personal County, have undergone careful medical, "The passing of Dr. William Charles Headquarters staff the Chairman read a letter psychological and radiological tests in order Ben tall, O.B.E., K.St.J., ,yho in 1936 was from the Surgeon-in-Chief sending greetings that the fittest and most suitable candidates promoted to \ssistant Surgeon-in-Chief of might be selected for this special work. and good wishes for the success of the occasion, the Brigade, has caused deep regret to his and referring to several matters of current They have received instruction in the care yery wide circle of friends. In all rny dealings importance . and handling of patients in the air, including with him, I found Dr. Bentall a most loyal and The Commissioner in his remarks attendance upon emergency midwifery cases. energetic colleague; and nothing which 1 emphasised the important part to be played On Saturday, October 25th, the team from asked him to do was ever refused. He was by Surgeons in the training plans in con- Reading Great Western Ambulance Cadet present at (and assisted me) in all the Final templation and the necessity for stimulation Division, captained by Cadet Sergl. J. Wise, Competitions, and his cheery smile and bright of interest. who won the cup in the County Competitions, conversation will be remembered by the Following upon a review of the geographical reached second place in the Regional Commany thousands who, drawn from all parts area covered by the District, and possible petition which was held at Slough. They of the Brigade, took part in those contests. Although in failing health, he insisted on being reorganisation, the Chairman initiated a put up an extremely good show, their marks present at the 1947 Finals, and on taking his discussion on training, competitions, and the being 265! out of 320, the winners (the team from High Wycombe representing Buckingpart in the parade of Surgeons at this function. necessity for training judges. The Conference concluded with a feeling hamshire) gaining 27It marks. Every County He will be sadly missed, and it will be no easy that good work had been done and the conin the Region was represented. matter to replace him." templated continuance of such conferences READ I G The National Ambulance and Nursing at quarterly intervals will contribute much In connection with the County Competition Cadets' Competitions to the future efficiency of the District by' The 6rst National Competitions open to securing co-ordination of training plans, and for the Porter Rose Bowl, a brief ceremony Ambulance and Nursing Cadet~ of the Brigade afford an effective liaison between Surgeons recently took place at the Reading Post Office Nursing Division headquarters, when presentawere held in the Royal Horticultural Hall, at District, County and Divisional level. tion of silver spoons awarded to individual London, on Friday, November 28th, teams County of Berkshire members of the successful team was made by 'who had previously won their County and The first post-war competition for the the Diyisional President, Mr. e. R. Fright, Regional Competitions competing. A large Porter Rose Bowl recently held among l\:LB.E. Corps Superintendent Miss Sudul crowd was present to witness the display in 'which a high standard of efficiency was shown. Nursing Divisions in the County of Berks arranged a demonstration of the Competition was arranged on unusual lines, the competing Test and the meeting concluded with a Sir Henry Pownall (Chief Commissioner) presided at the presentation, whilst Sir Edwin teams being c,hosen at random at ordinary demonstration of bandaging by the Cadet Divisional meetings. The test was set and class supervised by Ambulance Officer Mrs. King (Chancellor of the Order) welcomed H .R.H. The Duchess of Kent, who graciously conducted by County Officer Miss D. K. Woolley. Gibbins and fourteen Nursing Divisions took presented the Championship trophies and County of Dorset part. Competition was keen, with only three individual prizes. WEYMOUTH marks separating the 6rst three teams and the The results were as follows :This year was one of the busiest on record winners wue Readin g Post Office with l \ :MBULAKCE at the St. J ohn Ambulance Brigade Beach Hut Seniors: 1st, Horsham; 2nd, Hasland and Reading South and Maidenhead as runners- and statistics show that some 886 cases were Grassmoor; 3fd, Wolverton. Trophies: up, and Reading Central taking third place. The trophy and keeper silver spoons were dealt with. Of these, 38 were referred to the Championship (" White Knox" Cup) and local hospital or one of the local medical Individual Tests (" New Zealand" Cup) both presented to Divisional Supt. Miss Coombs practitioners. A great variety of injuries were by the County Superintendent the Hon. Mrs. gained by Horsham. encountered ranging from small , cuts from J/(~}iors: 1st, ?outh\\'ick; 2nd, Frickley Leslie Gamage, in the absence of the donor, old tins, glass, barbed wire, etc., to those of a Colhery; 3rd, Ihghbury. Trophies: Cham- Dame A. F. Porter M.B.E., at the Quarterly more serious nature requiring suturing and pionship (" Schooling" Cup) Southwick, Cou.-nty ?uperintendents' Meeting at Foxhill, hospitalization. Several fractures were also Individual Tests (" Jarvis" Cup) Frickley Whltek11lghts, Reading. dealt with, including two fractured thighs. Colliery. The Brigade in Berkshire has given a lead The summer would not, of course, have been NURSIKG in providing what in this air age may become complete without the all too frequent crushing Seniors: 1st, \X'eymouth; 2nd, Brighton; a very real and extensive service. A small of 6ngers in deck-chairs and our old friend 3 rd , Chelmsford. Trophies: Championship band of volunteer nursing members has been the" sea sting." (" l\Iountbatten "Cup) : Weymouth, who also formed into an Air Unit for the purpose of On the medical side, the usual cases of gained tbe Im'ididual Tests (" Senior Indivi- accompanying patients who are being transexposure to the sun were encountered and dual" Cup). ported by air. The official opening of the several cases of collapse whilst in the water.

FIRS T County of Leicester Mr. J. J. Dexter, Superintendent of the Leicester Corps for twenty-one years, died suddenly at his home, 4, Gaul Street, Leicester, recently. Superintendent Dexter, who was 67, had recently been made a presentation on behalf of the Corps in recognition of his service. He joined the Brigade in 1907, and became a Serving Brother of the Order. An employee of the L.N. E.R ., Mr. Dexter had worked in the carriage workshops for many years, but at the outbreak of war he was called upon to su pCl"Vise the organisation of Leicester's Civil Defence 6rst aid services. County of Staffordshire TIPTON Great local interest was taken in the Tipton and District Competitions which were held recently. Corps Supt. E. Lakin, who has b een a member of the organisation for 6fty years, was in charge, assisted by other Corps and Divisional Superintendents. All the competitions were well patronised and the general efficiency of the competitors was commented on by the judges. Mr. Alfred Chatwin, President of Tipton Parish Ambulance Division, distributed the prizes with the exception of the Kemp trophy, which ,vas presented by Mrs. Shilvock. Thanks were accorded to the judges, timekeepers, stewards, "patients" and all who helped in the work. County of Surrey GUILDFORD The fast, cream-coloured ambulance cars are n ow a familiar sight in Guildford, and they, together with drivers and other personnel of the Corps, symbolise that « torch of service" to which the County Commissioner, l\Ir. W. George Pape, referred when, at the North Street Congregational Church Hall recently, he called upon the boys and girls of the Corps who stood before him to carry on the noble traditions of their predecessors into the future. The occasion was the Annual Inspection of the Guildford Corps, and the County Commissioner's speech was the overture to a special event in the annals of the Corps, the presentation of the Jubilee certificate, the first presentation of its kind in Surrey, to the No. I Ambulance Division, in honour of fifty years' service. The presentation was made by the 1ayor (Councillor A. W. Graham Brown), and the certificate was received by Divisional Supt. J. E. Cheshire. Divisional Supt. E. e. Stevenson, of 2 , The Oval, Guildford, who had served in the Guildford Corps, St. John Ambulance Brigade, twenty-one years, died recentl~, aged 55. He had been in failing health a long ttrne. Mr. Stevenson came to Guildford about twenty-seven years ago, and was enrolled a member of the Corps in D ecember, 19 26 . He was appointed an Ambulance Officer ~n 1938 and Divisional Superintendent 111 January, 1940. During the war he was an officer of a bomb disposal squad in Middlesex. County of Warwickshire (North) NUNEATON A successful social evening was held on November 20th in the Ambulance Hall Nuneaton; over eighty members and theil friends attended. Owing to illness Count) Officer J. Bonham was absent. . The Ladies' Committee were responSible for the hall decorations which were much admired.

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Supt. G. A. D yde acted as M.e. during the to im~ginati~n. pro W. L. M. Bigby adjudivariety show and dance. Amongst those cated 111 the mdlvldual and v iva voce tests. present were the Divisional Surgeon, Dr. The result of competition, announced by D. W. Hendry, and Mrs. Hendry. Mr. F. A. Trott, Centre Secretary, was as follows: RAILWAYS London, Midland & Scottish 181 Yeovil We are indebted to Mr. G. H. Hill, General Chard Junction 173 Ambulance Secretary, for a copy of the Templecombe o. I 154t Twenty-second Annual Report on the Conduct Templecombe o. 2 153 of the Ambulance Movement in England and ... 110 Exeter .. . ... Wales during the year ended 30th June, 1947. . Yeovil and Chard Junction will compete In this, particulars of classes and examinations 111 Group I Competition to be held in March held by the Cornpany since 1925 are given, and to decide the two tcams that will represent it is pointed out that so far as the Company's the District in the Southern Final to be held staff are concerned, there is a small increase at the Borough Polytechnic on April 2nd, in each grade of examination this year, a 1948 . feature which it is hoped to develop . Many SOCIAL FU CTIOl S instances of exceptional first aid rendered are Presentation of awards have been held in recorded and also the awards made during conjunction with social functions at ewhaven, the year. Croydon, Launceston, Redbridge, Delabole, Particulars are given of competitions in Exeter, Ramsgate, ine Elms, Dover and which members of the Company's staff took Newport, I.o.\"X'. Each event demonstrated part and on the whole, the results are that there is plenty of enthusiasm for the satisfactory. work and that an "esprit de corps" is Reference is made to the Women's Ambu- developing. lance Section, and in conclusion the Secretary expresses his appreciation to the medical READING Recently at the Palmer Hall, the Reading profession, the hon. district and class Secretaries and Committee men, and the instructors Southenl Railway Ambulance Class in conwho have rendered valuable senrice. Thanks junction with the Reading Southern Ambuare also recorded to the Company and the lance Division, held their Annual Presentation of Awards. The Chairman was Mr. J. H. St. John Ambulance Brigade who have given Chitty, Welfare Officer, Southern Railway, much assistance. who said, in his opening remaks, that the London and North-Eastern Southern Railway was very proud of its A list of ambulance competitions to be ambulance staff. One never knew when their held in the Great Central, Great Eastern, services would be required, and he sincerely Great Northern, North-Eastern and l\IIidland hoped many new members would be forthand Great Northern centres during 1948 has coming and thus make this vital service a been issued by the Centre Secretary, l\Ir. e. highly efficient one. Mr. e. A. Poole, County Greenwood, Liverpool Street Station, London, Commissioner for Berkshire St. John AmbuE.e.z . We regret that space does not permit lance Brigade, said he was very pleased to us to publish the list, but feel sure that Mr. welcome the Mayor of Reading especially as Greenwood will be only too pleased to supply she had been unable to atcend any St. John interested readers with full details. Social functions during her term of office. Southern The Commissioner went on to say that it COMPETITIONS was up to everyone of us to be mas ters in the Group 2 District Competitions haye been art of first aid. ~Ir. O. Cromwell, Chief successfully concluded at Salisbury, l\Iaidstone, Officer for Labour and Establishment, Redhill, Exeter and Woking. Southern Railway, when making the presentaThe Exeter team test was a unique one in tions, said how delighted he was to have been that the judge, Dr. F. R . B. H. Kennedy, of given the opportunity o{ coming to Reacling the Isle of Wight, was a " deaf old gentleman" as he himself had been associated with the in a wayside cafe where a waitress met with an Ambulance Movement for over forty years. accident. The judge expected everyone to act Following the presentation a concert was as they should, because the setting left little given by the "Melodies."

FIRST AIDERS, J UDGES A m S TEWARDS AT T HE SOUTHERN RAILWAY CO~f1'ETITIONS, EXETER.

FIRST

AID

P RACTICAL NURSING IN THE HOME BY

AGNES E. PAVEY, S.R.N. Diploma 1n Nursing (University of L ondon)

pin will be required to Ex the dressing in position. A Local Applications of Moist Heat towel is used to protect the bed and to cover the part of OIST heat is applie? locally ir:- the ~orm. of fome.ntations and poultices. Theu actIon IS to dIlate the patient that need not be exposed, and a receptacle superficial bloodvessels, to allaY'pain and to help tc: over- should be at hand for the used wringer, or for a fomentation come inflammation. When applied to unbroken skIn they that is being removed. These requisites may be collected are regarded as medical appli:ations. .\Xl~en applied ove~ a on a tray. The patient is then prepared, the clot~g or wound they are known as surgical ap'plz~atzons and they ~equue bedclothes being arranged so that the part to which the an aseptic technique in theu apphcatlOn. FomentatlOns to fomentation is to be applied is easily accessible. The area which drugs have been added are often calle? "stupes," may, if desirable, be covered by the cotton woo~ wh~lst the and althouO'h this word is really synonymous wlth fomenta- nurse pours boiling water over the fome?tatlOn m the tion it is g~nerally reserved for the J?Je~icated fome~tation.s, wringer and brings the tray to the bedSIde. She then as distinct from those known as medlcal fomentatlOns, m takes one end of the wringer in each hand and twists in opposite directions, wringing out as much water as possible, which plain water is used. for if it is applied too wet the fomentation might scald the MEDICAL FOME TATIO S. Satisfactory materials patient. Then, opening the wrin~e.r, t~e flanr:-el or lint is to use as medical fomentations are pieces of old flannel or lifted by the corners and, after glvmg It a qUlck shake to blanket. They are light and hold a proportionately large expel the steam, it is applied to the part, covered with the amount of water and they can be washed and used again waterproof material and cotton wool and bandaged in and again unless they become hard and felted. Th~ir position. It may be kept hot by a half-filled hot water disadvantage is that they are ~ath~r rough to the ~kin. bottle held against it if the weight can be tolerated, or an Other suitable materials are white hnt and cellulose tIssue electric pad may be used. covered with gauze. If the object of the treatment is to Fomentations should be changed before they become relieve congestion or pain in a deep-seated orsan the quite cold. This may be as often as every 15 minutes, the fomentation must be large. For mstance, for an mflamed skin being inspected for undue redness before each fresh joint it should pass completely rour:d the limb and e~tend fomentation is applied; this seldom occurs unless the for several inches above and below It. For renal or kidney fomentations are applied too wet or the steam is not congestion it should co:ver the whole of the lumbar reg.ion and reach round to the SIdes of the abdomen. For abdommal shaken out. SURGICAL FOMENTATIO S. When a wound is pain it must extend from jus~ below th~ waist to the. top of the thighs, and when apph~d to relIeve congestIor: or present boric lint may be used. It sh ould be boiled in the inflammation of the breast It should be cut as a cacle wringer for five minutes, the ends being pinned together sufficiently large to cover this organ completely and then over the top of the lid so that they do not become burnt. a wedge-shaped piece, with its apex in the centre ot the E verything that comes in contact with the wound should flannel, should be cut out, so that the dressing fits ~ nugly . be sterilised, the nurse thoroughly scrubbing her hands The nipple is never covered by the flannel or by the Jaconet before touching the wound. If possible, two pairs of forceps should be added to the instruments required for the or waterproof material over it. . When applied for a definitely local effect the fomentatlOn wound dressings and these should be sterilised by boiling should not be larger than is necessary to dilate the vessels them for five minutes. The fomentation is lifted out of in the superficial tissues. If it were large enough to dilate the wringer by the forceps, shaken and applied over the the artery supplying the part, the conges tion and therefore wound, covering and bandaging the area as with a medical the pain, would be increased. For example, when applied fomentation. Some surgeons prefer that no waterproof to the face to relieve toothache a fomentation must n ot material should be used. In this case, a thicker and larger extend to the region of the neck or it would dilate the pad of wool is placed over the fomentation. branch of the carotid artery that supplies the face. MEDICATED FOMENTATIONS OR STUPES. Preparation and Application. -The flannel or lint is used Certain substances may be added either to the water or to double and, after cutting it to the required size and shape, the lint or flannel that is used in preparing a fomentation, it is folded and is placed in a wringer which, for ordinary in order to enhance its effect. The chief of these are soda, fomentations, is made of strong cotton material and is magnesium sulphate (Epsom salts), belladonna, opium about 24 X 14 inches in size, or a small face towel or tea and turpentine. With the last three it is important that the towel could be used. The centre of this, containing the prescribed quantity of the drug is actually incorporated fomentation, is placed in a bowl with the ends hanging in the stupe, and the method adopted must be one that over the edge-at opposite sides. A piece of waterproof ensures this. material, such as jaconet or plastic, is cut slightly larger SODA OR ALKALINE FOMENTATIONS. These than the fomentation and a piece of cotton wool is cut an are used in the treatment of painful arthritic or rheumatic inch or so larger than the jaconet. A bandage and a safety joints. A teaspoonful of washing soda is added to each

FIR ST pint of water that is used in p reparing the fomentation, or two teaspoonsful of bicarbonate of soda may be sprinkled over the flannel betore it is placed in the wringer. MAGNESIUM SULPHATE FOME TATIO S. These are used for swollen, cedematous wounds, such as carbuncle of neck. Two teaspoonsful of magnesium sulphate (Epsom salts) is added to the water in which the fomentation is boiled. Being a hypertonic solution, that is, of a higher specific gravity than that of body fluids, it acts by osmosis in reducing the cedematous swelling of the part. Alternatively, two teaspoonsful of common salts may be added to each pint of water, or the wound may be packed with a paste made of g lycerine and magnesium sulphate. BELLADON A STUPE. This may be ordered to relieve pain of a spasmodic nature, such as that of lumbago, or the painful swelling of the parotid gland in mumps that renders it very difficult to move the lower jaw. Thirty to sixty drops of tincture of belladonna are sprinkled over the

A ID

lint befo re it is placed in the wringer, the boiling water is poured on and the fomentation is immediately wrung out, betore all the belladonna has soaked out of the flannel. Another method is to paint the painful area with tincture of belladonna and then apply a plain water fomentation. OPIUM STUPE. Seeing that opium is one of the drugs that come under the control of the Dangerous Drugs Act, ~he prescribed quantity must be carefully checked and It must be seen that the patient receives the tull amount. An opium stupe may be ordered for intestinal colic or any other painful condition. The usual dose is thirty t o sixty drops. It is measured in a minim glass and it is placed on the tray containing the prepared fomentation. After. the flannel is .wrur:g ou~ and taken trom the wringer the t111cture of opmm IS sprInkled as evenly as possible over it. This must be done quickly, for the fomentation must not be allowed to cool before being applied. (to be continued.)

ANATOMY A N n PHYSIOL06Y IN FIRST AlB by J. WE LLS, M. R.C.S., loR.C.P. The Bones of the Foot consist of ;(1) The Tarsal Bones. (2) The Meta Tarsal Bones. (3) The Phalanges. The Tarsus consists of seven bones, of which the astragalus and the Os Calcis are the largest. The Os Calcis, or heel bone is the bone on which we walk, it lies directly below the astragalus. The NIeta Tarsus are the five long bones which support the toes. The Phalanges are the toe bone, two in the big toe and three in each of the others. Joints A joint or articulation is formed where two or more bones meet. Movement mayor may not be present at a joint. In movable joints the end surfaces of the bones which form tbe joint are covered by :very s~ooth .cartllage which lessens friction when the Jomt 1S m actIOn, and together with the synovial fluid contained in the joint lessens the shock of a fall. The joint is enclosed by a bag of strong tissue called the capsule of the j o~nt . T?i:, seal.s off the joint and prevents the synOVIal flu~d or JOInt 011 escaping from the joint. Thus. th~ synOVIal membrane, by secreting synovial fluid frc:rr: ItS. mner surface, acts as a lubricant to the joint. The )omt IS a.lso sttength~ned by ligaments, which are bands of strong ~l:,sue supportmg and holding the bones of the joint posltlon. . There are different types of Jomts, these conSIst ot : (1) Ball and Socket Joints. ---:-E~a:nples or. these are .s~en in the shoulder and hip Jomts. This typ~ ot iomt allows of very free movement.0 many directions. A dislocation of the shoulder )omt happens mu~h more frequently than the hip join~ .. This can ~a.slly be seen and appreciated by exammmg these Jomts

Jr:

on the skeleton. The glenoid cavity of the scapula in which the head of the humerus rotates, is very shallow and therefore in excessive moYements this joint is easily dislocated. The hip joint examined on the skeleton shows a deep cup-shaped depression, the acetabulum, in which the head of the femur is also held firmly in movements of the joint by the round ligament which is fastened to the head of the bone . This joint, therefore, requires great force to cause dislocation at the hip. The jaw joint is another example of a ball and socket joint. \vhen dislocated it causes severe pain and immobility of the lower jaw. This must not be confused with lock jaw, which is caused by the germ of tetanus. (2) Hinge Joints.-Examples are-elbow joint, knee joint and ankle joint. These joints permit only of flexion (bending) and extension (straightening). Gliding Joinls.-Allow a small amount of movement. Examples are seen in the small joints between the bones of the carpus and tarsus and in the spine. Dislocations rarely occur at such joints. lIJ11JlolJable Joints.-Examples being ot the skull and pelvis. In the skull many of the bones fit together like two pieces of finely dovetailed wood. This makes a very strong joint and union of bones. There are no ligaments, synovial fluid or articular .. cartilages taking part in these joints. The sacrum is separated from the IlIum by a layer of fixed cartilage, which .acts as a ~uffer. This cartilaginous type of buffer IS also seen I? .the spinal column. Ligaments surround these JOlr:tS but there are no synovial membranes or synOVIal fluid in them. (to be cOlltillued.)

FIRST

AID

FIRST

r lRST .,\ID I

SCIlOOLS

SIR,

Before starting on thc ubject that caused me to writc this letter, allow me to congratulate you on the high standard attained and maintained by your paper. It is both cducati ve and instructive. And now to work. In thc Editorial of FIRST /UD for July, 1947, you deal with thc aboyc very important subject. I agree wholehcartcdly ""ith you and from actual experience, being Corps Officer in charge of Cadets in Hutt Valley, .Z. I havc personal experiencc of the intelligent intere t taken in this most important subjcct by thc rising generation. There is one point, howc\'cr, I would like to mcntion, that is the method of teaching. I ha \'e observed that wherc some schools have ' taken up this subject and made it an unofficial part of their work, the teaching has not followed any proper programme. The result has been difference in tcaching causing an irregularity of action, To abolish this I think thc best mode of procedure would bc for the St. John Cadet Preliminary Course to be adopted, and that the teachers be provided \"ith a syllabus of lectures, and practical work stretching over the period of time to be dedicated to this very excellent work. In addition, an official examination could be held and the successful pupils presented with the Cadets' First Aid Certificate. In the course of instruction it would not be a bad idea to encourage the students with a brief resume of the history of the Order. This would impress upon their minds the fact that their work was truly-" Pro Fide and Pro Utili/ale HO/l/;mllll."

Replaces Bandages and Plasters THE HOUSE FOR

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Plastic Skin was originated for use as a dressing after blood transfusion Later, surgeons discovered its special qualities made it an ideal pre-operative surgical barrier. Today it is superseding bandages and plasters as a dressing for cuts, abrasions and small burns . Not only is it neat, flexible, waterproof, transparent and selfsealing, but because of its high phenol content it also greatly accelerates healing. " Portex" Plastic Skin is now available through all chemists In tubes, price 1/ Iod. including tax, and in larger size bottles. In case of difficulty, write direct to the proprietors, giving the name of your pharmaceutical suppliers.

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WATER?

O RDINARY drinking water is the best medicine, as well as the best food, known. The reason is that all of the poisons from the body are eliminated chieAy in a water solution. The less water available for such elimination, the more concentrated poison, and the more elimination (e.g., through the kidneys) will lead to damage . The more water availab le the more diluted the poison eliminated and the less danger of damage. About 60 to 70 per cent. by weight of the human body is water, either in free or combined state. The body of a I50pound man contains roo pounds or about fifty quarts of water. Each day the body loses 7 per cent. or three quarts of water which, in order to maintain good health, must be replaced. This loss is effected through the urine, the feces, the breath, the sweat the saliva, nasal secretion and tears, Th~ chief sources of bod~ . fl.UJds are (r) food and the metabolism of food, accounting for two quarts each day ; (2) drinks, which must supply the remainder-usually one and one-half quarts .

equipped

A'd Equipment

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ANATOMICAL CHARTS By G. DOUGLAS DREVER , M.B., Ch.B. I. FRONT VIEW. 2. BACK VIEW. 3. BONES OF THE SKULL. 4. ARTERIAL CIRCULATION AND PRESSURE POINTS. 5. TYPES OF FRACTURES (Each size lOx 7 ~ ins.) Price per set of 5 cards in stout envelope Is. 6d. net; postage 2d. ISs. 6d. per doz., postage 7d.; 3:>,. per 24, postage 9d. : r.J per 50; £5 16s. per 100. Obtainable of all Booksellers,

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When more poisons are present, the intake of more fluids is essential. _" FIRST AID / I.TTENDENT."

FOR A.R.P. AND OTHER FIRST AID STUDENTS

She studied with Clough's and said :

JAMES W. ROY.

SKIN

per cent. , R esorcinol, 'Spercel1i., !;;Il.s;ell(l/, '25 per cent., Chlo1'ojorm, 10 per cent. 11l a base ()j po1.Y-lJlP/!,-,'!11lelhacr},late and solveuts. 10

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WHY DRINK

NEW PLASTIC SURCICAL DRESSINC

Letters to the Editor. DE/IR

AID

Chambers, London, E.C.4 Founded 1886

Telephone; EUSton 4282 (5 lines)

THE TRAINING OF FIRST AID COMPETITION TEAMS 2nd 2nd By

EDITION

"Gives clear and constructive advice on selecting and training .teams for fi~st aid competitions, and proVides us~ful tIpS .on individual and team behaViour dU!1ng competitions . . . . . should find a ready public."-Fi re Protection.

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FIRST

AID

FIRST

------------------------------------- - ------

Queries and Answers to Correspondents Queries will be dealt 11)ilh tinder the fol101villg mles : r .-Luters containing Queries JJltl.rt be 17lark.ed 011 the top left-hand corner of the envelope "Query," and addressed to cc First Aid," 32, Finsbl/f]' Square, London, E.C. 2. . z.- All Queries must be 'IJri/ten on one stde of the paper onb', 3.-AII Queries mt/St be accompanied fry. a "Query C01!POtl" cut from the current issue of the JOllrnal, or, zn case of Qllenes fro", abroad, from a recent issue. ' . ' 4.-The textbook to 1vhich reference 1?lf!Y be made til tht~. colum~7 IS the 39tb (r 937) Edition of the S.J.A.A Mantlal of FIr sf Au! to the !Jyured.

A Case of Epilepsy R. P. (Darlington).-At the )vorks 1I'bere I am emplqyed as ambulance attendant one of 111)' f ello)1J atte1Jdallts had a pecttliar case. W'e could !lot agree as to the diagnosis dNe to SOI1IJ peculiarities it! the siglls, etc. The patient prst reported for treatment 11);tb a cut on bis left forearlJl, wbich II'as drt'SJed as uS1lal, and be returned 10 1vork. After being at II'ork sOJlle lIIillUfps he faillted. 01le of bis l1)ot"/emates look him inlo fhe fresh air alld lA' recovered again. Abotll a quarter of an hour later he fainted agail1. He lI'as rell/oved to the Ambulance Room alld later to the hospital )I'bere he )vas detained tmder obsen 1alioll. The ambulance JJiall 011 duO' could find 110 other il?JtlfJI alld ]~'as a bit puzzled ]vben he did 110t re-act fo the normal treatmellt f or illsensibilif)'. His pulse ]Vas normal, his breathing quiet but nomlal and his f eatures she]ved no signs of concussion or compressioll. A dqy or two later he handed il1 a Doctor's note stating that he suffered from EpilepS),. The JJJall who atfended him l1JOU/d not belielJe this although I fold him that it was possible to halJe epileptic fits )I'ithout cotll'ulsions. He said that there would bound to be some appearance 0111 of the normal. I should be l'eIJ' /lIuch obliged if )lOll IVOU/d settle this p oint for lIS, as 111e are botb members of the Brigade.

This is evident! y a casc of .i\Iinor Epilepsy (otherwise known as Petit Mal, which is recognised by momell t ary insensibility without further signs or effects) to distinguish it from lajor Epilepsy (otherwise known as Grand Mal, which is recognised by sudden and complete insensibility associated with convulsions).- .CF. Examination Howler M. B. (Cambridge). - In a recent examination a candidate .'1)as asked lvhat he )J)ou!d do if be was called to a man who had been fighting and had sus/ainN. r black eye. To our amazement he replied-" I llJ01t1d at once apply a lJJustard leaf fo tbe nape of the patient's neck. Good! ext please!!.CP. Fracture of Forearm II. G. (New Cross).-At a recent DilJisional Practice I produced a nel1),paper photograph of a recent accident which depicted a smiling bqy lyillg face dOlJ!1I1Vards 011 both forearms at the side of the road, and which clearly

THE FEMALE ATLAS

Humour in First Aid WI. A. (Slough) .- TII 011 examination T once asked a candidate 10 show lIIe hOJv he would treat a loeb' 11)ho Ivas suffering from prq{use bleeding from the 1I0se. Seating patient 011 a chair the candidate proceeded to balance a bunch of k'!)ls on the lady's nose. Of course, the k,!),s kept falling off but the candidate Ivas assiduous in replacing them in position withottt tmdtlc delay. Good! Next please! !-N.CF. Butane Gas F. T. (Harlesden).-Will you please tell 17Ie the effects and treatment qf poisoning b), Bufane Gas (Calor Gas) ? We are using it in ottr factory for testing heating appliances. It is a product ofpetrol, is used for industrial alld domestic heating, and is supplied in steel containers under pressure in liquid form. Also Jvhat gas is produced fry incomplete combustion? W'ould it be Carbon 1l'Ionoxide ? Further, should a qlinder leak, ]vottld the gas diffuse rapidly ? The uses of Butane Gas are similar to those arising from any other gas used for heating purposes. Provided that due care is exercised in its use, it is harmless. Should any of the liquid Jeak from a container it would quickly vaporise.-Editor.

BE Wise. Get that extra Wear and Appearance from you r Shoes.

Send for a pair of Vic Shoe Trees 8/· including post. Cash gladly refunded if not satisfactory. CLAYTON Leather Crafts, Sutton in Ashfield, Nottingham. 250 Concert Tickets, 7/ 6 . Posters, Memos, Rubber Stamps. Samples free. "A" Tices, II, Oaklands Grove, London, W.lz. HOW to Stop Smoking. Save Money. Safeguard health. Thousands cured. Send stamp for Booklet of World Pamous Remedy. Stanley Institute Ltd., (Dept. 75) 265, Strand, London. R UPTURED ~ FORGET IT! Use Brooks Rupture Appliancethe new dlscovery. Wonderful! No lumpy pads, no springs,

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THESE ATLASES, printed in colours , are clear and easy to follow. The Female Atlas has lift- up-parts which plai nly show the various organs and structures and their relative positions and sizes. The text gives a concise and accurate outl ine of the anatomy and phYSiology of the human body. The Mcle Atlas is the complement of the Female Atlas but only deals with the Male Body. Each Atlas is complete in itself.

SYNTHETIC ANATOMY

A more advanced Atlas. complete in 14 parts. Each part has 12 coloured . transparent, superimposed plates. showing successive layers from skin to bone . Each Part is complete in itself. Price per Port

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Price 5/6d. each Postage 6d. or 11 /7d. the two BAILLIERE, TINDALL & 7 - 8, Henrietta Street, London, W.C.2.

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durable, cheap. Binds and draws parts together quickly. Sent on trial. Catalogue free. Address: Brooks App lian ce Co., Ltd. (7 18A ) 80, Chancery Ltne, London, W.Cz. (7 18A) Hilton Chambers , Hilton Street, Stevenson Square, Manchester, I.

and other accident prevention appliances

" FIRST AID" To be cut out and enclosd wi~h all Queries. December, 1947.

Showing the Anatomy and Physiology of the Female Generative Organs and of Pregnancy.

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.. As an aid to nurses and first-aiders these Atlases take a place in the foremost rank. "

Miscellaneous Advertisements. Advertisements with remittance should be s ent to First Aid, 32, Finsbury Square, Londo n, E.C . 2 . Rate :?d. per wo r d , m inimum 41. 6d. minim u m 65. Box numbers 15. ex tra .

BAI LLfERE'S MALE & FEMALE ATLASES

sbollJed the t.J'pical and marked tleformi{y 011 Ibe dorset! aspect of a bad case of simplc /rac/tlre of the left forearlll illllllcdiatei.J, above the ]nist. Placillg this before Ibe other mell/bers of tbe Dil'isioll I asked Ibem to treat tbe (ractllre as though they hod been called indilJiduali.J, to the accident. 011 'checkillg tip their efforts I lllas s1lrprised to 1Iote tbat on6' one member out of tell bad applied the double splint mcihod as laid dOlJlf/ il1 the T extbook for fracttlre q{ forearm. 1\1y o])m lIfetbod )vas the sanlc as that in Ihe Textbook but ]vith extra padding to support the fingers and hand so as to maintain them in the same position as the patient is already supportillg thelll in. After much disCtfssion I admit defeat by asking )lOti to gilJe us yotlr lJierlJs on the salllc as to ,vhe/her the single splint or the double splil7l should halle been used. Meamvhile, Ottr best thallks.

Whilst the Textbook on page 85 teaches you that two splints are usually indicated for the treatment of fractured forearm (with which ruling no one will disagree), it also tells you on page 18 under" Essentials of First Aid" that first-aiders must "decide on the character and extent of the treatment given." In these circumstances and also in view of the fact that there was considerable displacement of fragments of bone at lower end of the forearm, the decision to use only one splint was probably wise, provided that special care was taken to immobilise the fracture during transport to bospital, becio1use it would give the necessary support and also avoid pressure on the displaced fragments of the fracture.- N.CF.

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Treatment of Fractured Spine B. C. (Paltertoo).- The frealmelll of ca,res qf fractured spil1e 7111dergro/ll/d

he asked what 11 'C should do in StIch all cmcrgenry Ol1e member replied: " /f"hen I-Titler starts to drop sllakes, I 11'ill k efp 012 rWllling! "

has alw(qs gil'ell rise to IIJllch arglllllfllt alld COllllllelll, and after gil'jllg seriotls cOl/sideration to the subject, I stlblJlit heren'ith details rif a 'travenillg splillt )'phich affords a firlll basis all the streicher 1I'hell such cases are transported underground. It is l)Iost ojlen tbe case ill the pit that sufficient sllIall splil7ts are 110t forthcoming or that the sawillg of boards to the correct lengfh is an operafioll taking up too IIIl1ch /'aluable tillle; and consequent!] it is f elt there is a serious need for SOllie Call/Pact appliallce specifically designed fo r cases of fracttmd spine. 111 its cOIISfructioll the trat'crsillg splint is made up of eight sl7lali splints, I jI. IO ill.-4 ill.- 1 in. spaced at 8i centres, beil1g held at these illterpals b)' two 7 ft. 6 i1l. lengths of 2 in. webbing aboNc and belOJv. Prol'isi01l is made 0' the attachlllellt of buckles and straps to each length rif lI'ebbing to seCHre tbe splint 011 to the traverse bars of the standard sfrelcher. IP"hen IIOt in ttse the iral'erse splillt folds up into a compact bllndle I]t. IO in.- 4 ill.-6t in. high, alld might be accoll/modated in the p resent tinderground first aid rylinders. A lternatively, it is suggested that a separate dttstprorif container be p rovided fo r the appliallce to hang n'ith each first aid callister p rovided tl1Idergroul1d. As a member of tbe Brigade and a reader of FIRST Am for many J'ears, I sfill e/~iOJ' readillg the QueYJ' Colult/II, and I await ~'i/h interest )lottr COll/llie/itS on 711)' s7(f!,gested appliance.

Good! Next please I I-N .C.F. Superficial Wounds M. D. (Wandsworth) .- I respectjttllj, venture to approach you Illith a query

The apparatus which you describe appears excellent for the purpose for which it was des igned. Its usefulness, however, depends upon its safe and convenient storage at a fixed Firs t Aid Post. Por this reason it is not an apparatus which is suitable for ordinary fi rst aid work.-N.C.F. Shock

E. W. (Manor Park).-Ca/1 ) 'OU p lease tell us lI)here the blood goes in a patimt II)ho is suffering from shock? fWe kl10Jv that in shock the pttlse is rapid and f eeble; and that this tells us that there is not much blood il1 the arteries. l\Ieamvhile, I thank you for your tII/SIver to 7ll)f queYJ'.

The one striking phenomenon revealed at post morten examinations of cases which have succumbed to shock is an enormous distension of the abdominal vessels governed by the intestinal nerves . Thus the abdominal organs are engorged with blood destined for distribution over the rest of the body; and, as a consequence, the medulla and spinal cord are reduced to a state of feebleness, the first effects of which are shown in the weakened action of the heart. T his, combined with the scanty supply of blood which passes through its cavities, leads to a great reduction of the general, vital activities and produces the well-known signs and symptoms of shock.-N .C.P. Humour in First Aid D . L. (Bristol).- If7hen giving lec/urn on first aid during the late 1llar, one of our officers so f requently referred to the treatment of snake bites that ,ve got tired of hearing about then;. Consequcntlj', on Ol1e occasion zvhen

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all a l1Iatter lvhich has been exercising my mind fo r a long tillle althougb I alII afr'aid that it is p robably the outcome of either presumption or obstinaex In short, I JI)aflt to know if it is strictly correct to bathe the slllall sup erficial cuts sustailled on cOlJ/ing out of a swimming bath. A s far as I can understand they are not " surgical wounds " within the true meaning rif the term; also the Black Book does not make mention of mashing the lvotmd unless " it is oblJiously dirty ." Personally, I think the lvotmd is not strictly dirty coming out of the clean water and that it lvould not require surgical technique. Incidentalb, a friend, ,vho is a I ulry trained nurse, tells me that just a dab 011 a p ledget of cotton wool dipped in diluted D ettol is sufficient to cleanse a 'Ilourid, because antiseptics have the p ower of btlrlling tip the fatty tissue !]ingjust under the skill, and of retarding the healing lJalue, if not applied carefullj, ! In the Supplement to the T extbook there is 110 mention fIIade of " cleansing the 1vound " in cases of capillary haelJJorrhage-or of lJe1l0US haemorrhage. I t would be difficult to comlBJ' 10 ),Otl h011) much I value alld appreciate )'our articles in the f irs! aidjournals. T hC)' are most helpful and interesting, and I wish that we could halJe more.

1£ you have n o reason to doub t the clean liness of a superficial wound I see no reason for washing it ; and this conforms w ith the instructions of the T extbook. My own practice when dealing with clean superficial wounds is to spon ge them with cotton w ool soaked in methylated spirit and then to cover them with dressings.- N .C.F. Bleedin g from P alm D. T. (Shorcham-by-Sea) .-SoTne would-be first-aiders htrre are tlncer/ain as to the correct method of bandaging the pad over a clean wound in the palm rif the hand, associated with arterial haemorrhage. As pages II3-130 (except fo r the three allowed pressure p oints) of the Black Book are now superseded by the Supplement, grasping pad Oller wound in the pallJl is, apparmt!], Ottt of date. We take it that the fingers are now kept out-stretched? Is the pad tied over the l1)otmd by means of a figure-of-eight bandage completery covering the pad, "and emboc(yil1g the lvrist," then tied with knot olJer the pad ? Also, is the thumb kept outside the bandage ? Your kind help will be greatlJ' appreciated.

Although it is not mentioned specifically in the Supplemen t to the T extbook, I see n o reason why the old method laid down in the T extbook should not be used when we have to treat a wound of the palm accompanied by artrial h remorrh age. T he clenched hand certainly affords the best means of keeping up pressure on the dressed wound; and this is the essence of treatment of wound s as set out in the Supplemen t to Textbook.- N.C.P.

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VI/expected chanl5e~ in temperature and (lima ti c conditions all 00 freqllelltly precipitat e rz slIdden I'hill. Wi th prompt mediro tioll the severi/y i.!{ th p (·hill (' /111 often be mitigated.

Editorial A Course in Advanced First Aid N ews from all Quarters Practical Nursing in the Horne

Two or three lable ls should be laken al ,he onset of symptom s , follot('ed by one ,ablel II Ollrly for Lhe next lour hours.

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PENETROL

on your handkerchief InhaVe freely and prevent infection

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The Medicine Chest Anatomy and Physiology in First Aid A Team Test and Marking Sheet Queries and Answers to Correspondents

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NOTICE TO READERS. FIRST AID is published on the 20th of each month. The Annual Subscription is 5•. post free; single copies 4<1. , Its aim. a.nd objects being the advancement of Ambulan~ e and First ~id Work in all branche., the Editor invites Readers to 5end Articles and Reports on subJects pertamIng to the Movements and al so welcomes suggestIons for PractICal Papers. All R~ports , &c. ,. sh,?uld be addressed to the Editor at the address below, and should reach him before the 8th of each month, and mu.t be occom anied p Subscriptions, Advertisements and other business Communications connected with FIRST AID should be forwarded to the Publishers. DALE, REYNOLDS & CO., LTD., 32, FINSBURY SQUARE, LONDON, E.C.2.

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CONTENTS

'Anadin' Tablels, containing a .~pirin . pill'l1aCclin. caffeine , alld quinine, p rovide 11 safe and rapid treatmenl (or th e condition .

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JANUARY, 1948.

ARTIFICIAL RESPIRATION EXPLAINED

A POCKET MEDICAL DICTIONARY

By FRANK C . EVE , B.A., M. D. , F. R.C.P . (Lond.) Crown 8vo . 80 pages with 26 photographic illustrations 35. net. ~ .. Should find its way into the hands of every First A id worker and be included in the equipment of every centre and first aid post . "-Red Cross.

By LOIS OAKES, S.R.N. , D . N .. and Prof. T. B. DAVIE, M.D.

CASUALTY WORK FOR ADVANCED FIRST AID STUDENTS

FIRST AID TO INJURED AND SICK

By A . W. MacQUARRIE , M.B., Ch.B. Demy 16mo. 254 pages fully illustrated. 45. 6d. net.

Revised and Rewritten by HALLIDAY SUTHERLAND, M.D.

Seventh Ed itio n. 464 pages. 267 illustrations. 45. net. esential part of the First Aid er's equipment .

~ An

Forty-F ifth Ed ition. 88 pages. 46 illustrations. 9d. net.

GOOD HEALTH WITH DIABETES By IAN MURRAY. M.D ., F.R.F.P. S.G ., F.R.C . P.E., and MARGARET MUIR, S.R.N ., 48 pages . 25. net. .. The purpose of this little book is to present briefly and concisely the essential Information required by the d iab etic patient." -Extract from Preface .

PUBLISHED BY

LIVINGSTONE of EDINBURGH-

How the Red Cross Began. LOO KING back on the two terrible wars from which the civilised world has just emerged we can take pride in t he wonderfu I efforts that were made to rei ieve the suffering of the wounded, and the fine organisation that cared for the injured, the sick, and the distressed regardless of danger and impartial as to nationality. But the Red Cross is a comparatively young organisation, and the wars of the 19th centu ry were made ghastly by their neglect to succour the wounded and to organise help for those who fell on the battlefield. It was becau se a young Swi ss traveller happened to witness the aftermath of one of these battles that the noble idea of the Red Cross was born, and from the small beginnings he in itiated has grown the great Society we know to-day. That young man was J. Henry Dunant and he told the story in A Memory of Solferino," first published in 1862. Now the Brit ish Red Cross Society have published a new edition (Cassell & Co., Ltd" 6/-) and we recommend the little book to all our readers. It is a tragic story. The Battle of Solferino was fought in 1859 between the French and Austrians, and in the fifteen hours' bitter fighting some 42,000 men were ki lled and wounded. There were few medical arrangements and the wounded were left to die or to recover as best they might. Carted into the little town of Castiglione they were placed in the chu rches , in the houses and squares, and left in terrible congestion to tile care of the townspeople. But II

the convoys of wounded increased to such proportions that they were absolutely incapable of dealing with all the suffering. It was here that Dunant organised what relief he could, and he describes the horrors of the place with a vivid yet restrained pen. Later, he visited the hospitals at Brescia, and saw again the neglect, the congestion, and the terrible shortages of materials and hel p. Such were the cond itions that two months after the battle another 40,000 men had died or were smitten with sickness and fever, and Dunant did not exaggerate when he called Solferino a European catastrophe. It was these scenes that inspired him with a great and noble idea-the organisation of relief societies for the purpose of caring for the wounded in wartime by zealous and qualified volunteers. He writes: "If these pages could bring up the question (or lead to its being developed and its urgency realised) of the help to be given to wounded soldiers in wartime, or of first aid to be afforded them after an engagement -if they could attract the attention of the humane and phi lanthropically inclined -in a word , if the considerat ion and study of this infinitely important subject could, by bringing about some small progress , lead to improvement in a condition of things in which advance and improvement can never be too great, even in the best-organised armies, I shall have fully attained my goal." To that goal Dunant worked through many years of discouragement and the great organisation he conceived - now no longer restricted to the battlefield but ranging wherever suffering and distress are foundstan ds as a great monument to his Iife work,

FIRST AID

COURSE IN ADVANCED FIRST AID BY

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

with her knees drawn up and her buttocks brought towards First Aid in Maternity Cases (ii) T was emphasized in the last article that. a first-aider the edge of the bed. (5) Delaying Birth.-One of the objects of first aid is should not normally undertake materruty work. It is only in the extreme emergency when it is quite imposs- to delay, whenever possible, the birth of the baby in the ible to obtain qualified help that he is entitled to render hope that professional assistance will arrive in time. In assistance. \"X7hatever the circumstances, his first duty is any event, however, even if there is no h~pe of obtaining to make certain that every possibJe effort is being made professional aid, the slower that the head IS born, the less risk of a wound, called a tear, between the rectum and the to obtain a doctor and a midwife. . vulva. . In spite of this strict inju.nction, h?wever, the. first-aid~r With this object in view the patient should be advised may find himself suddenly lDvolved in a materruty case lD several ways . He may have to assist a patient while awaiting not to hold her breath or bear down when the pains come the arrival of a doctor or midwife; if a maternity nurse on but to cry out. She should also be prevented from is not available, he may have to assist the doctor during the pressing with her feet against any article that is available, labour. Finally, he may have to deal with a case entirely such as the framework of the bed, or from pulling with on his own. -Moreover, he should be able to diagnose her hands on any object that is near such as a sheet. The not only the onset of labour but, also some of the com- first-aider must not be surprised to find that all his advice, plicatio~s of pregnancy such as a miscarriage. These are in this respect, is completely reversed when the doctor or some of the reasons why first aid in maternity work should midwife arrives since their object is to speed up the delivery as far as possible although they themselves will be included in the syllabus of advanced first aid. Throughout this description, the first-aider is referred usually try to slow down progress just before the head to as « he " for the sake of clarity. First aid in an actual is born. case, however, should be undertaken by a woman first(6) Wash-tp.-Great attention must be paid by the aider, whenever possible. first-aider to the subject of cleanliness. He must scrub The procedure will be described in stages as follows :- his hands for at least ten minutes, if time allows, using (r) Ensure Privacy.-If the patient is in her own home she liberal quantities of soap and water. The wrists and foremay be allowed to remain in a sitting-room during most arms should not be forgotten. Shirt sleeves, etc., should be of the first stage of labour. This gives the first-aider an rolled up and if possible a clean overall put on. opportunity to make preparations in the bedroom. If, It is also advisable to cover the nose and mouth with a however, the case is one of precipitate labour and it is mask which can be readily made by interposing newspaper obviously quite impossible to move the patient to a between layers of gauze cut in the form of a rectangle; hospital or other shelter, the first-aider must ensure such to the corners of this are fastened, by small safety pins, privacy as is possible, e.g., by placing improvised screens pieces of tape which can be tied at the back of the head round her, etc. and neck. As an alternative, a large pocket handkerchief (2) Prepare the Bed.-The second stage of labour must be folded diagonally can be placed with its base over the conducted with the patient recumbent, preferably in bed, nose and its end tied at the back of the head. but failing this on a couch or even a stretcher. Under the The importance of cleanliness cannot be over-emphasised. patient should be placed a mackintosh sheet to protect If germs from the first-aider's hands or from his breath the bedclothes or if not available, brown paper. The contaminate the vulva, the patient may develop the severe mackintosh should be covered with an ordinary sheet to complication called puerperal fever or sepsis which was promote comfort. A top sheet and one or more pillows responsible for many deaths following childbirth in the should be supplied. days when unquali6ec1 women attended con6nements. (3) Prepare Equipment.-So far as time permits, equip(7) General Care of the Patient.-It has already been ment for the confinement should be prepared. This mentioned that towards the end of the first stage the includes hot and cold boiled water, several sterilised patient will often desire to pass motions and urine b~wls, cotton wool, boracic lotion, sterilised thread and frequently; this also applies to the second stage. The SCissors. first-aider will be wise to make his patient use a bed-pan (4) Arrange the Patient.-The patient should wear a for this purpose, particularly if there is any chance of the nightdress which can be readily pulled up . If the case is labour being quick one. one of precipitate labour, clothing from the abdomen To some extent the pains can be reljeved by ru bbing the downwards must be removed including anything tight patient's back and at all times the value of words of symround the ntck and chest. After removal of such clothing pathy and encouragement should be remembered. as is necessary, she must be immediately covered with a (8) Cleanliness of the Patient.-As the head descends, the sheet so that unnecessary exposure is avoided. anus enlarges considerably and motions may be passed During the second stage of labour, the patient sh ould involuntarily. To prevent contamination a pad of cotton be advised to lie on her left side in a curled up position, wool or a towel should be pslaced oyer the vu Iva. If a small

FIRST motion is passed involuntarily, it should be mopped away with cotton wool by a movement directed away from the vulva and towards the spine. The first-aider must take great care not to contaminate his hands. The doctor or midwife takes additiona) precautions to ensure cleanliness such as cleaning the vulva with a weak antiseptic such as a solution of Dettol, but since there are few first-aiders sufficiently trained in hospital technique these additional precautions should be omitted. (9) Birth ~f the Head.-If the head is born too quickly, it is very likely that there will be a tear. When it is quite obvious that the head is about to be born, the first-aider

AID

from the navel. The cord should be cut between these ligatures using sterilised scissors. The stump is then covered with sterilised wool. Failure to tie the ligature tightly on the child's side may result in fatal ha:morrhage. The newly-born infant should be wrapped up in a warm blanket or towel and placed on its side in a cradle or improvised cot. (r3) A1.anage the Third Stage.-The third stage of labour lasts from the birth of the baby until the afterbirth has been expelled. It is a stage of great importance since there is a risk of serious ha:morrhage. The mother should be turned on to her back and her position arranged so that she lies comfortably on a pillow, her knees should be bent, her feet resting on the bed. So far as possible she should be covered with a blanket to prevent cold. The first-aider should stand by the side of his patient and feel the fundus of the uterus. The uterus will feel hard but every few seconds it will become softer during the intervals between the muscular contractions. In addition to maintaining observation on the uterus, the first-aider must watch carefully the pulse and colour of the patient. If ha:morrhage occurs, the patient's colour changes, the face becoming pale and covered with a cold, clammy sweat, the pulse becomes quick and feeble and the fundus of the uterus soft and flabby; in addition, blood will begin to pour from the vagina. If ha:morrhage occurs the fundus of the uterus should be rubbed to increase its TIlE BIRTH OF THE HEAD. muscular action and if this fails, grasped with the palm of THE HEAD OF THE BABY IS ABOUT TO E1IERGE. the hand. From Handbook ofFil'Jt-Ald & Bandaging b)l Be/ilioJ }'1uIIJan)' & Armstrong Apart from maintaining observati?n and acting as ab?ve b)' cOflrte.ry of Bailfiere Tindall & Cox. in event of ha:morrhage, the first-alder should do as little as possible during the third stage, hoping that professional should stand facing the patient's body and using his right assistance will arrive and take over the case. In many hand place the first two fingers and thumb on the middle cases of precipitate labour, the placenta is born of its own of the scalp of the infant, the thumb being nearer the anus. accord about half an hour after the birth of the child. If As the head descends with each pain, upward pressure there is considerable delay in obtaining professional aid, should be made with these three digits, the greatest with however, e.g., more than two hours, the afterbirth can the thumb. Great care must be taken not to touch the be expelled by grasping the fundus of the uterus firmlr patient's skin whi~h would pr~cipitate a t.ear. and maintaining a continuous downwards pressure untIl The object of tlus procedure 1S to delay buth of the head; complete expulsion occurs. sooner or later it will be born against the resistance (14) After Care.-When the third stage i~ over~ the provided by the digits. patient should be cleansed thoroughly, aught blnder (ro) Care of the Head.- When the head has emerg~d, the placed round her abdomen and a materniryr towel fixed in first-aider should support the top of the scalp w1th the position. Her bed should be re-made and light refreshment, palm of his hand and by exerting a. slight upward .pressure e.g., a cup of tea, given, after which sleep. sh?uld be prevent sudden birth of the rema111der of the chi~d. encouraged. Careful observation should be ma111talDed for Doctors and midwives cleanse the eyes of the infant at ha:morrhage and should it occur, treatment should be this stage by wiping the lids with swabs soaked in boracic adopted as described under third stage. lotion. (rr) Birth of the Bo(ty.-With the next pain the shoulders emerge followed by the remainder of the b~dy. .The "FIRST AID ATTENDANT." infant should be supported under the armplts, lifted towards the mother's abdomen and placed on the bed DEAR SIR, From time to time extracts from "First Aid Attendant" have close to her and lying on its side. Normally, the newly born infant will now cry lustily. : appeared in FIRST AID. I should be pleased to know if this joulnal is published by you should it show no signs of life, treatment for asphYXla and jf so what is the sllbscription rate. must be undertaken after dealing with the cord. Yours faithfully, (12) Separate the Bary.-The cord which connects the WI. A. POTTER. baby's navel to the placenta shaul? ~ot be ~ouch~d .if there is any chance of a doctor or ml~wife arnvlDg WIthin Burnley, Lanes. We hal'e had sel'eral fIIquiries recmtlj' for this interrstitlg j otrmal. It is the reasonable time. In any event nothIng should be done official organ of The Industrial First Aid Attendants Anociation of BritiJh for at least four minutes following the birth. To separate the baby, two sterilised ligatures consisting Columbia alld if published IlIon/h!y at 603, rTf'est Hastings Sine!, VO/1CQuver, of three or four strands of pack thread should be tied B.C. EthJuiriu regarding subJcriptiofIJ should bl' sent to H. IT"'. lvIabler, the tightly round the cord at distances of three and four inches IIIOlazill( BlfsinesJ j\1(lIlaler, "I the abol'( aa'drrSJ.-Editor.

FIRST

AID

News From All Quarters two for Certificates and six Nursing Mr. Harris said that words could not THE ST. JOHN AMBULANCE lion, Cadets for Preliminary First Aid Celi:ificates. express what he felt. He was overwhelmed by The Examining Officer was Dr. J. Beagley, of their kindness and their speeches . He had BRIGADE. Thatcham. merely tried to do his duty which had always Birmingham County been a pleasure to him. He could hardly say which gift he appreciated more, the watch or County of Berkshire WITTON AND KINGST.ANDING the badge. The watch would always remind KINTBURY A t an Anniversary Dinner held recently at A successful Whist Drive was organised the" Old Crown and Cushion," Perry Barr, him of the happy times he had spent with by the Nursing Division and held at the the ribbon of the Long Service Medal was them on the executive side. He was deeply touched by the fact that the Nursing Divisions, Coronation Hall last month. The sum of £20 presented to Cpl. S. Butler. who were no longer in the Dudley & District was raised on the occasion and this was After dinner the Loyal Toast was proposed deyoted to an Old Peoples' Party held by the by Div. Supt. ]. S. Bone and" the Division" Corps, had subscribed. The badge would Division. There were 28 tables for the Whist by C01·pS Supt. S. H. Laruer. Dr. S. Silver- remind him of the great honour they had done him in asking him to be their first Corps Drive and l'vIr. R. Sanders was M.C man, Divisional Surgeon, replied . President. READI G County of Leicester On Wednesday, December 3rd, at the GIPSY LANE OLDBURY Ambulance Hall, Chatham Street, Reading, a The members of the Ambulance Division The Second Ceremony of the Old bury Christmas Fayre was held by the Nursing Corps in aid of their Medical Comforts Depot and the Cadet Divisions presented a CHRIST- Cadet Nursing Division of the S.JA.B. took MAS FAKTASIA at the Gipsy Lane Working place in the Bethel Schoolroom, Langley, at which £47 was raised for the funds. The Fayre was opened by the County Men's Club, Leicester, on December 18th recently. and 19th. The show was produced by County Cadet Officer Mrs. Hugh Robinson, Superintendent (the Hon. Mrs. Leslie Gamage) and was well attended by members and D . Supt. T. Hames, directed by Mr. L. Cooke Area Cadet Officer Mrs. Lamb, Dr. Stevens, and Musical Director Mr. P. Glover, L.L.C11. .Mr~. Stevens (Vice-President), Corps Sgt. friends of the Brigade. During the evening an entertainment was given by members of The hall was full both evenings and many Major Taylor, N. /Cadet Supt. Miss Darby, for repeat perrequests have been made Reading Town "A" Ambulance Cadet Division officers and members of Dudley, Brierley under Cadet Supt. F . G. Carter. Later, the formances. The proceeds ",'ere devoted to the Hill and Netherton Nursing and Ambulance Old Aged Pensioners' Treat. Cadet Divisions were present. After the goods which had not been sold from the stalls, were auctioned by Mr. H. S. Cook. A introductory remarks by N ./Cadet SuperinCounty of Worcester bouquet was presented to the County SupelinA very interesting function took place tendent Mrs. Brettle the Cadets were inspected tendent by Cynthia Judd the mascot of Reading recently at the Ambulance Hall, Lye. This by County Cadet Officer Mrs. Hugh Robinson West Nursing Cadet Division. Among those was the presentation of a gold wrist watch and and Area Cadet Officer Mrs. Lamb, followed who attended tbe Fayre were the Mayoress Corps President's warrant and badge to by the singing of the Cadet hymn accompanied (11rs. H. V. Kersley), the County Commis- .l\[r. J. A. Harris, until recently Corps Supt. at the piano by Cadet Josephine Baker. A sioner (Mr. C A. Poole) and Mrs. Poole, of the Dudley and D istrict Corps. very interesting address on the history of the County Vice-President Lady Denham, County Corps Supt. J. H. Watkins presided and Order was given by County Cadet Officer Officer Miss D. K. Gibbins, Div. Surgeon was supported by County Commissioner Dr. Mrs. Hugh Robinson. C A. Boucher (Reading Town "B " Ambu- F. L. Newton, Mr. and Mrs. ]. A. Harris, The demonstration of Practical First Aid lance Division), Div. Surgeon E. N . B. 1\11'. A . WinbO\,v, Corps Officers W. Ollis and and Home Nursing was exhibited in the form Merchant (Reading East Nursing Division) . H. G. 1Wls, A. /Corps Officer K. Northwood of a charade which was thoroughly enjoyed SHIN FIELD as well as officers and members of Ambulance, by the parents and friends of the Cadets. On Monday, December 8th, at Huntley & Nursing and Cadet Divisions . West Riding of Yorkshire After a meal, the Loyal Toast was given by Palmer's Canteen (by kind permission of Messrs. Huntley & Palmer Ltd.), a successful the Chairman. (South-Western Area) Cadet Sgt. Parkes (Brierley Hill), H. ,'Sgt. W.hi.st Drive ~Tas held by the Nursing Cadet Dlvlslon to ralse funds for the Cadets' Christ- Head (Lye), Amb. Officer W. Willetts BRIGHO USE mas Party. The evening was arranged by ( etherton), Amb. Officer A. E. Roden The 45th Annual Meeting of the Corps A./Cadet Supt. 11rs. M. Lewis assisted by (Stourbridge), Div. Supt. D. H. Burns was held on December 13th, 1947. A./Cadet Officer Mrs. M. Hunt and Mr. J. (Dudley), A. /Area Cadet Officer R. R. Hines, Th~ r~ports submitted r~lating to the year Pike who acted as J\I.C There were 75 Corps Officers H. G. Mills and W. Ollis all 1946 Indicated that the actlve membership of t~bles and gifts for. prizes were very kindly spoke in appreciative terms of the efficient the five Divisions of the Cmps was by no glven by the Readtng Co-operative Society service which Mr. Harris had given to the means as large as it should be, and it is underLtd., Messrs. Heeles Ltd., and the Palace ~rigad~ and to the Dudley and District Corps stood that the position is still somewhat Theatre. In partlCular. They all expressed their pleasure unsatisfactory in this respect. at seeing Mrs . Harris present. Corps Supt. With the Corps at present without a WINDSOR .Members of the Royal Borough of Windsor Watkins in presenting the watch said that he president, the chair was taken by the ViceDlvlslons held a successful Fete at Trinity did so with some feeling of regret. Mr. President, Mr. L. Brook, who was supported Centre last month at which they made £80 Harris had endeared himself to all ranks of the by the Mayor and Mayoress (Ald. and Mrs. W. Whiteley), Assistant Commissioner H. for Divisional funds. The Fete was opened by Corps. He was a very efficient officer. County Commissioner Dr. F. L. Newton Harrison (Huddersfield), and Corps and County Cadet Officer Mrs. J. F. S. MontaguPuckl~ and during the ceremony County said ?e was very pleased to be present. Mr. Divisional officers. Certificates, Labels, etc., for Supertntendent the Hon. Mrs. Leslie Gamage, Harns had done 40 years of efficient and the years from 1942 to 1947 inclusive, were who. was recently apP?inted Hon . Divisional faithful service in the Brigade. He took his presented by the Mayoress, while Assis tant Presldent of the Nurstng and Nursing Cadet First Aid Certificate in April, 1904, and joined Commissioner Harrison presented the permaD!visions, rec~ived her Badge of Office from Dudley Division in May, 1905. He was nent warrants and long service awards. instrumental in forming Netherton AmbuMr. Brook said that the work of the St. D1V. Supt. 111ss H. S. Neighbour. lance Division and Later Kinver Ambulance John Ambulance Brigade could justly be WOOLHAMPTON and Nursing Divis ions. He hoped that Following a course of lectures in first aid Mr. Harris would be able to come to their ~anked as among the finest voluntary work given by Div. Surgeon D. Munro-Ashman t~ functions as many times in the fu ture as he 111 the country, but he felt that it was not being the Nursing Division, an examination was had done in the past. Amidst applause, recognised by the Au thorities as it ought to be. recently held at the Chapel Room, Wool- Dr. Newton then presented to Mr. Harris the He suggested that the Education A uthorities might do worse than include first aid instl'uc hampton. Three members passed for Medal- warrant and badge as Corps President. tiOI1 in the schools, for example.

FIRST

AID

He announced that the Corps were having 7. Open Competitioll.-Open to teams con- Brigade and Nursing Division, the Police fortnightly lectures by Corps and local sisting of four Senior Nursing Cadets, the National Fire Service. the Souther~ doctors to whom they were greatly indebted one of whom may be an N.CO. Railway and business firms in Southampton, for their active interest and participation . 8. i\[rs. E . D. Jones B01vf.-O pen to teams of competed. Assistant Commissioner Harrison referred four Senior Nursing Cadets, one of The marking sheets were arranged, so that to the co-operation which the S.J.A.B. gave whom may be an N.CO., but all must allowances were made for the different methods to A. R.P. work during the war, and said that be members of the Brigade within the used by the various Societies. A large and County of Carmarthenshire. the organisation would be just as ready to enthusiastic audience watched the team test help in connection with the new civil defence oTE.-These two competitions will which was judged by Doctor R. A. Dench, be run simultaneously as one M.~., of York. The individual practical tests, scheme. Corps Supt. H. Hirst alluded to the lengthy event. The winner of com- which. were run along novel, modern lines, service rendered by Corps Treasurer H. S. petition 8 will hold the Mrs. were Judged by Doctor F. R. B. H. Kennedy Bastrich and Corps Inspector of Stores, F. E . D. Jones Bowl for one from the Isle of Wight. D octor Audrey year, and will qualify to J\[aclean, of Basingstoke, adjudicated the Kershaw. represent the County in the Viya Voce tests. In the course of an address to the meeting, Welsh Finals. the Mayor praised the selfless and public~ifteen teams entered the Competition, spirited work of St. John Ambulance Brigade Prizes: 1st, £3 ; 2nd, £I. which was won bv Messrs. Harland and Wolff 9 . COUllt)' Compeli/ioll.-Open to teams con- Ltd., with 279 points, closely followed by members. In regard to need for more memsisting of four Junior Ambulance the Southampton Police " B" team with 277 bers he suggested that the greatest efforts Cadets, all of whom must be members points, the Southern Raihvay, Southampton might be to recruit more Cadets, so that of the Brigade within the County of Docks S.~LE. team were third with 267t they would already be efficient first-aiders on Carmarthenshire. points. , reaching manhood and womanhood. Prizes: 1st, £1 lOS. od. ; 2nd, IS -. The Organising Cornmirtee representing PRIORY FOR WALES 10 . County COlllpetdioll.-Open to teams conthe \rarious Societies was presided over by Carmarthenshire County sisting of four Junior Nursing Cadets, the Chief Constable of Southampton, Charles ANNUAL COMPETITIONS all of whom must be memberc; of the G. Box, Esq., O .B.E. Valuable assistance It is announced that the Annual CompetiBrigade within the County of Car- was gi\-en by Mr. F. A. Trott, Centre Secretary tions will be held at Llanelly on 21St February, marthenshire. of the Southern Railway Ambulance Centre. 194 8 . Prizes: 1st, £1 lOS. od. ; 2nd, IS -. The Chief Constable introduced Mrs. Biddle, Competitions will be as follows :There will be no entrance fees for tbe \"ife of Mr. R. P. Biddle, CB.E., O.St.]., 1. Open COlJlpetifioll.--Open to teams consisting of four men, one of whom competitions. All entries must be sem to the J.P., D ocks and Marine ;\Ianager, SouthampCommissioner, 2, Nevill Street, Llanellv, at ton. He thanked her for giving the Trophy may be an officer or N.C.O. least fourteen days before the date of the and expressed the hope that in future the 2 . The KJllsal1t Shie/d.-Open to teams consisting of four men, one of whom competition. A copy of the regulations and entry for the Competition \vould be even may be an officer or N.CO., but all conditions may be had on application to the larger and that more teams from industrial concerns would be attracted. must be members of the Brigade same address. Mr. F. B. Di.mmock, Captain of Harland within the County of Carmarthenshire. BRITISH RAIL WAYS and \'(1olff team, receiyed the Cup from j\irs. NOTE.-These nyo competitions will Eastern Region Biddle, who was handed a bouquet by Red be run simultaneously as one Sir R. W. Matthews, the Chairman of the eyent. The winner of com- L.N.E.R. Company, has been promoted from Cross Cadet Wendy Davies. The Judges gave petition 2 will hold the Commander to Knight of Grace in the Order useful and encouraging comments to the competitOrs. The Hon. Secretary, .Mr. L. B. Kylsant Shield for one year, of St. John as from 31st July, 1947. Petty, warmly thanked all who had worked and will qualify to represent Sir Ronald, who was admitted to the Order and contributed to making the event so the County in the Welsh as an Officer Brother in May, 1932, has been successful. The Chairman was thanked by Finals. President of the Great onhern Centre since j\~ . R. P.B~dk. . Prizes: 1St, £5 ; 2nd, £2 ; 3 rd , £1. 1930, and succeeded Sir Gerald Talbot as 3. Open COlllpetitiol1.-0pen to teams con- President of the Great Eastern Centre in Western Region sisting of four women, one of ,-"hom September, 1945 . may be an officer or N.C.O. Mr. T. C A. Hodson, who has relinquished J t is well known that Sit Ronald has been 4. The Miss EvelYII Harries Ctlp.-Open to connected with the administrative and the position of Divisional Ambulance Secreteams consisting of four women, one philanthropic aspects of hospitals ovel· the tary (Central Wales Division) \Vas invited to of whom may be an officer or .CO., last forty years, primarily in the North of attend a recent meeting of the Diyisional but all must be members of the England, and he is very enthusiastic in Ambulance Secretaries' ConFerence during Brigade within the County of Car- connection with the Order of St. John on the the course of which ;\Ir. R. Burgoyne, marthenshire. Railway Company. He takes. a. very. import~t Chairman, thanked bim for his work for the NOTE.-These nvo competitions will part in the Ambulance admll11stratlOn, whilst mo\'emem. Mr. W. J. Waite, supported by be nw. simultaneously as one his influence as President of the Centres Mr. G S Hodder, Bristol, paid tribute to event. The winner of com- referred to is incalculable for greater good. J\Ir. Hodson's long service to the movement petition 4 will hold the Miss and Mr Hodder asked him to accept on behalf In his letter NO.3, dated 16th December, of the members of the Conference an umbrella Evelyn Harries Cup for one year and will qualify to 1947, to Class Secretaries, lIr. C. G reem,-:ood, and fountain pen. j\~. Hodson has been connected with the represent the County at the Secretary of the Eastern ReglOn Ratlway Ambulance Centre, writes :first aid moyement since 1895, when be became Welsh Finals. Assistant Secretary to the Oswestry Class. Prizes: 1st, £5 ; 2nd, [,2 ; 3rd, £lo "BRITISH RAILWAYS, 19.j.8 There will of necessity have to be some 5. Open COfIJpetiliolJ.-Open. to teams consisting of four Seruor Ambulance alterations in the administrati\·e ambulance LlSKEARD Cadets, one of whom may be an arrangements, but the important point is A presentation of awards was held at the that our work must go on. It must progress, Fountain Hotel and the Mayor, Alderman N.C.O. 6 . County COllIpetiliol1.--Open to teams of and improve, since when we cease to improve G. C Haddever, occupied the Chair and was four Senior Ambulance Cadets, one we begin to deteriorate." supported by Mr. J. S. Pearson, District of whom may be an N.CO., but all Southern Region Traffic ~fanager; Mr. . S. C~x, Divi~ional must be members of the Brigade Engineer· Mr. F . M. Da,"is, ASSlstant Dlstnct within the COLmty of Carmarthenshire. "KATHER1NE BIDDLE" FIRST AID TROPHY Traffic J\Ia~ager ; j\ [t. J. H. Tippett, Divisional Cm,IPETITlON, SOUTHA.HPTON NOTE.-These two competitions will To stimulate interest in the to,,-n, the first Ambulance Secretary and other OffiClalS of be run simultaneously as one the Company, also Dr. J. G. MOJ"gan, ~he event. The winner of com- of a new type of annual competition was held Class Lecturer. Among the long serVlCe petition 6 will qualify to at the Mount Pleasant School, Southampton, a,,-ards was a bar for 35 years' sen'ice to Mr. represent the County in the for the" Katherine Biddle First Aid Trophy. " P . G. Miller, the Station Master. An enjoyabk Teams from the British Red Cross Society \'\1els h Final!!. (men and women), The St. John Ambultmce mu~kal entertainment was provided. Prizes: 1St, /3 2nd, £ 1.

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PRACTICAL NURSING IN THE HOME BY

AGNES E. PAVEY, S.R.N. Diploma in Nursing (University of London) Local Applications of Moist Heat (continued) a cataplasm, from a Greek word meaning ,< to spread TURPENTINE STUPE. The amount of turpentine over." The substances commonly used in the making of prescribed is usually one teaspoonful. The choice poultices arc linseed, mustard, charcoal, kaolin and starch, of method in preparing and applying this stupe is one of although the last named is usually applied cool. In home the most controversial subjects in nursL.'1g procedures. nursing, bran, bread, fig or onion may be used when The stupe is used chiefly for the relief of abdominal other substances are not available, although these food distension due to an accumulation of gas in the intestines. materials are not employed for the making of poultices in Turpentine is an irritant that can readily burn the skin if hospital practice. it is applied injudiciously; this may account for the LI SEED POULTICE. The making and applying of various methods that have been introduced. Properly a linseed poultice is a basic procedure from which other applied, a turpentine stupe is almost always effective, but forms of poulticing merely involve some slight modificait becomes discredited when the skin is blistered or when tions, so that it would be well to discuss it in detail. the stupe is prepared in such a manner that the turpentine Crushed linseed is the meal obtained from the seed of the is lost before the stupe is applied and, therefore, the patient conUDon flax plant. It is cheap and it contains volatile does not benefit from the treatment. In deciding the and fixed oils and mucilaginous ingredients that render it method to be followed it must be remembered that turpen- an admirable substance for the making of a poultice. It tine does not mix with water and that, as it is lighter than retains heat well and air is readily incorporated with it, water, it will float on the top. Therefore, it cannot be making the application comparatively light. It gives the added to the water. If it is sprinkled on the flannel before patient relief from pain and a sensation of comfort if it is this is placed in the wringer and the water is then poured correctly made and applied. It can, however, cause discomon and several minutes elapse before the stupe is wrung fort and may be harmful if the procedure is not properly up, the turpentine will float out of the flannel. There will, carried out. It is essential that it shall be applied as quickly of course, be a strong odour of turpentine and much of it as possible after it is made, so that the nurse should first will adhere to the wringer as it is lifted out of the water, prepare ~ll the requisites and then prepare the pgtient, but very little remains in the stupe. If, however, the water after which she makes and applies the poultice. is poured over the stupe at the bedside and it is immediatelY Th~ Procedure.-The articles required are linseed meal, wrung up, very little turpentine is lost. Another suggested old linen, a poultice board, a bowl in which to mix the method is to follow the same procedure as for an opium poultice, a jug, a broad knife or spatula and two large stupe-place the turpentine in a minim measure on a tray plates. Cotton wool, a bandage and a safety pin are needed containing the prepared plain fomentation and sprinkle it to fix the poultice in position. These are collected on a evenly over the flannel after it is taken from the wringer. tray. With reasonable care the turpentine will spread quite Havin~ assembled the articles, the plates are put on a evenly in the wet flannel, so that there is no concentration stove or ill an oven to warm and the cotton wool is warmed. in one area. An American method is to mix the turpentine The linen is cut half an inch larger all round than the with twice its volume of olive oil and paint this over the ~shed poultice is- required to be, and a half-inch square skin, and then apply an ordinary medical fomentation. IS cut out at ~ach ~orner so that the edges will turn up A turpentine stupe should be covered with a fairly thick neat~y. The ~en IS placed on the board, the spatula is pad of cotton wool but never with a waterproof material, put illtO the Jug and. sufficient boiling water is poured in ?r blistering may result. The skin must, in any case, be ' lllspected for undue redness by lifting the corner of the to. c.over the ?lade. Boiling water is also poured into the flannel at frequent intervals after the first ten minutes. D11X1Dg bowl ill order to heat it, and a container with the The stupe may be left on for twenty to thirty minutes in amount of linseed meal that will be required is placed on a an adult. When it is removed the skin will probably be a stove, or other warm place, so that it will become warm. deep pink, but it will not be angry-looking. It can be The tray contai~g the warm wool and bandage is then powdered and the cotton wool replaced if the patient taken to the bedSIde and the clothing is removed from the ~rea to be poulticed, which is covered by the wool. If it feels that this gives comfort. ~s the ~~est or the abdomen a many-tailed bandage is placed Poultices, or Cataplasms ~ posHlOn so that the patient will not need to be moved Th~ word p~:)Ultice is derived from a Latin word-pultis- ill order to fix the poultice, and the bed-clothes are lightly mearung porr1dge. In nursing practice a poultice is a hot replaced or the area is covered with a small blanket or application in the form of a soft paste made of a substance shawl.. Then .the nurse returns to make the poultice. The 0at retains heat well and which usually contains natural water 1S emptled from the poultice bowl and sufficient fresh OIls .that soothe the tiss~es and reduce the danger of boiling water is poured in. This is much less than might ' burrung; so that a poultlce can often be applied hotter be supposed by an inexperienced person-usually about a than most other heat treatments. A poultice is often called quarter of ~ pillt for ~ poultice about nine inches square

FIRST and a quarter of an inch thick. The linseed meal is sprinkled in handfuls into the water, stirring all the time with the heated spatula until the mixture is smooth and thick and cuts away cleanly from the sides of the bowl but does not crumble. The whole of it is then turned out on to the linen and is spread evenly over its surface, leaving a halfinch margin. The spatula must be held flat and horizontal whilst doing this, dipping it into the water from time to time in order to give the poultice a perfectly smooth surface. The margins of the mixture can then be straightened by quickly cutting off the unwanted part with the side of the spatula, and the edges of the linen are folded over. The poultice is lightly rolled or folded, placed between the two hot plates and carried to the bedside. It should be held flat on the nurse's outstretched palm and, holding it at right angles to the lower border of the part to be poulticed, it is gradually applied to the patient's skin as he can tolerate the heat without undue diswmfort. The wool is then replaced and the bandage fixed in position. Debatable Points.-The use of jaconet, or other waterproof substance, over the poultice is not advisable as it may result in the skin becoming too sodden. Some authorities suggest covering the poultice with a layer of

AID

gauze or spreading a thin film of warmed olive oil over its surface. Both of these interfere with the action of the poultice an~ are unnecessary for the patient's protection If the poultIce has been correctly made. The gauze is also advo~ated for prev~nting the. poultice from crumbling or adhenng to the skin, but this should not happen with a well made poultice, and during the moments spent in adjusting the gauze the poultice is losing its heat. The use of the oil is suggested so that burning may be prevented, but it is no compliment to the nurse's skill in carrying out a treatment to infer that such a preventive is necessary, for a properly made and applied poultice will not burn, and the film of bland oil will act as a barrier to the action of the heat and of the remedial substances in the linseed itself. Changing the Poultice.-The application of poultices is usually ordered four-hourly. This does not mean that each poultice should remain on for that time. It should be removed when it has lost its heat-which may be from half to one hour-otherwise it not only causes discomfort, but it may produce an effect contrary to that desired. The warm wool and the bandage are replaced until the next poultice is due. (to be continued. )

The Medicine Chest By FRANK BERRY, PH.,C.

A GAR-also known as Agar-.Agar or Japanese Isinglass, is a Aloin is a yellow powder extracted from Aloes. It has a similar bitter gelatine-like substance extracted from certain seaweeds, particularly certain red varieties prevalent off the Japanese coast. It became unobtainable during the recent war and substitute substances hav-e now been prepared from the seaweeds found arow1d British shores. Agar is capable of absorbing a large quantity of water, and in doing so increases greatly in bulk. For this reason it is largely used in treatment of chronic constipation, and is often given in emulsion form with liquid paraffin and other laxatives. Alkalies The term alkali is applied to a whole group of substances which are the chemical opposites of acids. When an acid and an alkali come in contact, each loses its characteristic properties and a neutral substance or salt is formed which is neither acid nor alkali. Thus, if Sulphuric acid, a typical corrosive acid, comes imo comact with either Sodium Hydroxide (Caustic Soda), a typical caustic alkali, or Sodium Bicarbonate, a typical mild alkali; chemical reaction takes place and a neutral, harmless salt, Sodium Sulphate (Glauber's Salt) is formed. The neuttalisation of acids and alkalies is of interest in connection with the treatment of corrosive poisoning. Caustic Soda and Caustic Potash are examples of strong caustic alkalies, solutions of which feel soapy to the touch, cause burns if splashed on the skin, and act as corrosive poisons if swallowed. They are largely used in soap manufacture and as paint and grease removers, while medicinally they are sometimes used for destruction of warts. The principal alkalies are the oxides, carbonates or bicarbonates of Sodium, Potassium, Calcium or Magnesium. These will be described later wlder theit respective drug names as also will Ammonia and Lime Water. Aloes is the dried juice of certain plants growing in Africa and the \'(!est Indies. It is widely used in the treatment of constipation, being given as powdered Aloes 2 to 5 grains or as a decoction or extract. Many purgative pills contain Aloes together with appropriate carminatives to lessen griping.

taste and purgative action but is somewhat more powerful, the average medicinal dose being grain. Compound Aloin Tablets contain Aloin together with Ipecacuanha and Extract of i ux Vomica.

Alum This substance, available as a white powder or colourless crystals is a compound salt of Aluminium Sulphate with Potassium Sulphate or lUnmonium Sulphate, the t\vo types being described as Potash Alum and Ammonia Alum respectively. 1'dum has a powelful astringent action and solutions of approximately one per cent. strength are used in treatment of certain types of inflam· mation of mouth and throat, and also as a vaginal douche. Alum is often used in form of a lorion, to arrest bleeding after tooth extraction and from superficial cuts and abrasions. Styptic p~D cils genetally consist essentially of Alum. Ammonia Ammonia is a water-soluble gas formed Juring the destructive distillation of coal, and the ammoniacal liquor from the gas-works can be purilied to yield a colourless solution containing about 33 per cent. by weight of the gas. This is often referred to as 880 Am ':nonia because its specific gravity is 0.8 o. This strong solution should be stored in a cool place. and handled with very great care. When opening containers of this product, the face should be held well away from the containers. The pungent, characteristic smelling vapour given off from these solutions is yery dangerous, and many accidcnrs have occurred through neglecting to take adequate precautions when dealing with them. I\.mmonia is used in refrigeratOrs and danger may arise when leakage occurs. Inhalation of concentrated Ammonia vapour may cause inAammation of the air passages or even sudden death.

(PlctfSe ftlm fo page 14.)

FIRST

AID

FIRST

ANATOMY ANB PHYSIOLOGY IN FIRST AlB by J. WELLS, M.R.C.S., L.R.C.P.

Other points of value and interest to be Itoted }phen examining the skeleton are :The Spinal Column: The curvatures of the spine, as shown in diagram in the October, 1947, issue The cervical vertebrae curve slightly forward. The dorsal or thoracic vertebrae curve backward. The lumbar vertebrae curve forward. The sacral vertebrae curve sharply backward. The coccyx curves sharply forward. The shape of the spinal column with its curves altering in position and having ru scs of cartilage between the vertebrae, lessen the amount of any force travelling up it. For example, when falling from a height on to the feet. The first shock occurs at the feet, this travels up the legs, along the femurs, then through the pelvis and into the spinal column. Here again its force is lessened by the cartilages between the vertebrae and the changing directions in the curves of the spine, so that, by the time the force reaches the occipital bone and the base of the skull it is greatly lessened, so often preventing a fracture of the Base. The Skull: Important points to look for Occipital Protuberance at the back and lower part of the occipital bone. This can be seen on the skeleton and telt on the living body. When covering the head with a ~riang~~r bandage,. this protu.be~ence holds the bandage m POSItIon so that It cannot slip If the bandage is crossed below it. The Mast(}id Portion of the T emporal Bone.- This can be seen and felt behind the ear. If the thumb is placed on the mastoid portion of the temporal bone and dropped down:vards ~nd .backwards . towards the spine for about Ii mches, It Will then be in the occip ital triangle in which are place~ the occipital artery, vein and nerve. In doing this, use right thumb for left artery and left thumb for right artery. The Angle of the Jaw.-This can be seen and felt on the skeleton and felt in the living subject. From the angle of the ja'Y the facial artery can be located. Feel for the angle of the Jaw, then place one finger on the angle of the jaw and t~e next finger. in front of it. The second finger then lies on th~ fac1al artery. When examining the skeleton look at this spot and a groove will be seen on the lower jaw in which the artery lies. The Anterior Temporal A rtery can be felt i inch in front of the upper border of the tragus of the ear, lying on the temporal bone. The Clavicle and First Rib These. are important in lo~ating the ~ubclavian artery (~ub clavzan-sub, ~nder; clavzan) the clavzcle.) The artery lies u.J?-der the c.lavlcle on the first rib. The position of the first nb can eaSIly be seen on the skeleton. The anatomical position of t~e s ubcl~vian artery is at the junction of the Inner and mIddle thirds of a line drawn from the midsternum to the tip of the shoulder joint. This line can be mar~ed out on the living body, with a blue skin-marking penCIl.

The NIanubriulII or Handle of the Dagger-shaped Bone-the Sternum.-The second rib is located by this bone. The second rib is attached to the sternum, where the manubrium forms a prominent ridge at its junction with the body of the sternum. By: running the finger. outwards from this ridge the second nb can be felt. Havmg located the second rib the other ribs and spaces can be counted. Second rib, second space; third rib, third space; fourth rib, fourth space; fifth rib, fifth space, and so on. The Apex .Beat of the Heart is in the fifth space, inches from the m1d sternum, on the left side, if in its normal position. Placing the palm of the hand on the left side of the chest at this point, the apex beat of the heart can be felt. It will be noticed on examining the skeleton that the ribs lie obliquely downwards and not horizontally round the. body, s.o t~at .when they are raised or depressed as dunng th~ mspuatlon and expiration of air in breathing, the capacity of the chest is alternately increased and decreased. The eleventh and twelfth ribs can be seen as floating ribs, that is, with no cartilaginous attachments to other ribs. The head of the humerus can be seen lying in the shall.o~ hollo:v of the scapula, the glenoid fossa, and in the lrv:mg subJect.can be felt .by pressing up to the apex of the aXilla or armpIt. In certain dislocations of the shoulder joir:t. the head of the humerus can be distinctly felt out of positlOn when comparing it with the sound side. When possible) all dislocations and fractures should be compared lvith '.he sound limb. When compressing the axillary artery, press It on to the head of the humerus at the apex of the axilla. . Th~ Humerus is important as the biceps muscle is inserted Into Its shaft ar:d is attached by its tendon to the upper end .of the. radius, below the elbow joint. When contractmg, this muscle lifts up the forearm. To demonstrate this, close the hand tightly and raise the forearm at the same time clasping the upper arm with the othe; ~and. The biceps muscle will then be felt contracting, as it does when flexing the forearm. On the skeleton the hinge jo~nt of the. elbow ca~ be plainly seen. The line of the brack/al artery zs along the mner border of the biceps muscle to the mzddle of the elbmv joint. The enlarged end of the radius at the wrist should be noted. It will be seen on the skeleton to expand at its lower end. When fractured, the shaft of this bone is sometimes driven into this enlarged end of the radius and becomes fixed, thus forming an impacted fracture of the bone. The in~ernal and external malleoli at the ankle joint should be exarruned on the skeleton, the external malleolus is the enlarged en~ ?f the fibula, the internal malleolus is the enlarged en~ of the Ubia. The pos:erior tibial artery is midway between a line drawn from the mternal malleolus to the tip of the heel. The artery lies on the os calcis bone. The anterior tibial artery is midway bel1lJCen the internal and ix tental malleoli on lhe fi'ont or dorsal aspect of the foot.

Differences between Bones of Male and Female Skeleton In the Female Skeleton the bones generally are lighter and the roughened surfaces on them for the a ttachment of muscles and tendons are not so pronounced. The clavicles are straighter in the female than in the male. The clavicles in the male are more " S" shaped.

- :::::t;

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~ ;: :~ ~e clavicle ~

AID

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FIRST

Team Test and Harking Sheet of the "Katherine Biddle ~~ T,·ophy Competition.

THE

NEW

You and your team are on duty on the dockside, where a crane is unloading a ship. A messenger arrives to tell you that an accident has happened about 300 yards along the quay. The railway line on \,-hich the crane is working runs along the quayside to the site of the accident. There is an ambulance hut nearby. TilJ/e Li1Jlif-IO J..1.imlfeJ

DISPOSITION OF PATIENTS

Pa/ienl I-is lying on his back across the railway line. A yery large packing-case, marked "HEAVY GOODS" has fallen from a truck and completely coyers his lo\\'er limbs. He is bleeding from a small wound above the left ear-arterial h:emorrhage. He is in slight stupO! and his breath smells of alcohol. Both legs are paralysed, and there is a fracture of the right thigh. Patiellt 2-friend of the first patient, is obviously under the in.fiuence of alcohol and keeps interfering with the treatment actually claiming that he has injured his head too. No injury is present, the condition being hysterical. Details Team runs to assistance One member fetching kit ... Asks bystander what has happened (incoherent reply) Speak to patient, and warn him against struggling (stuporous reply) Quick appreciation of situation Ensure that there is no further danger Quick examination of head, noting injury Arterial h:emorrhage ? (Yes) ... Depressed fracture (none obvious, but doubtful) Arrange for ring pad to be made Examination for signs of fractured base ;Colour of face (pale) Eyes: Pupils (equal) Dilated? (Yes, slightly) Bloodshot? ·(Yes, alcoholic) Nose and Ears; Blood or fluid? (No) Breath (smells of alcohol) ... Paralysis of arms ? (None present) Apply light dressing on 'w ound Ring pad, COtfl!ctly made Narrow bandage Tied over ring pad H:tmorrhage controlled? (Yes) ... Examination for any further injuries to parts exposed (none)

lIIax. Marks 2 2

4 4 2 2

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i\Ieal11vhile--Arrange for crane to move up and lift packing-case Doctor and ambulance sent for Loosen tight clothing Prepare and administer alkaline solution (Soda, Bicarb., dessertspoon to pint) Filst testing ability to swallow And noting quantity given Ensure warmth to patient Place friend under supervision COl"efu/!J, examining his head for injury (none) ... THE CRANE HAS NOW REMOVED THE PACKING-CASE Examination of lower limbs : For fracture (right leg deformed) Compound ? (No) For limpness (both are limp) .. . Examination of pelvis (normal) .. . Diagnosis: Fractured spine and fractured right leg Warn patient to lie still Traction on the head-correct method ... Extension of right limb ... Maintain traction on both limbs Pads between ankles, knees and thighs Figure of eight bandage round ankles and feet use splint of sufficient length If padded Five bandages: Above fracture Below fracture Both thighs Ankles and feet Knees .. . Preparation of stretcher : Correctly blanketed And padded for neck and back Loading stretcher : Looped broad bandages under : } ... Neck ... ... ... or Loins . . . Blanket Knees . . . method Tied over poles . . . . .. Carefully lifted without jerking Loaded feet first Traction at head and feet maintained until loaded on stretcher Wrap the patient carefully Watch patient for signs of shock Carrying the stretcher Loading ambulance Constant to general condition For not asking unnecessary questions Team work and general smartness

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THE NEW PEOPLE'S PHYSICIAN Written by Medical Experts and Edited by DOUGLAS HAY scon, M.B., Ch.B. 4 2 2

NEW Edition Revised to Date Numerous Colour Plates.

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THE NEW PEOPLE 'S PHYSICIAN, informed ,,"ith the latest scientific knowledge and practice, is the most authoritative up-to-date, comp:ehensiye and practical work of its kind. -r:he ehapter~ on first-aId, diagnosis and treatment, anatomy and phYSIology, dealIng most fully with these subjects, make it a work of the greatest \·.allle to the fir taider. It should find a place, too, in every home-:-an In\'alua?le source of guidance in time of illness or accident, and an aid t ? the ll1amten~nce of good health and physical fitness. Home. nUl'Smg, sex hYgIene, symptoms and treatment of disease, pr~verl:tlOn of dIsease, care of children, motherhood and \\ ifehood, SCIentIfic cookery, ar~ but a few of the subjects that come \\·ithin the wide scope of thIS work.

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Replaces THE Competition was organised by Southern Region Ambulance Centre British Railways and held at Southampton on Saturday, December 6th, 1947. A rep on of the proceedings appears in " Ne\\"s From All Quarters." CARD

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Some salts of Ammonia are used medicinally, the chief being :_ Smelling Salts owe their restorative properties to the Ammonia they Ammonium Acetate This is given in mixture form in treatment of many feverish con contain. This, when carefully inhaled, acts by reflex action and accelerates the heart and stimulates respiration. Owing to the irritant ditions, especially in children. action of Ammonia solutions, great care should be taken when using a Ammonium Carbonate This is a white ]1t>wder smelling strongly of Ammonia and often bottle of liquid smelling salts, to prevent the liquid from coming in used as solid smelling salts. Taken internally it acts as a stimulant and contact with the patient's nose and to avoid spilling any on his face. Strong Ammonia solutions are used in many households and may expectorant and is a frequent ingredient in certain types of cough mixture. be the source of accidents. Known as Sal Volatile or Volatile Salt, it is sometimes used in If swallowed, serious symptoms rapidly develop; the mouth and tongue become red and swollen, and covered with white pieces of baking. Its solution in water, being alkaline, is a useful application to allay detached epithelium. Great irritation of lungs and air passages occurs, with loss of voice, retching, vomiting, purging, suffocation and final irritation due to insect bites. It is an ingredient in Spirit of Sal Volatile. AmmoniullI Bromide collapse. This is sometimes gi ven in mixture form either alone or mixed with Treatment of such cases should be in accordance with Standard Text Book rules for Treatment of Corrosive Poisoning-avoiding other bromides, as a sedari ve. emetics, but giving as antidote, acid products such as vinegar or AmlJJonium Chloride This is a white powder given in mixture form as an expectorant to lemon-juice, diluted with water. If the victim is unable to swallow, inhalation of acetic acid or vinegar relieve irritant cough, and to enable mucus to be coughed up. Pastilles and lozenges are also prepared containing 2 or 3 grains of from a pocket handkerchief may be of some assistance. Half an ounce of the strong solution usually proves fatal if swallowed. the substance, and are extensively used in treatment of laryngitis and Accidents have occurred as a result of taking Ammonia solution in allied complaints. During the treatment of certain infections of the urinary tract it is often essential to maintain a certain degree of acidity mistake for Spirit of Sal Volatile. Dilute Ammonia solutions are often used externally to neutralise of urine and this is achieved by administration of 15 grain doses of Ammonium Chloride, although in this high dosage the substanc is the acids injected by stinging insects. Many liniments contain Ammonia, which acts as a useful counter- extremely nauseating to take. irritant in treatment of muscular pains, lumbago and allied complaints. (to be cGntinued.)

Miscellaneous Advertisements. Advertisements with remittance should be sent to First Aid. 32, Finsbury Square. London . E.C. 2. Rate 3d. per word. minimum 41. 6d. Trade Advts . 4d. per word, minimum 61. Box numbers 1s. extra.

FOR SALE-Carte~s "Portland" l<?~ding platform, carries two stretchers, practlcally new condJtlon, ready for bolting to ar;nbulance floor. Any reasonable offer for quick sale-Div. /Supt. W. Smith, 4, Douglas Street, Selby, Yorks. 0 Concert Tickets, 8/6. Posters, Memos, Rubber Stamps. Samples free. "A" Tices, II, Oaklands Grove, London, W.I2. HOW to Stop Smoking. Save Money. Safeguard health. Thousands cured. Send stamp for Booklet of World Famous Remedy. Stanley Institute Ltd., (Dept. 75) 265, Strand, London. RUPTURED? FORGET IT! Use Brooks Rupture Appliancethe new dlsco,:ery. Wonderful! No lumpy pads, no springs, dura~le, cheap. BlOds and draws parts together quickly. Sent on tnal. Catalo~e free. Address: Brooks Appliance Co., Ltd.

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DYING, APPARENT - DEATH AND RESUSCITATION By STEFAN JELLINEK, M.D., Professor of Electro - Pathology at the University of Vienna " By far the 1I10st important poreion of the book is the one dealing with the Technique of life-saving. We regard this as a Volume of considerable importance and originality. A 21aluable contribution." - Medical World.

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Queries and Answers to Correspondents

A HINT TO HELP Queries )vill be dealt with under the following ru/~s : I.-Letters containing Qtleries 1I114St be marked 011 the top left-hand cortler of tbe envelope" Query," and addressed to "First A id," 3 2, FitlJbury Square, London, E.e. 2. 2.-AII Queries tJlflSt be Ivritten 011 one side of the paper OIlIY. 3.-AII Querics Il1tlSt be accompanied by. a "Query Co/!pon JJ cut from the current issue of the Journal, or, tn case of Quertcs from abroad, from a recent iuue. '" 4.-The textbook fo Iphich reference mqy be made ltJ thlJ column IS the 39th (1937) Edition of the S.J.A.A Manual of First Aid t o the 11'!/ured.

Transport Down Narrow Stairs T. S. and F. ?II. (Kenering) .-f1"e mpectjul(y beg to disagrt'e lI}itb tht! allS1ler 1J'hich IIllder the abo/'e heading lW1J published in the J.\-ol'etJIber isslie of FIRST Am f'otlceming Ihf' dijfiml(l' of getlillg a palient d()lI"l atl o]l'kJl'ard staircase) llarr()Jv 01' tlJ'iJ/I'r/. f1"/f catl gllaralllee to gel a patimt lIith a fracltlred few"r) Jplinted, alld wit/) olfr type v/ carO'illg rIIg dO]},11 aiD' fJ'Pe of staircase witbolll diflicull.Jl, alld are quite prepared to dell/onstrate ollr lIIethod to ),011. Jrre lIIight add that, being 1I1f11/bers of a Dil'ision lI'hich has IlU'lJerOIlJ I'illages tinder its cOlltrol) ]/'e oftm gel this fJ'Pe of staircase to dealll'ith.

Pmcrice makes perfect; and in the hands of experts difficult tasks often become simple. So congratulations on oyercoming the difficulties a~socjated with carrying recumbent patients down narrow stairs and best wishes for the future.-N. Corbet Fletcher. Examination Howler W' . \. (Slough).-In all exalllinatioll sOJJle ),ears ago I asked a candidate tou' hg lvould cOlltrol haemorrhage frol7l a wound ill which tbe temporal arter:J' l1/as invoked. I confess that I 1/'as surprised lI,ben tbe cqndidate uplied: "I ll'ollld at alice app!), a tourniquft roulld the patient's JJeck I"

Good! Next please j 1- .C.F. Duties of a Doctor \VI. C. (Chester).-At Dil'isiollal Practice recently the question was asked when shoHId first-aiders take upon themse/ves the duties 0/ a doctor . As Superi1ltendent of the Division I referred the queJtioner to the 13th Principle of First Aid as set 01lt 011 page 26 o/the Textbook. Some members replied that thl!)l do perform the duties of a doctor Jl'ben the illstructions of the Textbook suggest treatlllent to be adopted" if medical aid is 110t readilY aMilable" as in cases of fracttlred spine, bul'lls, scalds, foreign bo4J iJl Uf, ftC. To this J replied that the Textbook does 110t set out tbe duties of a doctor but only ireatment ll 'bicb call be carried Ott! b)' all)' first-aider and II'hicb aillls al easing pain alld preventing aggral'atiofT of injuries. As a regular reader of FIRST Am I shall be gratfful for )'our ruling on tbis poiJlt.

Of course your answers were perfectly sound and strictly cO:'rect: So there is nothing further to be written.-N.C.F.

in that positioll bllt tbere Il'fre no .riglls 0/ in;lll]" So I fixed the limb ill tbe positioll assullled b)1 /ileal/s of a St. J ohll Jling and a broad balldage l'01lJ1d elb01v and bod)'; and this dOlle) I sellt patient to hospital. Later I lI'as told that patiml had sustail/ed a fractllre 0/ arlll. I hOi'e beell a lIIelllber of the Brigade for sixteen )lears but hal'e IJel'er before seen a ji'actllre l1'ilhollt signs or s),IIJPloIIIJ' which lJ'e are tallgbt to expect. ff70tlld )'01/ please explaill Il lbich bOlle IJlas brokell, IPby there )I'as all absence of sigll alld J)'I71PtOIll , and lI·bat treatlllent should hat'r been applied if other than as staled?

From your statement of facts it sounds as if your patient cracked the upper en.] of his humerus. Also on the same authority I gather that you found pain, swelling and loss of power which are important signs and symptoms of fracture. Of course, yo ur first aid treatment was strictly correct, and nobody can find fault with it, much less impro\"c on it, because, being in doubt, you treated for the more serious injun' and so protected your patient from further injur y.- ~.C.F. Treatment of Poisoning P. :'II. (Cardilf) .-RecentO') I l1'as asked lvhal I would do if I }}Jere called to a patiellt who IMS el lidel1t/y suffering frolll poisOiling 0' 1II0II/h aitbough

1 couid 1I0t decide Il'hetber Ihe poison takell Ivas a corrosil'e, all irritant or a narcotic. As I Jl'as stumped bJl this _Droblelll, 1 re,~istered a VOJJ' 10 seek)'otlr kind help at the/irst opporttlllilJ' .

The classification and treatment of poisoning by mouth is based in our Textbook on the conditi on of the patient's mouth. If, therefore, you are called to a case such as you describe you would at once examine the patient's mouth for signs of burning. If these are present you would treat for corrosive, whereas if they are absent you would treat for non-corrosive, poisoning. This done you would watch patient and continue treatment in accordance with the General Rules set out on pages I70-176 of the Text book.- N .C.F. Fotf'ign Body in Stomach N. O. (Finchley).-RecClJt{y sOllie of liS Il'ere disCtlssillg whal first-aidn:r should do if th~)' are called to a palient 11'ho has sllJailo}J.'ed a pill or a needle alld for lJJhOIll medical aid was l1:Jt immediate!;, allailable.

Since there is no immediate danger to life or to part, except from attempts to make the patient vomit o r by administration of aperients, no active first aid is indicated. The patient should be told to keep quiet or, if a child, to go to bed until medical aid is available. If this be long delayed, no harm can result from giv ing stodgy food or perhaps sandwic hes composed of thin bread and butter with a la yer of cotton \vool between the slices..C.F. Fracture of Ankle

Signs of Fractured Arm . \'<'. j\I. (Barki.ng).- Beillg puzzled abot!! a case whic/) I recm/o' treated, I tbought that I l1'ould lvrile and ask),ollr observation and adl'ice. On December 12th I was in attmdance at tbe local football grOtmd lJ1ben I lvas called to a pla)ler mho had fallen on his left shoulder and CO/11piained of intellse pain. On examination I found no signs of ir!Jury except the pain and a sligh! swelling at the shoulder. (The patient informed me thai, as he fell his left arm was slightlY to tbe rear.) He had put this arm ill the position often assumed fo r Facttlred c/(J/licle and W4S holding it

R. 1'. (Wellington, New Zealand).-We were recellti), discussing the treatment of a fracttlred allkle alld could 110t arril/e at allY decisioll e.rpecially as there are 110 specific inslmctions ill the T exthook. Til these circlI'll.rtancfs l1'e once a~a1tJ seek )'our kind help.

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PENETRATING I r is th~ pt>netrating power of GermoJene which enables it to sink right in through the top skin into the true, ]iying skin below-and so to r :Clch the tortured nerve "'1dings-which brings such (lUderful relief.

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

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In this important and informed book the author vigorously criticises existing methods. He offers fresh guiding principles for practical life-saving and shows how the results of research may be placed a t the immediate disposal of first-aiders to the common good.

PPviii. + 264.

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APPARENT - DEATH AND RESUSCITAT ION By STEFAN JELLINEK, M.D. , Professor of Electro - Pathology at the University of Vienna " By f ar the most important porrion of the book is th~ one dealing with the Technique of life-saving. We regard thIS as a V olume of ~onsiderable importance and originality. A valuable contribution." - Medica l World.

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No. 644.-VOL. LIV.

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FEBRUARY, 1948.

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CONTENTS Editorial A Course in Advanced First Aid The Medicine Chest Practical Nursing in the Home

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News from all Quarters Anatomy and Physiology in First Aid Letters to the Editor Queries and Answers to Correspondents

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doctor or midwife; if a nurse is not available he may First Aid in Maternity Cases THE art icl es on first ai d in childbirth in the series have to assist the doctor during labour; or, in circum" A Course in Ad va nced First Aid ," by Dr. A. D. stances of extreme emergency when it is quite impossible Belilios, which have been ru nn ing th roug h our recent to obtain qualified help it will be his duty to render iss ues, have aroused some interest among readers who assistance . It is obvious therefore that the first-aider have not failed to respon d t o the Author's stat ement that should possess some knowledge of first aid in childbirth, the subject has been sad ly neglected in fi rst aid training. and always remembering that the first duty is to obtain It is one, in fact, which sel dom fin ds a place in normal qualified help, we strongly support Dr. Beli lios in his training, and is not, of co urse, inclu ded in the syllabus. contention that the subject should be included in the The reasons for t his are, we be lieve, quite obvious. syllabus of advanced first ai d. That we are not alone in Maternity is a spec ialised sub ject fo r both docto rs and t his opinion is shown by th e interest taken in the articles, nurses, faulty treatm ent o r the slig htest neglect may well and th ere does seem to be some need for more training have disastrous con seque nces t o moth er an d child , an d in this subject for wo men first aiders, at least, for it is it is illegal for anyo ne except a med ical practioner to des irabl e th at first aid wo r k in maternity should be underundertake mate rnity work unless a special qualification- taken by women wherever possible. But one swallow that of State Ce rt ified Midwife-is obtained. The dangers does not make a summer, and a few congratulatory letters of unqualifi ed atte ndance in maternity cannot be over are not sufficient evidence to come to the conclusion e mphas ised , puerpe ral fever an d other complications that this is so. We intend therefore to seek our reade"rs' follow in its t rai n, an d t he first rule in any approach to opinions in this matter, and to ask them to debate it the subject mu st be t o sen d immediately for qualified in our correspondence columns. The motion is "That ass istan ce. All t his was po inted out by Dr. Belil ios in his some training in maternity work is desirable in advanced arti cles. "No first-aid er (he states) shou ld atten d a first ai d training ." W e await the verdict of our reader-so maternity case except in extreme emergency : in any It may be added as a mattel- of interest, that an arrangeevent he shou ld sen d immed iately for qualified assistance." me nt was ma.de in Wimbledon some few years ago But the case of ext reme emergency remains, an d the first- wh ereby senior women first aiders could attend one of aider may at any tim e fi nd himself invo lved in such a the local nursing homes and thus witness confinements. W e shoul d be interested to hear of any similar training case. As the Auth or of t he art icl es points out, he may have to assist a pat ient whi le awaiting the arrival of a sche mes.

FIRST A ID

A COURSE IN ADVANCED FIRST AID BY

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

MISCELLANEOUS AILMENTS ANYONE who has worked as a first-aider in the ambulance room of a factory, school or place of business, will have noticed that patients seek adviGe for numerous ailments which cannot be easily classified according to the systems of the body upon which these articles have largely been based. It is the object of this article to describe some of these miscellaneous ailments.

general rules of health such as care of the bowels, adequate sleep and regular daily exercise in the open air such as cycling, playing games or walking. Most important is that young women should be taught to appreciate that the monthly periods are a natural function and not in any sense a malady; those who are perfectly healthy both in mind and body often feel no discomfort. When symptoms arise, the patient should be advised to continue with attention to the general rules of health. It is far better, in a mild case, to carryon at work particularly if this involves bending movements of the body, which are beneficial. Similarly, baths and playing games should be continued and the bowels should be kept well open. More severe cases require rest which should be provided in a recumbent position in a suitable rest room; hot applications, e.g., hot water bottles, should be supplied. If there are facilities, a hot bath taken just before or immediately the period has begun is more satisfactory than hot bottles. Two tablets of phenacetin may be given and are often more effective than aspirin. A quarter of a teaspoonful of sal-volatile in water may be given at the same time and repeated in an hour. Stronger remedies should only be given if specially ordered by a doctor whom the patient should be advised to consult if her trouble is recurrent.

Miscarriage This is a form of premature birth which may occur at any time during pregnancy, although it is most common during the first few months. Technically, it is called an abortion if it takes place before the third month of pregnancy and this is far more common than a true miscarriage. Usually, the first symptom of either condition is bleeding from the vagina which may at first be quite slight in amount. This is followed sooner or later by pains resembling dysmenorrhoea, but gradually becoming like those of labour. Ultimately a miniature confinement may occur resulting in the birth of a small foetus and placenta. . Many abortions and miscarriages can be arrested by Immediate first aid. The slightest bleeding occurring during pregnancy calls for prompt treatment. The patient should lie down immediately and not rise for any purpose whatever without the permission of a doctor. If a case occurs at work, it is wiser to wait for the doctor before sending the patient home by ambulance, for he may be able to Headaches give an injection which will prevent the miscarriage. In These can be due to many causes. If the headache is of a.ny event, the patient should be advised to take only a hg~t dIet and to avoid aperients. Everything that the recent origin, it may quite likely be a symptom of an patIent passes should be carefully preserved for inspection illness such as influenza. It is essential therefore to take the patient's temperature and if this is found to be raised, by the doctor. The management of an actual miscarriage which takes to send him home immediately with instructions to call place before the arrival of medical aid is very similar to that in his doctor. Usually, when a headache is accompanied of a confinement except that the first-aider must not inter- by fever, other symptoms and signs will be present such as fere with the process in any way. His duties are restricted pains in ~he back, arms and legs, a furred tongue, shivering to er:suring privacy, preparation of the bed, removal of or sweating. No one can say at this stage what complaint clothing so far as is necessary and cleansing the patient the patient may be developing. Severe and recurrent headaches are the chief symptom hen the miscarriage is over. Never should he forget the Importance. of p.erson~l ~leanliness since the risk of sepsis of migraine, a disease of unknown causation, but often after a mlscarnage 1S Just as great as that following associated with worry and emotional stress. The headache is of a dull character chiefly noticed in the forehead or childbirth. occipital region; often it is present on only one side of Dysmenorrhoea the head. Blurred sight, nausea and vomiting frequently This is the name given to the pains from which many accompany the attack which may be so severe that the women suffer monthly to a greater or lesser extent. Usually, patient is completely incapacitated. young women are more affected than those who are older . First aid consists of supplying complete rest preferably while after childbirth .dysmenorrhoea often disappear~ m a darkened room where freedom from noise can be altoge~her. Nausea, vom1tmg and headache may accompany o?tained as far as possible. Hot strong coffee can be the pam. g1ven .and there is no objection to aspirin, phenacetin or The first-aider should be interested in the prevention of vega run, although these remedies often fail to bring relief. dysmenorrh?ea alt~o.ugh this is primarily a job for the ?leep should be encouraged. The services of a doctor are doctQr. It 1S surpns.1n~ how many cases improve or are mvaluable for he may be able to give an injection which even cured by hygieruc measures and attention to the will quickly relieve the headache.

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Another common cause of recurrent headaches is eyeT.el?J-pora~x relief can be obtained by Sltting up and strain, this may occur in people whose sight is normal aVOldmg b1tmg on the tooth. A small piece of bread but who suffer from a mild degree of astigmatism. They, soaked in hot water or milk, can be held between the gum too, must be advised to see a doctor who w.ill arrange for and the cheek. As soon as possible, the patient must go their eyes to be examined. It cannot be too strongly to a dentist who will probably have to extract the tooth; emphasized that it is a most improper practice for a first- gas will be used as an ana::sthetic since it is dangerous to aider to distribute aspirin and similar tablets to cases of give an injection when there is sepsis in the mouth. The this kind. There are many patients who, if allowed, will first-aider should therefore advise his patient to go without " live" on these remedies rather than go to a doctor to the meal immediately prior to his visit. find out the real cause of their headaches. Sometimes the first-aider will have difficulty in persuading the patient to go to a dentist because there is a widespread Toothache Everyone sympathises with the patient suffering from belief that a tooth should not be extracted until all the toothache; this sympathy, however, is not always deserved swelling of the abscess has gone down. This is entirely for toothache could be almost eradicated if people would fallacious and out of date. go regularly to their dentist to have their teeth overhauled. Fracture of the Nose A small cavity, caused by decay, can easily be painlessly Broken noses are comparatively common and usually filled provided it is taken in time. Unfortunately, however, result from direct violence such as blows sustained in small cavities do not cause pain hence the patient has no football, boxing, etc. It is surprising how lightly the warning that he has a decaying tooth until the process has injury is considered by laymen and also in first aid books, progressed to a marked extent. but a broken nose is a serious accident and failure to The first-aider must use his discretion when asked to recognise it or treat it properly .may be followed by help a sufferer from toothache. If a dentist is readily unpleasant after-effects during the subsequent life-time of available, no treatment should be given because it only the patient. encourages the patient to postpone the visit which may The condition is not always easy to diagnose. In typical save his tooth. In an emergency, however, a small piece cases, pain, swelling and bruising are present; epistaxis of cotton wool, well powdered with bicarbonate of soda, may occur and the nose appear deformed and out of shape. may be inserted into the cavity and the patient instructed Sometimes, however, the only sign of a fracture is tendernot to bite on the tooth. Two tablets of aspirin, or ness over the bones forming the organ and if this tenderphenacetin and caffeine, may be given and the patient ness is present a provisional diagnosis of fracture should advised to sleep high on several pillows or even to sit up always be made. in bed if the toothache recurs during the night. Often the chief injury is internal, e.g., damage to the A common complication of neglected decay is an abscess turbinate bones or to the septum. on the tooth. The patient complains of severe pain of a First aid consists of relieving pain by applying cold throbbing character which is worse at night. He may also compresses and treating for shock if this is present. The notice, when he bites, that the affected tooth appears to chief duty of the first-aider, however, is to ensure that have risen to a slightly higher level than the others in his the patient goes to a doctor for further advice and treatment. (to be continued.) jaw. Later his face becomes swoJ)en.

The Medicine Chest By FRANK BERRY, PH.,C. Amyl Nitrite HIS is a yellow, volatile and inflammable liquid w~ch, when inhaled, causes rapid dilatation of blood vessels and 1S therefore frequently used to relieve attacks of angina pectoris (a form of heart disease) when such attacks are associated with high blood pressure. For this purpose the drug is supplied in small glass capsules or ampoules each enclosed in a padded wool or silk covering and containing about 3 minims of the substance. For use, an ampoule is crushed between the fingers, and the released liquid thus absorbed on the covering can then be readily applied to the patiem's nostrils in the manner of smelling salts. The action is very rapid and the effect on the pulse is evident within two seconds of inhalation. Persons who have frequent attacks of angina pectoris often carry one of these ampoules about with them. Under medical supervision, amyl nitrite has been used to restore the heart's action in case of chloroform syncope; to control certain types of hremorrhage; and to relieve the spasms associated with strychnine poisoning, tetanus and whooping cough. Amyl nitrite is unstable and bulk supplie~ ~hould be ~tol'ed in ~mall, well closed containers plOtected from light.

Antimony Metallic antimony is not used medicinally, but some of its saltS have useful medicinal applications. Tartar Emetic or Tartarated Antimony is a white, water-soluble powder formerly much used as an emetic and expectorant but now chiefly used by intravenous injection in treatment of certain tropical diseases caused by minute organisms known as Protozoa. Antimonial Wine and Antimonial Powder (James's Powder) were once used to induce perspiration in feverish conditions and to alleviate severe cough and bronchitis. Antimony compounds are very poisonous, and if taken in excess, induce vomiting, difficulty in swallowing, increased salivation, abdominal pain and violent purging. Cramps in arms and legs, and acute depression and faintness precede severe collapse and early death. Treatment of antimony poisoning should aim at rapid elimination of the poison and alleviation of the profound collapse. The patient should be kept warm, and strong tea or coffee given freely.

Antipyrin

Thi~ i~ aho known M phenazone. It i~ It white crystalline powder prepared indirectly from coal tar and used extensively for easing pain

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and reducing temperature. It is given in mixture, powder, tablet or granule form and is an ingredient in many proprietary pr~ations used in treatment of neuralgia, headache, toothache, etc. The usual dose is 5 grains but if taken too freely untoward symptoms may develop, the most alarming being intense cyanosis or blueness of the lips, mental confusion and collapse. Treatment should be on general lines, keeping the patlent warm and in a recumbent position. Antipyrin should be distinguished from the similar but more dangerously toxic substance amidopyrine. Apomorphine This is a substance prepared from morphine the active principle of the opium poppy. It is usually available as apomorphine hydrochloride which is a greyish white powder. It readily decomposes on exposure to light and air, becoming green in colour, and for this reason the solid or its solutions should be stored in small, well-closed containers protected from the light. Small doses are expectorant and useful for relief of bronchitis, but the major use is as an emetic. One-tenth grain apomorphine hydrochloride injected hypodermically will produce vomiting in a few minutes and this is of particular value when a patient is unable to swallow or when emesis is urgently necessary. Argyrol This will be described under Salts of Silver. Arnica The arnica plant, one of the dandelion family, grows wild in Central Europe. A tincture is made from the dried flowers and roots and is a popular local application for sprains and bruises when the skin is unbroken. Taken internally, arnica acts as an irritant poison and treatment should be on general lines. Arrowroot This is a starch obtained from the underground stem of a plant grown in Central America, the West Indies and many other tropical and sub-tropical countries. Varieties are named according to originBermuda, Natal or St. Vincent Arrowroot. Arrowroot is a fine, white powder with no odour or taste. It does not dissolve in cold water, but on adding boiling water the starch grains swell and a thick mucilage is formed. Such a mucilage consisting of easily digested carbohydrate constitutes a demulcent nutritive admilably suitable for infants and convalescents. Arsenic Arsenic occurs naturally in mineral form often associated with iron ores and is extensively used industrially in preparation of many dyestuffs and pigments and in many chemical processes. It is an ingredient in many weed-killers, sheep dips and rat poisons. When arsenic is referred to in connection with medicine, the substance normally implied is the white oxide of arsenic, a heavy, white powder which is slowly soluble in water. Chemically, this substance is arsenic trioxide, but it is generally known as white arsenic or even simply as arsenic. In small doses it is given internally as a general tonic and in treatment of such skin diseases as psorIasis and chronic eczema. It is usually administered as arsenical solution in mixture form, or as pills or tablets, the latter often containing quinine or strychnine and some form of iron. Two rypical preparations are ;_ Pill of Iron and Arsenic, each contains; Dried sulphate of iron .. . 3 grains 1/60 grain Arsenic trioxide ... Blaud's Pill ,'vith Iron and Strychnine, each contains: Pill of iron carbonate (Blaud) 5 grains . .. 1/100 grain Arsenic trioxide ... Strychnine ... 1/100 grain Arsenic is also given internally as arsenic triiodide, an orange red compound of arsenic and iodine useful in treatment of gastritis,

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AID neuritis and many skin conditions. Donovan's solution, a liquid containing I per cent. of arsenic triiodide and I per cent. iodide of mercury, is frequently prescribed for syphilitic skin diseases. Externally, arsenic trioxide has a caustic action and is sometimes used mixed with morphine and creosote to destroy nerves before filling teeth. Arsenical solutions are often used in treatment of pyorrhoea and allied complaints. Many complex chemical compounds containing arsenic have been prepared synthetically for use in treatment of syphilis and some of the tropical diseases. Among the better known of such products are ; Acetarsol

In addition to its use against syphilis and tropical diseases, this substance is also issued in special tablet form for local application in treatment of certain vaginal infections. Arsphenamine

Known also as arsenobenzene, salvars~ and 606, was one of the earliest antisyphilitics introduced after much detailed research work by Paul Ehrlich and his colleagues. Atox),1

Used in treatment of those tropical diseases caused by small organisms known as trypanosomes, ,.g., Mrican Sleeping Sickness. Carbarsone

Is given in 4-grain doses in treatment of those intestinal troubles consequent upon presence of the small organisms known as amoebae, I.X., Amoebic Dysentery. Mapbarside

Is a white, water-soluble powder used as an antisyphilitic. Neoarsphenamine

Known also as Novarsenobenzene, Neosalvatsan and Novostab, is a yellow, water-soluble powder which has almost entirely replaced arsphenamine. It is issued in sealed ampoules for administration by intravenous injection. It has been widely used in treatment of syphilis and many tropical diseases, and has given good results against anthrax and disseminated sclerosis. S ulpharsphenamine

Known also as Sulpharsenobenzene and Sulphostab, is a yellow, water-soluble powder given by intramuscular injection and is of particular value in treatment of congenital syphilis in infants. Tryparsamide

Is given by injection and is of value in treatment of African Sleeping Sickness. While arsenic has many useful medicinal applications it must also be remembered that if taken in too high dosage it constitutes a dangerous poison and has often been employed for criminal purposes. It has been aptly stated that the history of arsenic is the history of murder by poison. In the 17th centuq the unscrupulous Madame Toffana was responsible for the deaths of hundreds of persons by use of arsenical solutions. The famous Borgia poison was essentially arsenical. Cases of arsenical poisoning may arise as a result of accident or criminal action. There have been national scares due to accidental presence of excess arsenic in beer, cocoa and sweets, and the names of Mary Blandy, Elizabeth Fenning, Madeline Smith, Florence Maybrick, Mr. and Mrs. Seddon, Mr. Greenwood, Mr. Armstrong, Mr. Harry Pace and Mr. Edward Black serve to remind us of the more sinister possibilities. During war time one must not overlook the dangers of the arsenical nasal irritants commonly known as DA, DM, DC, the vesicant Lewisite; and the highly toxic gas Arsine (arseniuretted Hydrogen) more popularly known as " Arthur gas." In poisonous doses arsenic acts as a typical irritant and treatment i1hould be on the general lines for such poisons. (to b, continmd.)

AID

PBA(;TI(;AL NURSING IN THE HOME BY

AGNES E. PAVEY, S.R.N. Diploma 11l Nursing (University of London) The Application of Poultices (concluded) of using carbolic in the mixing of a charcoal poultice, and MUSTARD POULTICE. Mustard applications in any see whether the necessary degree of surgical cleanliness form are often called "sinapisms," from the plant can be attained without it. The linen or lint upon which Sinapis Nigra, the ground seeds of which produce mustard. the poultice is to be spread can be sterilised by ironing it The way in which mustard acts upon the skin is interesting. with a hot iron for several minutes. The bowls and spatula In its dry form it has no action, but when combined with can be sterilised by boiling them for five minutes and, water a chemical action takes place and an irritant volatile of course, boiling water is used. The cotton wool that is oil is produced. This action is most potent at a tepid freshly unwrapped from its packet is sterilised, for all such temperature, which accounts for the fact that a mustard dressing materials are packed under aseptic conditions. plaster or a musta.rd leaf-for ~hich tepid water is use~ There remains the linseed meal and the charcoal, and will blister the skin more readily than a mustard poultice, neither of these form good breeding grounds for germs. in the making of which boiling water is used. The additional safeguard of using an antiseptic such as A mustard poultice is intended to redden the skin but carbolic appears to be greatly outweighed by its dangerous not to blister it. The mustard is mixed dry with linseed properties in this instance. meal in the proportions of one part of mustard to fifteen In making the poultice the nurse must be careful not to parts of linseed for a small child, to one part of mustard to touch the mixture of charcoal and linseed with her fingers, five of linseed for an adult. Care must be taken that no not only because she is working with an aseptic technique, small lumps of mustard remain. These can be avoided by out because the charcoal-being pure soot-is capable of pressing the mixture again~t t~e sides of the bowl wi~ t~e causing innumerable smudges on everything that the mixing spoon. The poultice 1S then made and applied ill nurse subsequently touches. Like all dressings for bedthe same way as a linseed poultice-described last month- sores, the poultice should be made the size and shape of but it is left on for a shorter time. Mter the first ten the sore and must not extend over the surrounding skin. minutes the corner of the poultice should be raised and It must be retained in position by strips of adhesive plaster the skin inspected every few minutes until it is a d~ep, which are cut long enough to be attached to perfectly sound healthy pink in colour. This may take as long as thi:-ty skin, for bandages are themselves a cause of friction and minutes, but it varies in different patients. The poultice pressure, and under them the dressing may ruck up instead is then removed and the area is quickly sponged and dried, of remaining perfectly fiat. to remove any particles of mustard that may adhere to the KAOLIN POULTICE. Kaolin is a China clay comskin, and dusted with powder and covered with cotton posed of hydrated silica of aluminium. A proprietary wool. Exposure to the air may intensify the action of the product known as " Antiphlogistine ". is a paste. co~pos~d mustard, so the area should be covered as quickly as of a kaolin base with glycerine, bonc and salicylic aCId, possible. If the poultice has, inadvertently, been left on iodine, menthol and eucalyptus. The trade name is derived long enough for the skin to l~ok inflamed and. ang~, an from a Greek word-phlogistis-meaning "burnt." The application of olive or castor oil may prevent blistenng. word "phlogiston" was formerly given to the supposed CHARCOAL POULTICE. For the making of this principle of inflammability. "Antiphlogist0e" therefore poultice powdered wood charcoal is mixed with linseed means counteracting inflammation. In hOSpItals a preparameal in the porportion of one part of the former to three tion called "Cataplasma Kaolini" is used instead of the to five parts of the latter. A charcoal poulti~e is a useful proprietary product; it is of the sam.e nature b?t m~ch application for cleaning up a large sloughing bedsore, less expensive. It is applied as a poultice and as It ret~llls which is, unhappily, a much more common occurrence heat for a much longer time than any other type of poultIce, among aged invalids than wa? forme~ly the case .when it does not need to be renewed more than once every better nutrition and better nursillg serVIces were available. twelve to twenty-four hours; this is a gr.eat ~dvantage to As a charcoal poultice is applied over an open sore the the patient who is seriously ill. The volaule ol1s and other question of surgical clea~~ss must b~ con.sidered: Some substances are, to a certain extent, absorbed and have a . authorities suggest that boiling carbolic .l?tion, I ill.60 to chemical action on the superficial tissues. Kaolin is supplied in tins containing very well-fitting I in 80, should be used instead of boiling water ill the making of the poultice. It must be remembered, however, lids in order that its volatile contents may not be lost. that a bedsore is a localised area of gangrene and that the It is heated by standing the container, with the lid loosened chief factor in its causation is the limitation of the blood but not removed, in a saucepan of hot water over a stove, supply and therefore the nutrition, of the part. Healing and stirring it from time to time until it is really hot and depends to a large ext~n~ upon impr~)Ving the blood supply. soft enough to be spread evenly, abo~t a q.uarter of an The action of carbolic IS to constnct small blood vessels. inch thick, on old linen cut to the reqwred SIze, or ?n t.o In fact, it can cause gangrene by this very.process, whi.ch the smooth surface of lint. If only a small poultice IS Please turn to page I6 would appear to make it necessary to recons1der the practIce

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News From All Quarters County of Berkshire Commissioner, in congratulating him, said, THE ST. JOHN AMBULANCE BRACKNELL " This is the highesr honour we can award." On January 20th at the Ambulance Head- Mr. Lambourn joined the Brigade in 1927 BRIGADE. quarters, Bracknell, members of the Royal when he became a member of Reading Town Borough of Windsor Ambulance and Nursing Division. In 1933 he was promoted to Corps Divisions were entertained at a Social given Sergt.-Major, returning to his Division in Prince of Wales's District by the Bracknell Ambulance and Nursing 194 1 when he was appointed Ambulance The Department of the District Surgeon Divisions. This was a return visit arranged Officer. In 1947 he became Corps Store announces a course of six special First Aid as a result of a party held recently when the Keeper, which appointment he now holds. Lectures to be held in the Court Room, Bracknell Divisions were entertained at During his nineteen years' service Mr. Holborn Town Hall, W.C.I, at 7 p.m. on the Windsor. The evening was a great success. Lamboutn has done a great deal of work undermentioned dates for members of No. I training personnel in all branches of first aid 1-IAIDENHEAD District. On New Year's Day at the Ambulance Hall, and ambulance work. In 1936 he gave first The lectures will be on general lines and aid lectures at the Home Office and during are not intended for Association purposes. East Street, a Pantomime was given to the the war he assisted with the training of They will deal with the subjects in a broad Good Companions' Club by members ttt' the Special Constables and with the Red Cross and interesting way and will introduce subject Ambulance and Nursing Divisions. The personnel at the Royal Berkshire Hospital. matter which is not normally included in Pantomime, Cinderella, was written for the After the presentation, the Commissioner . routine lectures. Illustrations will be provided occasion by Cpl. Mrs. E. Turner. The pro- held a promotion examination for members gramme also included a play by Nursing by lantern slides, epidiascope, and models, of Reading Town <CA" Ambulance Division and opportunity will be furnished for general Cadets, which was performed at their Christ- with the result that Sergt. A. Ashton will be mas Party. The Good Companions' Club, discussion and questions. appointed Ambulance Officer and Pte. A. F. The following Surgeons of No. 1 District run jointly by the Red Cross and St. John, Clarke becomes a COl poral. will act as lecturers: Afarch 4th-The District consists of about 120 members over 60 years The result of the Reading South Nursing Surgeon, Dr. M. M. Scott (Member of the of age. They meet on alternate weeks at the Cadets' examination in Preliminary First Aid, Textbook Revision Committee) ; March 1 lIh-- respective Headquarters of the two Societies held on January 26th, was 100 per cent. pass. Dr. E. S. Abraham (Assistant Commissioner, for games, talks, plays and refreshments, etc. The Examiner on til is occasion was Div. On January 3td, at the Ambulance Hall, Eastern Area); March 18th-Capt. G. R. H. Surgeon C. A. Boucher of Reading Town Wrangham (Assistant Commissioner, Western East Street, a successful Christmas Party was " B " Ambulance Div ision, who commended Area); April IJt-Lt.-CoJ. E. J. Selby, given by the Nursing Division to members of the Cadets on their arl ificial respiration. O.B.E. (County Surgeon, Western Area); the Ambulance Divi:-ion with their families ApriI8th--Dr. G. Bousfield (County Surgeon, and friends. The hall was decorated with WHITLEY Southern Area); April 15th--The Commis- figures and scenery from" Snow White and DUrIng the last three months five new sioner, Major A. C. White Knox, O.B.E., the Seven Dwarfs" and eight members of the members have j01ned the Nursing Division. .i\LC. (Member of the Textbook Revision Nursing Division were dressed up to represent The Division was visited recently by 2. doctor these characters. There was also a Christmas from Dusseldorf who, having had some Committee). EarlY application is advisable as accommodation Tree. experience of Red Cross work on the Contiis strict!)' limited. A nominal fee of 2S. 6d. will At the Annual General Meeting of the nent, showed great interest in the work. He be charged for the whole series. Application Nu~sing Division, held on January 26th, the was pleased with the efficiency of members should be made as soon as possible to the chair was taken by the Vice-President, Mrs. who gave some practical demonstrations in Class Secretary, District Staff Officer C. E. R. Godfrey. The Divisional Secretary, first aid and home nursing. Bower, O.B.E., at District Headquarters, Am.bulance Officer Mrs. Bristow, stated that On January 28th fourteen Nursing Cadets 23, St. John's Lane, E.C.r. dUrIng the year 48 weekly practices had been were examined in Preliminary Home Nursing Holborn Town Hall is three minutes from held and special courses included first aid and by Sister Jones of Battle Hospital. Holborn Underground Station. child welfare, while the result of the Annual WINDSOR Re-Examination was 100 per cent. pass. ILFORD DIVISION On January 30th, at the Castle Hotel, the The Magnus Silver Challenge Cup, presented Members had covered 581 transport duties. Royal Borough of Windsor Divisions held forty years ago by the first Superintendent of The Medical Comforts were still going well their Annual Dance in aid of funds. The the Division, was competed for recently by and some new equipment had been purchased. music was provided by George Marshall's The Competition held each year for the Brodie Band and the dance was attended by about the six finalists who had qualified to enter. The Competition was set and judged by Moore Cup had been won by the DiVIsion for 300 members and friends. District Officer E. Howard, assisted by Cadet the second year in succession. The team District Officer Mulligan. For the setting of captained by Sgt. Miss Lovegrove, had als~ WOOLHAMPTON On J.anuary 17th, f!1emb~rs. ~f Woolhampton the test the competitors were told that the won the Gamage Cup, and in addition they Division was holding its Annual Social. ~ad won seconrl. place in the County Competi- and Brunpton Nursmg DlvlSlon, under Div. A Cadet was clearing up the dirty crockery tlOn for the Porter Rose Bowl, being onlv one Supt. Mrs. H. Bowden, entertained theil' and on reaching the " kitchen" a smash was mark bebind the winning team. High parents and. friends to a New Year Party heard. The Cadet then appeared holding his Wycombe Divisions had now challenged the held at the VIllage Hall, Aldermaston. Music right forearm which had been most cleverly Maidenhead Divisions to a Competition to be was supplied by the Sandfordian D ance Band faked by District Officer Howard to represent held in March and Div. Surgeon D. J. and during the evening County Superintendent a lacerated wound caused by the broken china. Turnbull had kindly offered to help the team the Hon. Mrs. Leslie Gamage presented First After a very keen contest, with all markings in their practices. Finally, they had much Aid Certificates gained in the recent very close, Pte. A. Bone was declared the pleasure. in welcoming the new Superintendent, examination. Mrs. Blick, who was a very popular member wirulcr and Pte. B. E. Sills runner-up. County of Leicester The" setting" of the test was transformed of the Division. Leicester Nursing Cadets recently held a Following the meeting, Mrs. Godfrey into reality when refreshments were served to "Pa.rents' Evening" at their Headquarters . the spectators who included wives and friends presented the Annual Awards. DurIng the course of the evening seven of me.m.b~rs. The Cup was presented by READING Ca.dets were enrolled by County Cadet Officer the DIVISion Surgeon, Capt. Noordin, who On January 12th, at the Ambulance Hall MISS E. L. Woolaston; following this the congratulated the winner and the other Chatham Street, the County Commissione; Cadets gave a display of home nursing. eont~stan~s for their fine display, and paid a (Mr. C. A . Poole) presented the Insignia of On January 9th an O ak Panel on which special tnbute to the Judge for the excellent Serving Brother of the Order of St. John to names of Grand Prior Cadets were inscribed "make up" of the supposed injury. Corps Officer J. W. Lambourn, M.M. The was presented at Headquarters.

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The Panel, which was received by Mr. A. days at Home" week, dances, public meetings Competition a success. He also thanked the Bream, was a gift of Miss E. W. Sansome. and duties with the Taunton Town Ambu- Langley Division for their hospitality. Cadet Officers and representatives of many lance, all of which were, of course, on a T. W. Lench's will now represent the Nursing Cadet Divisions, togcther with their voluntary basis. Corps against the winners of the Dudley and parents, were present. The Divisional Surgeon (Dr. W. J. Collins) District Corps eliminating round, for the right thanked the members of the Division for the to represent the north of the County in thc BRAUNSTONE unfailing assistance which they had given in County Competition. Officers and Nursing Cadets cntertained about seventy old age pensioners living on manning the Town Ambulance at night and The funeral of the late MI. P . II. Schofield the Estate to tea and social evening on during the week-ends, stressed the need for took place on January 26th . After a sen' ice continuing this duty in spite of the provisions January 10th. "The Wilson Hand Bell in Lye Church the interment was in Lye Ringers» gave an interesting entertainment. of the forthcoming National Health Service Cemetery. The respect in which Mr. Schofield Act, which aimed at maintaining an AmbuCadet Jean Wilson, accompanied by Cadet was held by members of the Brigade was lance Service of whole-time paid personnel. evidenced by the large number of its members Annie Heatherington, sang two solos. He pointed out that the Act cloes not come Community singing was led by District who attended. The late J\1t. Schofield had Sgt. Major Harbot and a one act play into force for several months, and even thcn spent many years in thc Brigade. He was there would be difficulty in engaging a presented by friends of one of the officers. responsible for forming the Lye Ambulance The pensioners were welcomed by the Vicar. sufficient number of trained ambulance men Division in 1916 and was its first Secretary. to cover the whole 24 hours. During the first world war the Lye Division County of Somerset In presenting the accounts, the Divisional was formed into V.A.D. Detachment WorcesTAUNTON DIVISION Treasurer (Mr. W. R. Bateson) stated that the ter 27 and Mr. Schofield acted as QuarterAt an investiture held at St. John's Gate, financial position was more satisfactory than Clerkenwell, London, in December, Lt.-Col. last year. This year, the Taunton Division master. This detachment assisted in unloading V. B. Thurston received from the Earl of would not be granted permission to hold a dozens of casualty trains at Stombridge. Clarendon, Sub. Prior (acting on behalf of Flag Day and expenses would be increased 11I. Schofield led the Lye Divisional team H.M. the King), the insignia of an Officer by the necessity of replacing equipment and which on several occasions reached the semiof the Order of St. John, in recognition of the setting aside of a small part of the income final round of the "Dewar )) Shield Comloyal service renucreu to the Brigade over a towards the ultimate purchase of a permanent petItIOn. Mr. Schofield was promoted to Ambulance Officer, then to Corps Secretary long period. Headquarters when circumstances permitted. Colonel Thurston, who has been a Serving It is obvious, therefore, that some alternate and finally to Assistant Commissioner. Brother of the Order for many years, was a means of raising funds must be found. To Throughout his long association with the Vice-President of the Division until a year this end, a series of old-time dances has been Brigade fiIr. Schofield, by his unassuming ago, when he accepted the office of President. arranged and the hope was cxpressed that they manner, endeared himself to all ranks. On the recommendation of the Central would be well patronised. BOULTON & PALL DIVISION Railways' Ambulance Committee, Ambulance The Directors of Boulton & Paul Ltd. ga\e County of Worcester Officer A. J. Rosewarn has been admitted as a Dinner at the Royal H otel, Norwich, on a Serving Brother of the Order of St. John. The North Worccstershire Corps held their January 6th, to the members of the Di,cision. The award has been made in recognition of eliminating round of the "Dewar" Shield Among the guests were the Chief Constable many years of instructional work to Railway at Langley recently. of Torwich (Mr. A. F. Plume-President of Ambulance Classes, for assistance in the the Norwich Corps), Dr. W. E . Rutledge There were six competing teams, Cradley, Norton Fitzwarren railway disaster of 1940 Halesowen, T. W. Lench, Langley, Rowley (Assistan t County Commissioner) and Dr. and for the training of the Home Guard Regis and Stewarts & Lloyds. The officials l\Iay Rutledge (County Supt.) Div. Supt. (2nd Battalion, Somerset Light Infantry) in were as follows: Officer-in-Charge, Corps S. Cogman attended with 25 members . first aid. Mr. S. Howes (President) proposed the Supt. F. G. Price, M.B.E.; Judges, Team Besides helping to form the Ambulance Test-Dr. R. M. Barron, Individual Tests- B. & P. Division, he mentioned that the Cadet Division, Mr. Rosewarn has done an Dr. Martin; Ring Stewards, Div. Supt. J. Division was formed in 1928, and six members appreciable amount of first aid work in con- Shakespeare, Ambulance Officers G. Ashmore were still serving, eight members also nection with the Scouts and outside classes. and G. Thorne; Mark Stewards: Corps held sen'ice medals. Dr. Barradell-Smith At the ArulUal General Meeting of the Supt. F. G. Price and Corps Officer F. Light- (Div. Surgeon) responded and said he was pleased to be connected with the Division. Division beld on February 4th the Acting foot; Timekeeper: Div. Supt. Pearson. Sgt. Berry proposed the Company of At the conclusion of the tests tea was kindly Divisional Superintendent (Mf. H. G. Eveleigh) reported a year of good progress. provided by members of the Langley Division. Boulton & Paul Ltd., and 11r. J. H. Tresfon Corps Supt. F. G. Price announced the (Vice-President) replied. Even the Brigade was not without its difficulAfter the Diru1er the part), numbering ab?ut ties in obtaining uniform, stol'es and equip- results as follows: T. W. Lench, 298 marks; ment, but this had not prevented the enrolment Stewarts & Lloyds, 255 marks; Halesowen, fifty, attended a performance at the orwich of several new members. During the year 252 marks; Rowley Regis, 2+3 marks; Hippodrome. Also among those present were Mr. H. A. ended December 31st, 1947, the Division had Langley, 241 marks; Cradley, 232 marks. performed 333 public duties, including atten- Corps Supt. Price thanked the judges and Towlson (Vice-President) and the Directors dance at sports and race meetings, the" Holi- other officials for their part in making the of Boulton & Paul Ltd.

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ANATOMY ANn PHYSIOLOGY IN FIRST AlB by J. WELLS, M.R.C.S., L.R.C.P.

FIRST AID IN THE TREATMENT OF FRACTURES S we shall be dealing with bone in the treatment of fractures, it will be of advantage to know something of its structure and composition. Bone consists of: (r) Organic or Animal Matter. (2) Earthy or Mineral Matter.

Simple Experiments to Prove This Weigh a fresh bone from a sheep or other animal and then place it into a hot and clear fire, letting it remain there until red hot throughout. Remove the bone carefully from the fire and allow to cool, then weigh again. It will be found that the bone has lost about one-third of its original weight. That part of the bone which has been burnt away is the organic or animal matter and that which remains is the earthy or mineral substance, sometimes called bone ash. It is therefore seen that the bone consists of 33 per cent. of animal matter and about 67 per cent. of mineral matter. The flexible bones of children contain little mineral substance, as many of the bones do not become fully matured until adult life. In old age the brittle bones contain a much larger proportion of the mineral substance. Again, if we dissolve out all the mineral substance of bone we have the animal matter left. To do this place a bone from a recently killed animal in a vessel of weak hydrochloric acid (one part of strong acid to about six parts of water) and let it remain for a few days, completely covered by the acid solution. Now pour off the liquid and cover the bone with fresh acid solution, again setting it aside for some days. The bone will gradually become softer and more flexible and elastic, and will bend like a piece of indiarubber. This is due to the gradual removal of the mineral substance of the bone. Therefore, the hardness of the bone is due to its mineral substance, and the organic or animal substance resembles cartilage or gristle. When studying the human skeleton, the student will have noticed that the different bones of the body vary considerably in shape. They are classified as follows : 1. Long bones, e.g., the femur and humerus. 2. Short bones, e.g., bones of the wrist and ankle. 3· Flat bones, e.g., bones of the vault of skull, the parietal bones, frontal bones, occipital bones and ribs. 4· Irregular bones, e.g., the vertebrae of the spine. THE LONG BONES consist of a long shaft, terminating at each end in a head. If a long bone such as the femur be taken from an animal recently killed, it will be seen that the bone consists of two distinct kinds of substance. It also has an outer covering of a tough, fibrous membrane called the periosteum. This covering is very vascular, and from it the bone receives most of its blood supply. When a bone is fractured it is from the under surface of the periosteum that the new bone grows to unite and weld together the fractured ends of the bone. This is why, if

bones are not set correctly, the new bone, thrown out by the periosteum, fixes them in an abnormal position. If the femur is sawn longitudinally into halves, it will be seen that the bone consists of two distinct kinds of substance.

traflSlIerse section of ieritlll

~~~. com/2.ac! (;one OSJ(Je

::~ medl/iia (marrow)

~., Mlinq In. spaces of the

caRcel/olJs h'sslJe

!tom the (Jnder surface of(fJhicn ~~"'~.~,~... ~~

cance!ious tissue

ne{j) uOlle (Jf'O{j)s

~ tcbie 8t Co

Geo.rge B. 1'-\ (lflSt G\asgoW

The outer substance, somewhat like ivory, is called the compact tissue. It is thickest along the shaft and is very thin around the heads of the bone. The heads of the bones are filled with cancellous tissue, which is very light and porous. In addition to these two kinds of tissue the central cavity of the bone contains a soft, pulpy substance called marrow, the cavity itself being called the medullary cavity. The marrow consists of fat cells and blood vessels, supported by a very delicate connecting membrane. The blood vessels enter the medullary cavity through small openings in the

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compact tissue, which can be seen on the outer surface of the bone. There is also a kind of marrow in the pores of the cancellous tissue, but this differs from that shown in the medullary cavity in that it is reddish in colour, more fluid and contains much less fat. THE SHORT AND IRREGULAR BONES have no medullary ' cavity. They have a thin outer layer of compact tissue, filled with cancellous tissue. THE FLAT BONES consist of a layer of cancellous tissue, between two layers of compact tissue. The part of a bone, or bones which assist in forming a joint, are covered with a very smooth layer of cartilage. The circulation of the blood within the substance of the bone is brought about by a number of minute canals, which are to be found in

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Concert Tickets, 8/6, Posters, Memos, Rubber Stamps. Sam"A" Tices, I I, Oaklands Grove, London, W. I z. HOW to Stop Smoking. Save Money. Safeguard health. Thousands cured. Send stamp for Booklet of World Famous Remedy. Stanley Institute Ltd., (Dept. 75) z65, Strand, L.ondon. RUPTURED? FORGET IT I Use Brooks Rupture Appliarl:cethe new discovery. Wonderful I No lumpy pads! no sprIngs, du.r able, cheap. Binds and draws parts together .qu1ckly. Scnt on trial. Catalogue free. Address: Brooks Appltance Co., Ltd.

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all parts of the bone. If a very thin slice of a transverse section from the compact tissue of the femur be ground down until it is semi-transparent, it will show under the microsc~e, cross sections of minute cana~s c~lled Haversian Canals so called after Havers who first discovered them. The can~ls vary in size, the average diameter being Ii'tI!l5VepSe secuo/Z

!/;ecomjJac! [isslJe of

oOlle, matjw/)ed

ISO !)lamefeN

FIRST

AID 3·

To assist the processes of absorption, secretion and excretion. Calcium Carbonate (carbonate of lime) is composed of calcium, carbon and oxygen. It exists largely in the bones and teeth. Calcium Phosphate (phosphate of lime) consists of calcium phosphorus and oxygen. This forms more than 50 per cent. of the weight of bone. Bone ash consists chiefly of this compound and calcium carbonate. Sodium Chloride or common salt consists of the metal sodium and a yellow.ish green gas called chlorine. It is present in small quantities in nearb' all parts of the body. • (to be continued.)

/;avel'siolZ cOllols

(oculne about r/sooth of an inch. The haversian canals are surrounded by small regular spaces called lacunae or cavities arranged in concentric circles, giving the bone a laminated appearance. The lacunae communicate with each other and also with the haversian canals by means of very minute vessels called canaliculi, which radiate from them in all directions. If a longitudinal section of the bone is taken then the haversian canals will be opened along their length, as they run in the direction of the long axis of the bone. They will then be seen to branch and communicate with one another. The haversian canals are well supplied with blood vessels. The canaliculi and lacunae take up the

loclJfloe

.fec/tolljol'allel fa tile svl'face from !he shaft

01 the lemur' mar;llili"ed I.oo[)lumetef's

Letters to the Editor WASP STINGS DEAR

SIR,

Fellow readers of FIRST AID may be interested in the following tip which was culled from a recent number of the "British Medical Journal." In a short nOte on mosquito bites a lady doctor stated that for the alleviation of the irritation following these bites, nothing, in her experience has proved more efficacious than a piece of soap-the more common the better-wetted and rubbed on the bite. It acts almost like a charm. The swelling" subsides as one looks at it," while the irritation soon disappears. The latter returns in about twenty-four hours, but less virulently. In conclusion she writes : " Having lived in a mosquito-infested country for many year~ and tried every advertised or recommended remedy with little or no success, the relief caused by this simple and handy remedy made one cease to dread the mo quitO anJ its bite." Yours f(lithfully, A. ALLA KERR. Cheadle Hulme, Cheshire.

OAT GROWS I I j\[A.[ 'S OSE! EDITOR, I enclose herewith a cutting from a local weekly paper, and am forwarding same as it may be interesting for publication in FIRST Am, of which I have been a regular reader for a number of years . Wishing you and your staff a "Happy ew Year." Yours faithfully, S. A. GLOVER. Bourne, Lines. DEAR

nutrient matter from the blood and distribute it throughout the bone. The inorganic or mineral compounds found in the body are derived from our food and drink. Many of these pass through the body without undergoing any change, but others form a necessary part of the structure of certain tissues. The bones are rendered firm and hard ?y the. presence of certain mineral ~ompounds. The chief tnorgamc compounds are, water) calczum carbonate) calcium phosphate and common salt (sodium chloride). Water is regarded as an inorganic or mineral compound, although it is largely present in all living animal and vegetable substances . More than two-thirds of the body weight is composed of water, being derived chiefly from our food and drink, but a small quantity is formed in the body. The Uses of LIVater in the Body are : 1.

To render the body tissues soft, elastic and flexible. If all the water is driven out of a piece of beefsteak by heating it then becomes dry, hard and brittle. To dissolve nutrient matter and carry it to all parts of the body in fluid form.

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" For some months, .l'v.[r. E. J. Reedman, the Barnack grocer, had been complaining of pain at the back of his nose and headaches . He sought medical advice, and it was revealed that a grain of oats had lodged in the cavity at the back of his nose and had commenced to grow! It was removed by operation. cc The only explanation Mr. Reedman can give of how the oat came to be there is that it occurred when he assisted in threshing operations about a year ago." Many thatlks-a/so jor the greetings.-Editor.

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Queries and Answers to Correspondents Bleach Cleaner Poisoning B. Y. (York) .-Please telime ,vhat 1vould be the effect of accidentally drinking one of the bleach cleaners ,vhich are nO/v sold under various trade names and abo ,vhat treatment is recommended. Prom the first aid point of view it is not necessary to know the chemical ingredients of bleach cleaners of which there are several, the commonest being chlorine. Indeed, the Textbook teaches you that if you should meet with a case of suspected poisoning you should promptly study the associated signs and symptoms, particularly burns of mouth and lips. These will suggest the appropriate treatment to be Burns Caused by Electricity applied even if you do not know the exact poisons. In brief, if the N. O. (Cardiff).-We are puzx.led to know what are the signs of burns caused patient's mouth is bumed you must treat for corrosive (or if not by electricity and if the burns are similar to those which result from dTJ' burned for non-corrosive) poisoning.-N.C.P. beat; and 11Je shall much appreciate your kind help. Electricity may cause death without any abrasion of the suxface. Butane Gas Again it may cause burns which will vary in severity with the strength T. P. (Hayle).-Your correspondent who) in the December issue of FIRST Am, of the current applied and which will present the usual signs of any sought injormation concerning the effects and treatment oj Butane (Calor) such injury due to dry heat, namely, reddening, blistering or charring Gas /71a)' be interested in the jollO/vingjacts 11Jhich are based on injormation of the part where contact takes place. Moisture and metals favour the contained in "Gas Installations," No.6, or the Post-war Building conduction of the current.-N. Corbet Pletcher. Studies, H.M.S.O., price 6d. : Butane and Propane are sold as " Bottled Gas," the jormer under Examination Howler the trade name oj Calor Gas. Bottled Gas is said to be nonM. R. (Cannon Street).-IlI a recent examination I asked one candidate poisonous but it is recommended that it should be made odoriferous lvhat IS tbe correct treatment of choking. He electrified all of us rIJithin by the additon oj a non-toxic odorant. bearing when he replied: "I would make patient bend forward and then Presumably the possible dangers arisingjrom its use are: thump him in the pit oj the stomach to encourage vomiting! " (a) Ij a large quantity escapes into an enclosed space and Good! Next please I I-N.C.P. displaces most oj the air, the occupants 1vould be starved oj Wound of Abdominal Wall oxygetJ ; R. S. (Hounslow).-The Textbook tells us on page 13I, when we have to (b) An explosive mixture oj gas and air might be accidentally treat an abdominal wound lvith b01vel protruding, to "cover this with ignited should sucb an escape occur; and lint or a sojt towel ,vrung out oj sterilised hot water at the temperature (c) Carbon monoxide would be a product oj incomplete combustion oj the body." Please be good enough to tell us in what way this treatment is in the absence oj sufjicient air. benejicial to the unjortunate victim and accept our best thanks. Users are advised to keep the cylinders upright wbile they are itl use Protruding intestines will suffer incalculable injury if they are not to prevent the escape oj the liquified gas. This 11Jouid} oj course, protected at the earliest moment, while the dangers of shock and sepsis immediatelY vaporise under atmospheric pressure. will be correspondingly increased if warmth and moisture are not As its density is about tlvice that of air and coal gas has a density oj quickly applied. Hence the need to cover them quickly with a clean, approximate(y half that oj air} Butane will difftlSe al about half hot fomentation made with lint or soft towel.-N.C.F. the rate oj coal gas. Treatment of Complicated Wounds Best thanks for your intetesting and informa"tive letter which will J. B. (Chester).-Our team is divided in their interpretation oj the treatment be welcomed and appreciated by all readers of the Query Column.oj wounds as shown on page 24 and 25 oj the Supplement. Rule 5 is the N.C.P. problem. Do you applY direct pressure by thumb or fingers on a wound, Haemorrhage and Asphyxia or on a pad if immediatelY available, ifyou know that the bone is jractured or that there is present a joreign body which is not easily moved, or do you L. M. (B.tighton).-We are having a difference oj opinion in our First Aid Team as to the correct treatment jor a patient suffering jrom asphyxia in this case applY the instructions as given in Rule 8 ? Those ]1Jho think and a severed jemoral artery ij one is entirelY alotle and has no hope of that Rule 5 applies in a/I cases do so because they say, if the ,vords " except assistance. in cases oj jracture or when a joreign body is present" would have been One section sa)' that ,ve should commence artificial respiration straight inserted in Rule 5 if Rule 8 was an alternative to Rule 5. away and get the patient breathing before touching the leg, ,vhile the rest Many thanks jor ) 'our past services and also jor )'our anticipated and say that ,ve should apply a constriction bejore starting artificial respiration autboritative anS1ver to my problem. as the time taken to do this would be negligible. Rule 8 lays down the special treatment of wounds complicated by a Your answer is awaited I1Jilh interest. subjacent fracture or foreign body for which direct pressure is contra indicated. In place of the latter, it describes a method of ring pressure Of course there would not be severe ha:morrhage while the patient by means of dressings built up to a height which allows (I) for the is asphyxiated; and a first-aider would not know the variety and complete covering of the wound, and (2) for pressure to be applied by extent of the ha:morrhage until breathing had been re-established. the bandage without pressing on the broken bone or foreign body. Theoretically, therefore, he should commence artificial respiration In view of this special paragraph, there is no need for the qualifying forthwith and watch the wound for onset or recurrence of bleeding. ~entence which some of your colleagues suggest should have been Practically, however-and especially if at the outset the first-aider placed at the beginning of Rule 5.-N.C.P. knows that the femoral vessels have been injured-he would be wise

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FOOD POISONING if he decided to treat the wound at top speed, as laid down in the Supplement, before commencing artificial respiration. Thereby, he TTACKS of vomiting and diarrhoea, fre.quently would save the time which must be spent in turning the patient on to associated with fever and general illness, are very his back to dress che wound and again to place him on his face for the often due to infected foods . \Vhile not usually fatal, these resumpcion of artificial respiration.- .c.P. attacks may be quite uncomfortable and may mean one or Treatment of Haemorrhage more days lost from work. E. ]. (Newtown, WaJes).-As a reader of PIRST Am I JI)ould like J'our

AID

l'iews on the followi1lg points which cropped 11P in a recent First ./ Jid Competition; perhaps ),011 ]vill be good enough to deal with thelll in ),ollr Quer), Column : (I) In a recent First Aid Competition one of the individual tests asked the competitor to state " the l1)a)'S of stopping external haemorrhage" and aJvarded marks for mentioning tourniquet and jlexion. The section on pages I9-26 of the Supplement to Textbook supersedes certain portions of the Textbook, includillg tourniquet and flexion of brachial artery) etc. (2) Also} in the team test the patient bad a compound fracture of tbe left tibia ,vith bone protruding and accompanied ~I arterial haemorrhage. Here again} marks were awarded for "presSf.lre on the femoral pressure point or elastic bandage." Rul; 5 on page 25 of the Supplement instructs" direct pressure with tbulllb to bleeding part} etc.," and Rule 12 refers to indirect pressure on the femoral pressure point ani), in the event of IJJofmds high up in the tbigh. What are )'otlr t';e11ls regarding the points raised} please? (I) The Supplement advocates the control of external ha:morrhage

by direct pressure, ring pressure in cases of subjacent fracture or foreign body, and tourniquet to apply indirect pressure on carotid and femoral arteries. As you suggest, pressure by flexion is now abolished. (2) The Supplement advocates treatment of this injury (i) by means of ring pressure as described in Rule 8, and (li) of a firm bandage placed a few inches above the wound-as described in Rule g-if the first-named method fails. As you suggest, compression of the femoral pressure point is now abolished as a dangerous practice.-N.C.P.

They may occur at any time of the year, but are more prevalent during warm weather as this is the most favourable time for the growth of bacteria. It is also the period when flies are most prevalent, crawling over every type of filth they can find, and then invading our kitchens to crawl over the tastily prepared food. It may be thought that a little thing like a fly cannot carry enough germs to be harmful. Investigations have shown that millions of germs are often found on the outside of a fly's body. But food is frequently contanunated by humans as weL as insects. Sometimes the dishes into which foods are placed have nct been properly washed or sterilized. Sometimes unclean hands have been the means, and sometimes careless coughing or talking over food while it is being prepared has added a few germs which grow rapidly in the warm, moist food, producing the toxins which cause the symptoms known as food poisoning. Germs are unable to grow in foods kept at a low temperature- say so°P. or less, and therefore an icebox or refrigerator is an excellent and useful piece of furniture for any home. If unable to obtain these, see that there are other cooling arrangements and that flies are excluded from all food. Also, see that all moist foods, including meats, are handled with the utmost care and cleanliness.-" First Aid Attendant. "

{oncluded from page 7

required, or the kaolin is supplied in a large tin, the amount needed must be transferred to a smaller containet to be heated, for if heated several times it becomes dry and crumbly, and its remedial effects are impaired by the loss of some of its volatile constituents. Care must be taken that the water is not allowed to boil over into the kaolin during the heating process. As with other poultices, everything used must be warmed-the linen or lint, the spatula, the plates between which it is carried to the bedside and the wool with which it is covered. Before applying it to the patient's skin the nurse should test the heat on her own forearm or the back of her hand. When in position, the poultice is covered with warm wool and a roller or a many-tailed bandage is applied. Kaolin is sometimes applied directly to the patient's skin, using a broad, flexible spatula, but this is a less comfortable procedure than applying the already made poultice. If desired, the surface of the kaolin may be covered with a single layer of gauze to prevent sticking, but no oil or vaseline should be used for this prevents access of the chemical constituents of the kaolin to the skin. When the poultice is removed any small pieces of dried kaolin that have adhered to the skin are removed with a cotton wool swab , and, unless a fresh poultice is to be applied, the warm wool is replaced and is bandaged in position.

BRAN POUL TICE. A flannel bag of the required size is filled with bran. Tlus is steeped in boiling water and is then twisted in a wringer to expel as much of the water as possible, or it may be heated in an oven. It is applied to the part and is covered with warm cotton wool. BREAD POULTICE. Stale breadcrumbs are put into a bowl, boiling water is poured over them and the bowl is placed in a vessel of very hot water for about ten minutes. The water is then drained off and the pulpy bread is quickly spread on linen and the poultice applied, the skin having been smeared with oil or a simple ointment in order to prevent the poultice from sticking. ONION POULTICE. A well boiled onion is used for this. When the water has been squeezed out, the onion is placed between two folds of muslin and is applied to the painful part. FIG POULTICE. This is a very old-fashioned treatment for toothache, especially when due t o abscess formation in the gum. A fig is boiled and is cut open and tucked between the cheek and the gum. As it retains heat well it may hurry the development of the abscess. The patient should, however, be encouraged to seek medical or dental advice at the earliest moment that this can be obtained, rather than to treat the symptoms himself.

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Editorial A Course in Advanced First Aid The Medicine Chest Anatomy and Physiology in First Aid

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Their Cause, Treatment and Cure. A few of the Subjects treated: How to Keep Well, First Aid The Principles of Nursing What to Do in Emergencies The Eye, the Ear Influenza, Colds, etc. The Throat, the Nose The Chest, the Heart Measles, Mumps, Catarrh Corns and Warts The Stomach, the Liver The Teeth, the Muscles Physical Culture Treatment for all Skin Diseases Infant Welfare The Lungs, Pleurisy Homoepathy, Neurasthenia Hygiene, Anatomy, Pharmacy 375 Prescriptions, etc., etc. THE YOUNG WI~E will.find just the information she requires. MOTHERS who Wish their daughters to develop naturally will find exactly the teaching they need. WO~EN OVER 40 will find their difficulties regarding health frankly discussed. PRESCRIPTIONS-375 proved remedies. Hundreds of subjects.

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Road Safety for Children. HE Royal Society for the Prevention of Accidents are to be congratulated on the publication of two attractive and colourful versions of the Highway Code, specially designed for children. It is a shocking fact that last year 891 children were killed on the roads, a figure which undoubtedly would have been far higher if it were not for the excellent work the Society are doing in safety education. Teachers and police are doing invaluable work in bringing home to children the part they have to play to ensure their own safety, and the new publications shoul d prove effective tools in carrying out this most necess ary propaganda. The child accident graph shows that the peak danger periods remain constant, the unwatched and inexperienced toddlers of from three to seven, and the youthful cyclists of ten to fourteen. The new versions of the Highway Code have regard to these factors. "Teddy Tells You" is for infants from three to eig ht, and "Children, Your Highway Code" is for older children from eight to twelve, and their colourful illustrations and simple instructions make use of visual appeal which plays so large a part in the environment of the modern child. Both publications have the approval of the Minister of Education and the Minister of Transport who express a hope that they will be used as widely as possible. Distribution is to (ommence shortly and

education authorities are being urged to see that each school has adequate sets. We are confident that there will be a big demand for these little books, for their purpose is excellent, and they will be greatly welcomed by all those who are working to ensure the safety of children on the roads. The Society have been responSible for many publications on safety, and all of those we have seen have admirably succeeded in putting over in an interesting way the hard facts of road and industrial accidents. Incidentally, they might give the Government some hints in this direction, for the latest edition of the official "Highway Code" does not inspire much interest. There is a great deal of difference in that publication and the two children's codes, which lend themselves more easily to vivid pictures and delightfully written verse, but it does seem to us that the stolid, unimaginative make-up of the former could be much improved. There is, of course, a school of thought which deprecates any light touch in dealing with road accidents, preferring to shock people into better road behaviour by such means as the "black widow" and similar posters. But the psychology of publicity does not confirm this as the best means. Rather does it show that anything which has colourful appeal attracts the most interest. The Children's Highway Code does exactly that; coul~ we have something in similar vein for adult consumptIon?

FIRST AID

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A COURSE IN ADVANCED FIRST AID BY

A. D. BELILI OS, M.B. , B.S. (Lond.) D.P.H. (Eng.) AFFECTIONS OF THE EYE

A DISADVA TAGE of the syllabus of training

first aid is that it tends to give the student an erroneous impression of the relative frequency of cases that occur in actual practice. Taturally, while learning, the first-aider must devote a high proportion of his time to those conditions which demand the most study such as hiemorrhage and fractures; he often curtails, therefore, even scamps, the miscellaneous ailments to which only one chapter of his Textbook is devoted. But when it comes to the actual practice of first aid on a public duty, in an ambulance station or in the first aid room of a factory or other institution, the first-aider soon finds that only a very small proportion of his cases are comprised by fractures, hiemorrhage, etc., the vast majority are made up of what may be called the "odds and ends " such as ailments of the eyes, ears and nose. There is no greater mistake than to think that the management of these" odds and ends" is any less important than that of the more dramatic conditions. To the contrary, faulty management may have just as far reaching consequences for the future welfare of the patient as the faulty treatment of a fracture or case of unconsciousness. It will be noted that the word " management" has been stressed in the foregoing lines. This is because many of the miscellaneous ailments require very little active first aid ; often everything depends on the way in which the firstaider manages the case, appreciates its dangers and tactfully but firmly insists on the patient consulting a doctor. Thus the efficient treatment of many of the miscellaneous ailments is often dependent on the good judgment of the firstaider-a quality which is much more difficult to learn than the correct application of splints or bandages. Of the various miscellaneous ailments, those affecting the eye are of cardinal importance since they are very common and often dangerous; indeed, more blunders in treatment are made in connection with the eye than with any other organ in the body.

the pupil, can be altered in size by muscular action in order to control the amount of light entering the organ. T he iris varies in colour in individual eyes, being usually brown or blue. The retina corresponds to the film of a camera. It is the nerve layer which conveys the sensation of light through the optic nerve to the brain. Within the eyeball are the lens, the aqueous humour and the vitreous humour. The lens is very similar to that of a camera and lies behind the iris. Its function is to focus images on to the retina and for this purpose its strength is adjustable. The aqueous humour is a watery fluid filling the space between the lens and cornea while the vitreous humour, which is like jelly, fills the space between the back of the lens and the retina.

FrG. I-The Eye and Lachrymal Apparatus.

Additional protection for the eye is supplied by the A11atomy.-The eye is a globe about one inch in diameter. conjunctiva and the tear apparatus . The conjunctiva is a It lies in the orbit, being held in position by muscles delicate covering which lines the inner surfaces of the which can turn it in any direction. It is protected from eyelids and the eyeball as far as the cornea. The tear injury partly by its situation and also by the eyelids. apparatus is made up of a gland secreting a liquid, the The eyeball has three coats called, from without inwards, tears which flow continuously over the front of the eye the sclerotic, the choroid and the retina. The sclerotic is and finally down fine channels into the nose. made of firm, white fibrous tissue which, however, at the front of the organ becomes transparent, forming the The Red Eye.- This is the term applied to any eye that cornea, the circular window which permits light to enter has become red or inflamed. It is a very common conthe organ. dition and may be due to a variety of causes. Whatever The ffilddle coat, or choroid, is pigmented and well the cause, however, the condition is usually, in the first supplied with bloodvessels. It corresponds to the black place, attributed to a foreign body; even more serious interior of a camera. At the front of the eye the choroid is that if no foreign body is found by the first-aider, the forms the iris which lies behind the cornea like a circular alternative diagnosis that is often made is that the concurtain with an opening at its centre. This opening, called dition is due to a " chill" or a " cold" in the eye.

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The latter is a wicked diagnosis and is responsible for many cases of loss of sight . . Every doctor wi~l agree t~at patients someti~es act peculiarly whe~ there IS so~ething wrong with theu eyes. If they susta1n even a mlnor cut of the skin they usually apply to a doctor, nurse or firstaider for treatment, but when it is a question of their eyes, thev will often be contented with the advice of any Tom, Dick or Harry with the most disastrous consequences.

FIG. ;.-Everting the Upper Lid (First Stage.)

PIG. 2.-Vertical Section of the Eye. Note.-The eyelids are shown closed in this diagram.

The symptoms and signs o~ a red eye inclu~e a fee10g of discomfort or grittiness as If there IS a foreIgn body ill the organ. The eye looks red and inflamed to a varying degree. In addition it waters profusely and there may be acute pain. The causes of a red eye are as follows : (r) Foreign bodies. (2) Scratches (abrasions) of the cornea. (3) Burns. . ... (4) Disease of the eye such as conJunCtIvItIS, corneal .. ulcers, iritis and glaucoma. Only one of these conditions, apart from the lffiilledia~e treatment of burns, falls within the scope of first aId treatment, namely, foreign bodies.; it cru:no~ be too strongly emphasized that i~ n? for~lgn body IS discovered by examination, the case IS InvarIably one ~or a doctor. Moreover unless there is an immediate lillprovement following'the successful removal of a fot{~ign body, t~~e must be no delay in seeking medical adVIce because It IS not at all uncommon for a foreign body to cause a corneal abrasion or ulcer. Foreign Bodies.-It is appalling that there. are so ~ew nrstaiders who can examine an eye satisfactonly to discover a foreign body. The method will be described in stages as follows : . (r) POSITIO .-Make the patient sit down on ~ low c~alr and incline his head backwards so that he IS lookin.g upwards. Stand behind him allo~ing him to suppo~t h!s head either on the back of the chalr, or on the first-~lder.s chest. Make certain that the maximum amount of light IS directed on the eye. . (2) LOOK UNDER THE LOWER Lm.-Tell the patIent to look upwards; then, using the forefinger, ~raw the lower lid downwards towards the cheek so that Its under surface is well exposed. . . (3) LOOK UNDER THE UPP~R Lm.-This is a very COr:1mon hiding place for a foreIgn body. T~e uI?per eyelid must be turned inside out (everted) which .IS a much simpler process than it sounds. Instruct the. patIent to ga~e downwards with both eyes and reassure him that he Will not feel pain. Place the forefinger of the left hand on the

middle of the upper lid and press it downwar~s and inwards on to the eyeball. Grasp the eyelashes WIth ~e forefinger and thumb of the right hand and draw the h~ slightly downwards towards the cheek: then turn It upwards over the forefinger of the left hand, which is being used like a lever; remove tms forefinger gently when the lid is everted. The alternative method of evertlna the eyelid consists of placing a match across the lid abouthalf an inch above its edge, and using this as a lever instead of .the forefing~r. (4) RE1IOVE FOREIGN BODY.-All that is n.ecessary IS to touch the foreign body with a dampened WiSp of cott;on wool or the twirled-up corner of a pocket hand.kerchief, to which it will adhere. Mter removal of the foreIgn body a few drops of castor oil should be inst~e? into the eye. There is nothing difficult about eXarn1D1ng an eye f<?r a foreign body. The trouble is that ~e a~erage first-alder will not practise the procedure on his fnends as he does fractures and hiemorrhage. How then can he expect to deal with a real case efficiently?

FIG. 4.-Upper Lid Everted for Examination.

Foreign Boc(y 011 the Corma.-If careful. examination under the lids fails to reveal a foreign body It may be adherent to the cornea; here it may be s~en .as a small speck, difficult to see unless the illuminatIo.n I~ good. The sole first aid treatment is to mstii a few drops of olive or castor oil and cover the eye with a pad and. bandage. Onl a doctor should attempt to rem<?v~ the foreIgn body. Blows Otl the Eye and Perforat~1Jg Ityunes.-Blows caused b tennis balls and the like, receIved on ~e eye, even when li~s are closed, may be followed by senou~ consequenc~s such as hiemorrhage or rupture of the retlna. Often t e

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patient does not complain of symptoms once the initial pain has passed off; later he may discover that his sight has deteriorated. It is always advisable therefore for a patient who has had such an accident to consult a doctor. Still more serious is when the delicate structures within the eyeball are damaged. Sometimes, for example, the iris may be torn, showing itself by abnormal dilatation of the pupil. Irregularity of the pupil may be seen after a perforating injury of the eye, caused by contact with a pointed object such as a spike. In this event, a wound of the cornea or

AID sclerotic is usually visible. Such an accident is always serious. The patient must be made to lie flat with his head kept as still as possible by placing sandbags at the sides. His eyes should be covered with a pad and bandage lightly applied-if too tightly some of the vitreous may escape from the eye. If moved before the arrival of medical aid, he must be transported by stretcher. (Fig. I is reproduced from Belilios' .. Outline of the Human Body" by courtesy of George Routledge & Sons. Figs. 2, 3, & 4 are reproduced from Belilios, Mulvany & Armstrongs' "Handbook of First Aid & Bandaging" by courtesy of Bail/;ere, Tindall & Cox.)

The Medicine Chest By FRANK BERRY, PR.,e. Asafoetida This is an oleo-resinous substance obtained from the living roots of the Asafoetida plant which grows in Persia and Mghanistan. The resin is characterised by its powerful onion-like odour and extremely bitter, acrid taste. It is used as a carminative and as a sedative, often in conjunction with Valerian, in treatment of hysteria and spasmodic nervous diseases. Owing to its disagreeable odour and taste it is generally prescribed in pill form.

Ascorbic Acid This will be described under" Vitamin c." Aspirin This substance is known to chemists as Acetylsalicylic Acid because it is manufactured by combining Salicylic Acid with Acetyl compounds related to Acetic Acid. It is prepared in the form of colourless needleshaped crystals or as a white crystalline powder. Pure samples have very little odour, but Aspirin that has been stored for some time under unsuitable conditions gradually develops a distinct smell of Acetic Acid. Aspirin and all non-liquid preparations of Aspirin should be stored in well-closed containers in a dry place. Aspirin is one of the most extensively used medicines and is administered in the treatment of a wide range of complaints, including headache, rheumatic conditions, neuralgia, pleurisy, the common cold, and influenza. It has valuable analgesic properties and is an ingredient in nearly all proprietary " pain relieving" products. Aspirin is only slightly soluble in water and when prescribed in liquid mixture form it is necessary to include in the formula some substance which will keep the aspirin suspended evenly in the liquid vehicle in order to ensure that each dose of the mixture contains the correct dose of the medicament. Acacia and Tragacanth Gums are often used for this purpose and the following is a typical formula : Aspirin MixtureEach tablespoonful dose contains: Aspirin 7t grains Compound Powder of Tragacanth,.. 5 grains Chloroform Water ... to i fluid ounct: In the following formula, the aspirin is rendered soluble by the inclusion of Potassium Citrate and the addition of gum is therefore unnecessary : -

Compound Aspirin MixtureEach tablespoonful dose contains : Aspirin Potassium Citrate Syrup of Lemon Chloroform Water

7t grains IS grains 10 minims

to {- fluid ounce

Aspirin powder is often applied locally in treatment of tonsillitis m: after removal of the tonsils. An aspirin gargle, prepared by dispersing 10 grains of the powder, or two S grain tablets, in a small glass of water is sometimes used for similar purposes. Aspirin is most frequently used in tablet form . The standard aspirin tablet contains 5 grains of aspirin, but it should be realised that the compressed tablet actually weighs about st grains, the difference being due to the presence of inert bases which are necessarily added in order to make manufacture possible. Aspirin tablets, placed in water, do not actually dissolve, but if of good quality they rapidly break up or disintegrate, and the aspirin contained in them is thereby released in a form which is readily assimilated when subsequently swallowed. Tablets of aspirin are often issued coloured red or yell o w, but these offer no advantages over the uncoloured tablets, any alleged extra beneficial effect being psychological rather than physiological. Aspirin may exert a slight irritant action on the stomach and is therefore best administered stirred up in a little water, preferably after food. Some people are remarkably susceptible to aspirin and even small doses give rise to unpleasant symptoms such as gastric pain, sickness, and skin rashes. Persons who suffer from asthma often experience severe reactions after taking aspirin and in such cases the drug should only be taken under medical guidance. Taken in excess, aspirin acts as an irritant poison and increasing numbers of would-be suicides have resorted to its use in recent years. 200 grains (forty 5 grain tablets) have caused death in an elderly person, but many people have recove.red even after taking 400 or 600 grains (eighty to one hundred and twenty 5 grain tablets). The symptoms which develop when large doses are taken include marked swelling of face, lips and tongue, giddiness, gastric pains, vomiting, profuse perspiration and finally, collapse. Treatment, on general lines for irritant poisons, should include administration of an emetic followed by copious draughts of water or milk, preferably containing a little Bicarbonate of Soda, and care should be taken to keep the patient warm. Aspirin is often issued in the form of compound tablets, the formul a: of which include other drugs which enhance or modify the medicinal action of the aspirin. A few typical formula: are noted below :Tablets of Aspirin and P henacetinEach tablet contains : Aspirin ... 3! grains Phenacetin 2l grains Tablets to this formula are widely used for the relief of headache and rheumatic and neuralgic pains.

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Compound Aspirin T abletsThere are several formula modifications for this valuable and frequently Each tablet contains: prescribed product and many proprietary pain-relieving tablets are of Aspirin .. . 3 ~ grains this type. The well-known analgesic properties of aspirin and phenacetin Phenacetin 2} grains are greatly augmented by the inclusion in the formula of a small Caffeine ... t grain quantity of codeine phosphate, an alkaloidal salt related to morphine This is the popular A.P.C. tablet in which the analgesic properties of but without the drug addiction dangers normally associated with both aspirin and phenacetin are combined with the stimulant properties morphine itself. One or two tablets may be taken for a dose. These of Caffeine. One or two may be taken for a dose. tablets are extensively used for relief of pain of all kinds especially Compound Tablets of .Aspirin and Dover's P01JJder. that associated with dysmenorrhoea (painful menstruation). Each tablet contains : Those people who develop unpleasant symptoms after taking Aspirin .. . 3 grains aspirin may find that they can take the substance known as Soluble Phenacetin I i- grains Aspirin without any ill effects. Dover's Powder I grain Soluble Aspirin is the calcium salt of aspirin (calcium acetylsalicylate) In this product, the action of the aspirin and phenacetin is greatly and forms a useful alternative to aspirin. Being soluble in water it is enhanced by the incorporation of Dover's Powder which has valuable more readily absorbed into the system and generally causes less gastric analgesic and diaphoretic (inducing perspiration) properties. The irritation. The powdered substance and tablets prepared from it easily tablets are very effective if taken in the early stages of a cold or influenza. decompose in presence of moisture and should therefore be stored in well-closed containers and used while reasonably fresh. . Dose I to 4 tablets. Compound Tablets of Aspirin and CodeineSoluble Aspirin is used for relief of pain and treatment of influenza, Each tablet contains : rheumatism and neuralgia. Dose 5 to IS grains. In addition to oral 4- grains Aspirin ... administration, Soluble Aspirin is sometimes given by intravenous 4 grains injection in treatment of many types of rheumatic affections. Phenacetin .~ grain (to be continued.) Codeine Phosphate

ANATOMY AND PHYSIOLOGY IN FIBST AlB by J. WELLS, M.R.C.S., L.R.C.P. The extensor tendon of the powerful extensor muscles HAVING studied the structure and composition of the of the front of the thigh, which passes over the bones, we may now proceed with the first aid patella and is inserted into the tubercle of the tibia ; treatment of bones when fractured or dislocated. on the sudden contraction of these muscles the If a piece of dry wood, about a foot long and a quarter patella is sometimes fractured. of an inch wide and a quarter of an inch thick be held at both ends and bent, it will be found to break or fracture. -+- A fourth cause of fracture is due to a disease of the 'J.he dry wood represents a fully grown and matured bone. bone, in which there is a deficiency of phosphate of The broken edges of the wood will be ragged, and it is lime. This leaves the bone very fragile and a slight these surfaces which can damage the surrounding tjssues, slip or tap on the bone will then cause it to become organs, nerves, blood vessels and muscles, and the confractured. This disease of bone is called Osteo tractions of the muscles can also cause shortening of the Malachia, and the fracture is called a spontaneous limb, as compared with its fellow. fracture. Now take a growing branch from a tree and bend this in the same way. It will be noticed that the green branch Varieties of Fracture 1. Simple.-Bone is fractured, no important injury to bends more and does not break clean at the site of fracture, surrounding tissues or organs. but cracks and splinters, This simulates a Green Stick Fracture. In this fracture the bone has not grown to 2. Compound.-Bone is fractured, skin and tissues are punctured or torn, allowing germs to infect the bone maturity, that is, the hard compact tissue of the bone is at the seat of fracture. The fractured ends may not fully developed. protrude through the skin or the wound may lead A Fractured Bone is a broken bone and may be caused down to the fracture, e.g., when a bone is fractured by:by a bullet. 1. Direct Violence.- The bone breaking at the spot 3, Complicated.-The bone is fractured and t..h.ere is an where the force is applied, added injury to some important organ, blood vessel, 2. Indirect Violence.- The bone breaking at some nerve or muscle. These added injuries cause the distance away from where the force is applied, e.g., complication. A fracture may become comp~~ated falling and dropping on the outstretched hand. The or compound as the immediate result of the illJury, palm of the hand receives the force, but it is the or a fracture which is at first simple, may be conlower end of the radius and ulna, or either of them verted into a compound or complicated fracture singly, which is fractured. Dropping on the feet from . by :-a height and fracturing the femur or base of the skull (a) Excessive or careless movement by the patient. , are other examples. (b) By carelessness or ignorance on the part of 3. Muscular Actio/t,--e.g" the sudden and violent conanyone rendering first aid. traction of the biceps muscle can fracture the humerus.

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4. Comminuted.-The bone is fractured in more than one place, it therefore requires special care in handling and rendering first aid. 5. Green Stick.-In children and young adults, owing to the softer state of the bony tissues, the bone may bend and crack, without completely breaking. 6. Impacted.- The broken ends of the bones are driven into each other, e.g., the shaft of the radius may be driven into its enlarged lower end and so become impacted. 7. A Depressed Fracture of the Skull.-The bone is driven into the skull cavity and may injure the brain and its meninges, that is the covering membranes of the brain. General Signs and Symptoms of Fractures I. Pain, at the seat of the fracture. 2. Swelling Around the Seat of the Fracture.-Owing to swelling it is often difficult to make out the signs of fracture, therefore, care must be taken not to mistake a fractured bone for a less serious injury. In all cases of doubt treat the injury as a fracture. 3· Loss of Power in the limb. 4· Deformity of the Limb.-The limb may be in an unnatural position and mis-shapen at the seat of the fracture. The contracting muscles, owing to their irritation and stimulation by the jagged ends of the fractured bone, may cause the broken ends of the bone to override each other, causing shortening of the limb. 5· Irregularity of the Broken Bone.-If the fractured bone is near the skin surface, the fracture may be felt. 6. Unnatural Mobility.-Movement may be noticed at the seat of the fracture, where normally no movement is present. 7· Crepitus.-Grating of the broken and jagged ends of the fractured bone may be felt or heard when the broken ends move on each other. N.B. Unnatural Mobility and Crepitus should be sought only by a doctor. In green stick and impacted fractures these two symptoms are absent. Whenever possible always compare the injured with the sound limb. The student will be more likely to remember these signs and symptoms if he works them out himself. Imagine a blow on the upper arm with a thick, hard stick, with sufficient force to fracture the shaft of the humerus. Ask yourself the following questions I. Would it be painful? Yes. 2. Would there be bruising and swelling? Yes. 3· Would there be loss of power in the limb, this is inability to use it ? Yes. 4· Would there be deformity of the limb, when comparing it with the sound side ? Yes. 5· Would there be irregularity of the broken bone, as compared with the sound side ? Yes. 6. Would there be unnatural mobility, where otherwise there should be no movement ? Yes. 7· Would there be crepitus felt and heard at the site of the fracture? Yes. First Aid Treatment of Fractures The object of first aid treatment of fractures is to guard against any further injury to the fractured bone, organs, muscles, bloo?ve~sels, nerves and surrounding tissues. ~areful first :iud treatment of a fracture often prevent~ a SImple fracture becoming compound.

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AID General Rules for the First Aid Treatment of Fractured Bones r. Attend to fracture on the spot where it happened,

unless life is endangered from some other cause. Do not attempt to move patient until the fracture has been rendered immovable by splints or other methods. 2. If the fracture is complicated by ha:morrhage, the ha:morrhage must be treated first and the wound covered by a clean antiseptic or sterilized dressing. The fracture can then be dealt with. 3· Steady and support the injured limb, so that no furthe r movement can take place, either by patient or bystanders. 4. Without using force place the fractured limb in as natural a position as possible. If shortening is present in a fractured bone of the lower limb place one hand behind the heel and the other on the instep and pull evenly upon the foot, until the limb becomes of more normal length, as compared with the limb on the sound side. Once the limb is in position do not let go your hold until it is secured in position by splints or other means, as then there would be great danger of the fractured bone becoming compound or complicated. N.B.-Never attempt extension in the case of compound fracture, when the bone protrudes through the skin. In these cases apply antiseptic or sterilized dressing to the wound and protruding bone, before dealing with the fracture. 5. Apply splints, bandages and slings where necessary. (a) Splints should be padded to fit the limb and applied over the clothing. The splints used should be rigid, wide enough to support the limb and long enough to fix and keep the joints immediately above and below the fractured bone at rest. If ordinary splints cannot be obtained, improvised splints can then be used, for example, a walking stick, umbrella, broom or brush handle, billiards cue, policeman's truncheon, riRe, cardboard and paper firmly folded, a rolled up map or anything that is rigid, long and wide enough to keep the joints immediately above and below the fractured bone at rest, after bandaging. In practice, corrugated paper, cut to tbe length required and folded several times to the width required and tied around the ends has been found to make admirable improvised splints. If splints of any kind are unobtainable, an upper limb, if fractured, can be tied to the trunk, and in all cases, a fractured lower limb should be bandaged to its fellow, in order to be certain of keeping the limb in position and in order to prevent movement. (b) The bandages should be applied firmly to prevent them slipping, but not so tightly as to constrict the circulation in the limb, thereby causing congestion and discoloration in the lower end of the limb. P ieau turn to page 14

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News From All Quarters E./icient-Jen)ice AIl ardJ.-I2 years each- ambulance service run more smoothly. First Ptes. Bealby and Bond; Service Medal aid duties had been carried out at various of the Order of St. John (for IS years' functions and first aid was rendered in 44 efficient service)-Cadet Officer cases apart from minor jobs. Assistance in Kitchener and Pte. Holden; First Bar first aid training had been given to the to the Medal (for 20 years)--Corps Newbury Boy Scouts. In addition to the Officer Green; Second Bar (for 25 above the Division had now taken over the Prince of Wales's District organisation of the Blood Transfusion Service years)-Div. Supt. Lifford .. The " Wright" Shield.-For high~st marks for the fuea and had formed a Committee for HORSEFERRY DIVISION in individual Home Nurslng-Cpl. this work, of which Pte. B. Harrison had been The Annual Dinner of the Division was appointed Hon. Secretary. Treadwell. held on Saturday, February 7th, when me~ The "ParJonJ" EJjicimcy Cup.-For most bers their wives and friends, sat down With efficient member for the year-Cpl. KINTBURY DIVISION the Commissioner, Major A. e. White-Knox, Treadwell (this for the third year in O.B.E., M.e., and Dist. Off. H. Dunford. On January 31st members of Kintbury succession). The presentation of trophies followed. Nursing and Nursing Cadet Divisions arranged The "Brooks" Cup.-For advanced indiThe Efficiency Cup was won by Pte. O. an old people's party which was held at the vidual Erst aid in the Ealing district of Coronation Hall, Kintbury. The High Street Eldridge, and the Competition Cup . by LondonPte . Bond. Methodist Chapel Fund contributed to the Cpl. R. P. Byatt, the runner-up being Pte. W. Hawkins. An Officer's Cane was then MALDEN & COOi'vIBE DIVISION cost and the cause was well supported by residents. About ninety guests were given presented to Amb. Off. T. Cranham by On Saturday, February 14th, the Mayoress tea in the decorated hall and each one was members of the Division for his untiring work for the Division and a Certificate was of Malden lYIts. Ed. W. Jones and the Deputy provided with a button-hole. Tea was presented to Mr.' Evans on his becoming Mayor and Mayoress (Councillor and Mrs. E. followed by a variety entertainment which Vice-President. Mr. Evans then presented Gordon) attended a party given to about f~rty included community singing, groups of songs Supt. F. James with a silver cup to be com- disabled ex-service men and women, orgarused by Commander Ewart and others, selections by the Malden ~ Coombe Nursing and Cadet by the band-bell ringers, items on the tabular peted for by members of !he Divis~on. . bells and ending with old-time songs by the Entertainment was prOVided by little MISS Divisions. Kintbury Mixed Choir. D. Harrison and her brother Rex, to the RICK.lYlANSWORTH DIVISION satisfaction and amusement of the company. All Divisions combined at Ebury Hall, Dancing followed until I I p.m. when Auld Rickmansworth, on Wednesday, January MAIDENHEAD DIVISION Lang Syne and God Save The King brought 28th in what the Organising Committee called At the Annual General Meeting of Maidenproceedings to an end, save for a vote of "a 'spot of first aid f~r our .own funds." thanks moved by Dist. Off. Dunford tc? Supt. They held a social everung which, although head Ambulance Division which was held James and his Committee for an enjoyable their first venture, was a great success and recently, Mr. A. E. Breakspear, Vice-Pr~sid.ent, told members that voluntary orgarusatlons evening. may well prove the forerunner C?f many mor~. would still be needed when the Health Services Andre Simone's Band supplted the musIc of the country were nationalise~ in July. HARLESDEN DIVISION for dancing and games, and Sgt. C: Lillington On Saturday, February 28th, th~ Mayor of was M.e. Among the entertalners were Referring to the Transport ServIce he sald Willesden Alderman W. A. Stilton, J.P., six-year-old Sheila Brown, Brian. ~drew:s and that Maidenhead would probably be one of and the 'Mayoress, Mrs. Stilton, pr~s~n~ed Nursing Cadet Halsey. A conJurm~ display the Eve main centres controlled by the Berkshire County Council. . various awards to members of the DivisJon by Mr. Eddie Long was greatly ~nJoyed. Corps Supt. J. Stevens said that the Drills on the occasion of their Annual Social, held Among those present were ASSIstant Comhad been well attended during the year and a at the Social Centre, Bridge Road, London, missioner Mr. Hart and Mrs. Hart, Area Cadet first aid course had been started for members N.W.IO. Officer Mr. Andrews, Area Cadet 0!Ecer Assistant Commissioner Dr. G. R. H. Mrs. Dove and 11r. Dove, Vice-President of the Police Force in Maidenhead. Hon. Sgt. H. Tomlin reported that the stre?gtb of Wrangham, accompanied by Mrs .. Wrangham, Major Fryor, Vice-President 11rs. Wel~h and the Division was now 26 and durmg the first presented to the Mayor his Ba~g~. of Mr. Welch, and Vice-President Mrs. Lmda.rs. Office as Honorary President of the D1VISlOn The evening was arranged by the Jomt year 1947 2 168 cases had been treated. Cpl. during his term of office. In reply, the Mayor Committee of which D. W. Supt. Mrs. S. Lovegro~e said that the. ambulance. had travelled 9,089 miles and carn~ 3II patients. stated that he was proud to accept thi~ honour, Sylvester is Chairman. Captain F. e. Armitage, Chalrr.nan of the particularly as he himself had obtalled two Hospital Board, was elected PreSIdent of the first aid certiEcates many years ago and. hence County of Berkshire Division. had a very strong bond of.sympathy With the HUNGERFORD DIVISION Brigade, whose n;embers <:li? such noble ~ork The Annual General Meeting of the in helping the Sick and IDJured but entirely Hungerford Ambulance Division was held READING DIVISION without any financial reward. h H H liord On February 4th the Reading So~th Nursin$ ouse, unge : In th e additional presence of County recently at the Churc ffi d under the chairmanship of Div. Surgeon Division held a party in celebration of thel! Surgeon Dr. F. StansEeld, Corps 0 cer an M. M. Wallis. In giving his report the fourth birthday which was attended by about Mrs. S. ]. Green, Divisional Surgeon J?r. Dl'VI'sl'onal Secretary (Hon. S.gt... W. J. Wells) ninety members and friends. The progra~e H. M. Setna and Mrs. Setna, the follOWing said the strength of the DlvlSlC?n was now included a dancing display given by the pupils awards were presented : b h ld d the year of Miss Stephanie Stevens. County Officer ·rsl Aid.-Labels, I947-Sgt. Parsons, 25 52 drills had een e urlng Fl P and all members passed the Annual Re- Miss D. K. Gibbins presented the Annual Cpls. Treadwell and Clover, tes. examination. The ambulance ha~ travelled Awards which included the ~ge Cup Bealby and Hoare; Labels, 1943/45/ 5 23 2 miles and carried 17 2 patients, both won by Sgt. Miss W. Taylor m a recent 6 46 /47-Pte . Samuel; Medal~ion, 194 . th'ese Egures being an increase of 50 per cent. competition. Div. Supt. Mrs. W. G. Thomas and Label, I947- Ptes . WJlcox and k d presented a bouquet to Miss Stevens and compared with 1946. Than s wer~ e~presse Kempson. to all members who had given theIr time and Cadet Supt. F. G. Carter, who acted as M.e., HOllie Nllrsing.-Pendants, I947-~pls. th' ss and also proposed a vote of thanks on behalf of the 0 Treadwell and Clover; Ptes. WIlcox energy to make e service a succe. visitors. . th to Me~srs. W. H. Barr and J..Tngg w:h At the Annual General. Meet:n~. of e W:,:d K}~~i~~n. CerIiJitalu.-Div. Supt. between them had turned out 44 times during Reading Post Office NurSing l?IVISlOn. the sons , thcDry.eWar·allis, at his first meeting as Divisional chair was taken by Mr. e. R. Fnght, M.B.E., Liffora, Staff Sgt. Gibbons, Sgt. Pa: Ptes. Perrett and Brewer. (The cer~cate d f d Hon. President. Reviewing the year's work, for Cpl. Treadwell had not then :l.ttlved.) Surgeon, stated that he ha not oun :l.t1

THE ST. JOHN AMBULANCE BRIGADE.

F IR ST

AID

Div .. Supt.. Miss G. E. Coombs said that 308 formed under his direction, were" Jumping Eastern Region public duties had .been attended during 1947, to Conclusions" and, "The Stowaways." The District Officers' Sheild was competed 44 cases of first aid had been dealt with, and The everung of v~t1ety was greatly enjoyed f?r at Colchester on Saturday, January 28th one adult and two preliminary first aid classes by all present, espec1ally the surprise element eIght teams competing. Clacton secured th~ had . been held. During the meeting, the of local talent shown in the Divisions. trophy for the first time by the narrow margin PresIdent handed an Honorary Member's o~ one. mark. Colchester were runners-up County of Somerset Badge to Mr. C. R. Watkins who had been WIth Wlvenhoe third. ' Hon. Divisional Auditor for several years. BATH CITY DIVISION The M. & G. N. Final was held in the The Harrex Vase, for efficiency was awarded A report of Divisional activities during the to.Amb. Sister :tvI.rs ..B. Green. County Officer two n::onths ended February, 1948, lists the Assembly Rooms of the Town Hall, King's Ly:nn, on, February 5th, the trophies and MISS D. K. Glbbms presented a Service followmg events : Chevron to Amb. Sister Mrs. G. Edwards 231'd January.- Old-Time Dance in aid of pnzes bemg presented by the Worshipful :wd County Cadet Officer Mrs. ]. F. S. Divisional funds held at the Pump May~r ,of ,Lynn. , The result was as under, Montagu-Puckle handed Preliminary First Room, Bath. Attended by over 300 and It IS Interestmg to note a ladies' team Aid Certificates to members of the Cadet including the Mayor and Mayoress of competed for the first time in the history of the Competition. Judge: Dr. E. J. Selby Class. At the close of the meeting, the ChairBath. O.B.E" M.A. ' man congratulated the Division on its 2nd February.-Commencement of First Aid (Maximum 340) efficiency. Course for personnel and members of 1. Melton Constable Traffic '.. 236i the public. County of Dorset 216 Sih Febrttary.-Commencement of Child 2. Eye Green... WEYMOUTH DIVISION 3· Sheringham 208t Welfare Course for personnel and In an effort to increase enthusiasm in first 4· South Lynn ... ... 191 members of the public. ai.d am<;>ng local ?~'ganisations, an "Open" 5· Melton Constable (Ladies) ... 180 loth February,-" Casualty Make-Up"Fust Aid CompetltlOn was organised by the The Melton Constable (Traffic) team will lecture and demonstration given by Weymouth Ambulance Division. The CO";lnty Cadet Officer Mrs. G. E. Moss therefore compete in the Inter-Railway " Glover" Shield was put up by the Division (Ungrouped) Competition to be held in (WiltS), to members of all Divisions. as a tr~phy for the winning team, this having London on March 31st, 1948. 12th February.-Old-Time Dance at the been glven to the Weymouth Division some Weston Hotel, Bath, organised in aid years ago by Mr. Glover, Sent., in recognition of Divisional funds by County Welfare BIRMINGHAM CITY POLICE of services rendered by Mr. R. Preston a Officer Mrs. Selwyn. member of the Division. ' ~~e Thirty-first Annual Ambulance ComThe Team !e,st, set and judged by the petJ.tJ.o~ for the" Rowland Mason" Challen e County of Worcester County CommlsslOner, Dr. R. V. S. Cooper DUDLEY DIVISION ~up WIll be held at the Central Hall, Corpor~ con~isted of a night scene at Westham Halt A ve~y interesting function was held tlOn, Street, Birmingham, on Wednesday StatlOn, two passengers having fallen from Apnl 28th, 1948, at 2.30 p.m., when team~ the platform. ,,:,hilst awaiting the train. The recently lr: the Queen Mary Ballroom, Dudley from the A, B, C, D and E Divisions will Dual and Indiv1dual Tests were set and judged ~?o. This was the first dinner to be held compete. by Div. Surg. Dr. Charlotte Ward and Div. Jo~~ly by the pudley AmbulallCe and Nursing . Members ,of t~e public interested in first Dlv1s10ns. D1v. Supt. D. H. Burns presided Surg. Dr. F. M. Hanna. aId are cordIally mvited to attend. sUl?ported by Mrs. Burns, Div. Supt. Miss County of Leicester W1tcombe, Asst. Commissioner T. C. Lench, SILEBY DIVISION Corps Supt. J. .H. Watkins, A/Area Cadet ROOTES GROUP The 2,Is,t .Anniversary of the Sileby Ambu- Officer H. R. Hines and Mrs. Hines Corps At Stoke Aldermoor near Coventry recently lt1?ce DIvision was held in the Unity Hall, Officer W. Ollis, Div. Surgeon N. M. 'Barron Slleby, on February I~th, the President, Dr. and. Mrs. G. W. Aston, Mrs. Walters' Lady Rootes opened the new headquarters of Rev. C. C. Harcourt, m the Chair. Also Mr. S1lllth, Div. Supt. (R.) Miss Ollis' the Rootes Group detachments of the St present were County Commissioner G. F. A/Ambulance Officer J. F. Bent, Sgt. A. E: John Ambulance Brigade and the British Browne, County Secretary Miss Ward Lees . and !ll~I?bers of the Ambulance and Re? C~oss Society. This was the culminating Divisional Surgeon Dr. J. S. Gray and Mrs: Nursmg D1v1slOns. pOl~t In. a ~ovement which began with the Gray, Supt ]. W. Marston, Ambulance reg1stratl?r: !n 1942 of the Stoke and AlderWest Riding of Yorkshire Offi,ce! W. E. Harriman, Div. Supt. Mrs. m<?or Dlv1slOn of the St. John Ambulance Whlttmgton, Ambulance Officer Miss Barber CASTLEFORD DIVISION Bngade and Sir William Rootes' suggestion Cadet Supts. Yates and Miss Betts. ' ,S~v:en me!llbers of Castleford Ambulance for mutual convenience and welfare, that th~ In a brief speech, Supt. Marston welcomed DlvlslOn, WIth a total of I30 years' service re~e~tly formed local detachment of the the men back who had seen" active service" betw.een them, have been awarded Long BritIsh , ~~d Cross Society might also enjoy and e~p~e,ssed the hope that they would rejoin SerVice Awards. They are: Div. Supt. H. the faclhtles provided. the DIVISion and help to continue the work Sch~field, First Bar; Amb. Officer H The building, once used as a social centre they had been doing for the past 2 I years. Addmell and Cpl. ]. A. Aston Second Bars : and subsequently for industrial purposes of Pte. C. Hetterley, in replying, expressed the Sgts. E. Farmer (Div. Secretary), H. Cox' the Group, has been completely renovated pleasure of the men at being present and Cpls: J. W. Wyatt and F. Townend, 15 year~ and. now contains considerable first aid thanks the. o~cers and members for the Serv1ce Medals. Corps Supt. A. Addinell eqUlpmer: t . It .will also be a source of supply contact mamtamed with them whilst away presented the Bars and Certificates with for me~lcal aId and comfort, not only for from home. nbbon to the recipients. m~~bets, but for any approved applicant A report on the work of the Division for WIthin the Coventry area. BRITISH RAILWAYS the year and ~etails of the many activities ~ady Rootes, in performing the opening Southern Region undertaken durmg the war was given by the ceremony, extended warmest wishes for the he -:r: Armual First Aid Competition of the succes~ of both sections and for their coAsst. Secretary, Pte. Allen. Though their strength .had been considerably depleted they Basmgstoke Class was h~ld recently at the operatIve. effort. Sir William Rootes took the ~d. earned on and trained personnel for the Great Western Hotel, Basmgstoke, when Mr opporturutY,also of paying tribute to members CIVIl Defence ?ervices, Home Guard, N.F.S., Mustard (Surgeon) and Dr. MacLean adjudi~ of both contmgents for the ilnmensely valuable cated the practical and oral tests. e,tc. A first ald post had been manned conwork performed within the factories during tmuously throughout the war and they had £ A very keen c:ompetition resulted in a win the war ye.ars. He felt this new expression of or Mr. C. Robmson-" Francis" C M also take~ their share in all the dfforts organised W 0 up, r. te~m splnt, of mutual endeavour, should runner-up won the" White" C by the Jomt War Organisation of the B R C S In . th wen, prove advanta&eous to all concerned. B ' , S ' up. and St. John. . ... e egmners ectlOn Mr. A. Hockin ~clmowled~IDg. t~e keen personal interest secured first place, and a special prize wa~ WhICh ~oth SIr Wllbam and Sir Reginald had ROTHLEY TEMPLE A. & N. CADETS ~warded to Mr. A. Stacey for the most A Parents' Evening was held at the Village Improved c<;>mpetitor. Mr. R. West, Station at all tunes taken in the welfare of the St :flaIl on Feb~ary 16th, when the programme M~ster, Basmgstoke, presented trophies and John Ambulance Brigade and the British u:cluded varIOUS demonstrations of work pnzes at a special meeting, during which the Red. Cross, Lady Shuckburgh (County VicepublicI pIanoforte, violin and vocal solos by Nursing doctors gave. a resume on the tests and Presldent, British Red Cross) announced ,Sir Wjlliam's appo~tment a~ C~dets, and two sketches written by A C exprlelssed thelt. pleasure in witnessing such Richard Mar'tm. These, which were .per-. H?~o.rary VIce-PreSIdent of the Warwickshir exce ent first ald. D1viSl0n. e

F IR ST

AID

INFLAMMATORY CONDITIONS OFTHE NOSE AND THROAT BY

AGNES E. PAVEY, S.R.N. Diploma l1l Nursing (University of London)

HIEF among ~he inflammatory conditions of the nose ordere~, or permangan~te of potassium, one to two crystals . and thro~t, IS the common cold. It is an highly to a ,Pmt. As a seda~lve gargle for a painful throat few ~nfectto~s conditlOn ,and because it does not completely solutions equal 10 graIns of aspirin in half a pint of water. illcapaclt~te the pattent he frequently mixes with his SPRAYS A D PAl TS. Many substances are comfellows ill such a manner that the condition is spread to monly ordered for spraying or painting the throat. They many of his associates, and it accounts for a high percentage are m~re e~cacio"?s forms of treatment than gargles when of absenteeism both from schools and from works. an an~ISeptIC~ astrmgent or anodyne result is desired. No Unfortunately, i~olation of the sufferer is seldom possible, effort IS requued on the part of the patient and the inflamed so that the. nurs~g treatment must aim at preventing the part is covered with a film of the concentrated substance spread of InfectlOn as ·well as giving comfort and relief which gives it protectio.n whilst the medicament acts upo~ to ~he patient. The ailment is usually of short duration, the membrane; the time of contact being much more lastillg only a few days, and it is characterized by nasal prolonged than when a gargle is used. catarrh and sore throat. At first the throat and nose feel !~e solutio,ns ordered may be thymol, iodine or tannic hot and dr y, and this is the stage at which treatment aCId m glycerm for an inflamed throat or tonsillitis whilst should commence. Then follows a profuse and infectious if ulcers a~e presen~ silver nitrate or copper sulphate, 10 watery discharge from the nasal mucous membrane. per cent. ill glycerill, may be used. In tuberculosis or Sneez~g and coug~ing are prominent symptoms and they ca?-cer of the throat and larynx an anresthetic spray, conr~sult In the expulslOn of a cloud of droplets in the expired talillng chloretone, cocaine or heroin, may be required aIr. These droplets contain germs and if breathed in by before the patIent can swallow food or drink, and in order other people can transmit the infection. To avoid the to give ~ relief at other times, or orthotorm powder spread of infection to other people the sufferer must may be inhaled through a special apparatus. cough or sneeze only into a handkerchief. Care should be TO SPRA Y OR PAl T A THROA T. A recttaken with these used handkerchiefs. They are so often put into capacious pockets or handbags with other articles angular spatula or tongue depressor is desirable, so that which they may infect. They should be soaked in a disin- the hand holding it will not obstruct the view of the fectant-such as Lysol or Dettol I in 20-for one h our throa~, but the handle of a dessertspoon provides a suitable before being washed, or dried preparatory to being sent substitute. The patient should sit up with the head held ~ack, the . nurse standing in front of him with a good to the laundry. light corrung over her shoulder so that it will shine on The danger of a cold to the patient is that there may be the patier:-t's throat when he 0rens his mouth. For spraying, an extension of infection to the bronchi or lungs, or the solution must be placed ill the container and it must through the Eustachian tube into the middle ear and be ascertained that the spray is working well. In holding mastoid cells. The risk of such infection, and also of danger down the tongue the spatula must not be placed too far to others, may be minimised by antiseptic applications in back or "gagging" will occur. The nurse must first the form of gargles, sprays, paints and inhalations. These inspect the throat, so that she knows exactly where to also relieve pain and discomfort and hasten recovery. direct the spray, which she then applies thoroughly to both sides of the fauces. If a paint is to be used, a camel-hair GARGLES. These cleanse and soothe the mouth and brush with a bent handle is the best applicator, but a throat. They are of value in preventing colds and influenza little cotton wool may be wound on to a spill, a cocktail as well as in treating the early stages of these conditions, stick or a straw. A small container will be needed into especially if they are used hot; but when the tonsils are which a little of the paint is poured. The brush must not inflamed and swollen the process is too painful for the be wet enough to drip. Having inspected the area, the fluid to be brought into contact with all parts of the nurse applies the paint quickly to both sides of the throat inflamed membranes, and the time of contact is too short taking care not to touch the back, or the patient may for the gargle to be really effective. cough or even vomit. For cleansing and stimulating purposes a teaspoonful of MOIST INHALATIO S. These may be given with salt to a pint of water is probably the most efficient gargle, a Maw's or Nelson's inhaler if only the throat is to be whilst sodium bicarbonate, in the same strength, will soften and help to remove mucus. Glycothymoline is treated, but if medication is needed to the nasal cavities antiseptic and soothing and so also are Dettol and Milton, also, an open jug must be used, with a folded towel arranged used in a strength of one to two teaspoonsful to the pint. around the top. In simple inflammatory. conditions the In cases of severe pyorrhoea or ulceration of the mouth relief obtained is probably dependent upon the warmth and moisture of the inhalation rather than upon any potassium chlorate, a teaspoonful to the pint, may be

FIRST

antiseptic contained in it. If the throat is septic, Friar's balsam, creosote or oil of pine can be added to the water, the quantity being half to one teaspoonful to the pint of water at a temperature of r600 to r80 °F. When an inhaler is used it is filled almost to the air inlet, the medicament being added to the water. In replacing the cork it is most important to see that the mouthpiece curves in the opposite direction to the air inlet so that if the inhaler is tipped forward the hot water will not run out on to the patient's chest. The inhaler is then put into a flannel bag, or wrapped in a piece of thick cloth, leaving the air inlet uncovered. The patient is instructed to breathe in through his mouth and out through his nose. The treatment should be continued for fifteen minutes.

AID and chin. IT both sides of the throat are to be irrigated the patient turns when half the solution 4as been used. He must be provided with a clean handkerchief with which to wipe his mouth each time the irrigation is stopped so that he can resume breathing. When the abscess bursts, or is incised by the doctor, it must be impressed upon the patient that he must not swallow any discharge or saliva. An antiseptic gargle and mouth wash should be used freely, and as hot as it can be borne, until the abscess has completely discharged its contents. NASAL TREATMENTS. Nasal sprays are frequently given by the patient himself but he may need instruction. An apparatus that gives a coarse spray is used, the tip of the nozzle being placed just llside the nostril and directed backward. Very little force must be exerted in squeezing the bulb. Benzidrine is commonly used. This dries up secretions. Ephedrine and adrenaline in oil may be used for hay fever and asthma, and menthol in liquid paraffin for cleansing and soothing effects. Sometimes solutions are "sniffed up" the nose from a shallow basin. The patient places his nose in the fluid, closes one nostril by compressing it with his finger and sniffs the fluid into the other. It passes through the back of the nose into the mouth and he then spits it out. He must be warned not to sniff too forcibly or the fluid may pass up into the frontal or ethmoidal sinuses, giving pain and headache.

FIRST

It:

EMERGENCY TREATMENT

OF SKIN INJURIES

194

rut~~ura ~ OINTMENT

STUDY WITH CLOUGH'S and SUCCEED

•

Our courses have been proved to be of First Class Value in assisting study forR.I.P.H.H. GENERAL AND SCHOOL HYGIENE AND MOTHERCRAFT AND CHILD WELFARE. University Diplomas it~ Nursing, e.g., LONDON UNIVERSITY NURSING DIPLOMA. 16th Nov., '47. •• I was successful and I am very gratefttl for the help tile cour se has been to me. The written papers were the greatest help. Please convey to Mrs.-- 1ny thanks for her remarks on the papers 1 sent ltp J01' carrectron." K . S. (Birmingha m). Details of other successes on request to-

MAw's INHALER

CLOUGH'S

(S. Maw, Son & Sons, Ltd.)

When a quart jug is used the patient leans forward with his mouth and nose over the opening in the towel. This is much better than the common procedure of putting a towel right over the patient's head, which results in unpleasant steaming of the face and eyes and serves no useful purpose. During and after taking a moist inhalation the patient should be protected from draughts and chills and should not be allowed to go out of doors for at least an hour afterwards, otherwise he may contract a fresh chill. It is best given when the patient is in bed. PERITONSILLAR ABSCESS, OR QUINSY. Sometimes an inBammation of the tonsils is followed by the formation of an abscess around them. Swallowing may then be so painful that the patient is unable to take even fluids until the condition is relieved. Gargling is most difficult, but it is desirable to apply heat to the area so that the abscess may burst or may develop sufficiently to be incised by the doctor. Hot fomentations can be applied to the front of the neck, being renewed every ten to fifteen minutes, and the throat may be irrigated with hot water or with salt and water. For this a tube and funnel and a small nozzle are requir~d. If available, a douche can may ?e used. The ~anger 1S that .some of the fluid may be ~~ale~, but this may be a.v01ded if the purpose of the lrngat1~n,. and the method, 1S . first explained to the patient ~nd he 15 lnstr~cted to hoI? h1s breath whilst the irrigation -15 actually flowmg. If poss1ble he should hold the irrigating nozzle ~self, hav~g b~en sho~n how to stop the flow. He can S1t on a ~ha1~ wIth a bas~ for the returning fluid on a ta~le) and tilt .his h:ad ove~ It. unable to sit up he should lie on the s1de ot the qumsy wIth his cheek on the edge <;>f the pillow, which is pro~ec~ed by some waterproqf matenal and a towel, ~nd a basln 1S placed under his f~ce

AID

Letters to the Editor

Dept. M.A ., T E M P LEe HAM B E R S, LON DON, E. C. 4 Centra! 4461 Founded 1886

FIRST AID TRAINING IN MATERNITY WORK

QUESTIONS ANSWERED about

DEAR SIR,

I was interested to read your leader in the issue which reached me to-day .... Can there be any doubt that a knowledge of first aid at confinements would be anything but desirable for senior students? As you state, this knowledge is purely for use in Emergcncies(with a big" E "), but it is a knowledge which may be life-saving, and, as such, should be known by as many individuals as possible. Is there any argument against it? If so, on what gro~ds ? I am only sorry that your periodical cannot take up instruction in " Mothercraft" and " Sex." We do not allow our ships to go to sea in command of men with no nautical training. We do not appoint, as mine managers, people with no knowledge of coal. Yet we do leave the most important job on earth-namely, the propagation and upbringing of sound, healthy citizens, to individuals who have had no training whatsoever in what is to be their life's work. I feel very strongly on this subject, and any move to increase knowledge in this respect will always have my full support. It should have the support of every thinking citiZen. I congratulate Dr. Belilios-his book is, in my opinion, far and away the best publication on the subject of first aid, and his chapter on maternity first aid is what has long been wanted. Yours, &c., BOWMAN EDGAR, M.B., Ch.B. Kir kconnel, Dumfriesshire. February 24th, 1948. (This is one of several letters we have received on the subject. We hope to include others next month.- Etlitor.)

THE

HUMAN by

The Body as a Whole; Skeleton ; Muscles; Respiration; Circulation of the Blood; Symphatic System; Oigestlve System; Various Abdominal Organs; Urinary System;

JORDAN

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We are now able to accept a limited

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If you have a friend

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regu lady,

LIMITED,

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BODY Nervous System; Brain; Genital Organs; Embryo ; Skin; SpeCial Se nses , Touch. Light, Hearing, Smell , Taste ; Internal Secretions; Death; Bibl iography ; Glossary ; Copiously Illustrated

116 CHANCERY

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FIRS T

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FIRST

AID

FIRST AID AND THE THAMES POLICE

In these circumstances it was natural that the services of the newly formed " Thames Police" were enlisted to transport the unfortunate by patient from the ship to the shore. Often, it is feared, owing partly J. A. COOK to the vety casual and often harsh treatment meted out, but largely THE "Thames" Police, originally classified as a "maritime» owing to the entire absence of any knowledge of first aid, many paid Police, was formed in 1798 at the instigation of the India for this trip with their lives. merchants for the express purpose of suppressing the considerable This sorry state of affairs tended to make the River Police do all amount of piracy, petty pilfering and larceny that marked the" Tea" in their power to alleviate the sufferings of the injured persons that it and" China" Clipper era of sailing ships. fell to their lot to convey on that perilous trip. Thus it came about In 1829, on the foundation of the Metropolitan Police Force by the that first aid, even if in the crudest form, became part of the normal late Sir Robert Peel, the" Thames» Police were absorbed into that work of this newly formed Police Force. Force and became the" Thames" Division, by which title they are With the advent of steamships, new and more serious injuries were known to this day. met with in the form of severe scalds and burns, whi~h were now Their efforts against crime on the River soon bore fruit and, as the becoming increasingly frequent owing to the very experimental risk of loss by theft lessened, more merchants sent their goods via nature of these new kinds of ships. London. This meant that even more ships began to use the Port of To cope with the extra work thus occasioned, the Thames Police London and it soon became evident that Custom House Quay and the were equipped with motor boats, and their first recognised first aid newly bullt docks, with their" Legal Quays," were inadequate to outfits. These latter consisted of the minimum of dressings, triangular deal with this ever increasing volume of traffic. As, at this period, bandages and (that wonderful stand-by of the older first-aiders), the ships could only unload their goods at the recognised" Legal Quays," inevitable bottle of iodine. This, meagre as it was, was a vast improveof which there were too few, considerable delay was ofren occasioned. ment on the rough and ready cauterisation by hot pitch and burning In view of this the merchants and shipowners petitioned for, and brands that served for so long as "anti-septics" J No splints were were granted, "Customs Privileges" or "River Sufferance." This provided at this period, however, and recourse had to be made to any " Sufferance" enabled certain types of goods to be unloaded directly piece of timber that came to hand. Stretchers were almost unknown from the ships (under the personal supervision of a Customs Officer, and the patient was almost invariably lashed, very expertly but not and on immediate payment of the requisite amount of duty), into the very kindly, it is feared, to the most convenient grating or hatch-cover lighters lying alongside such ships. to ensure that drowning would not be his lot as he was lowered over To accomplish this unloading the ship concerned had to make use the side of the ship. of its own gear and derricks. This resulted in a considerable number This was first aid indeed I of accidents, both to the stevedores (the men unloading the ships), This method of removing an injured person remained standard and the lightermen in charge of the lighters. (if one may be excused for using such a description), for several years. Medical attention and knowledge being, as it was in those " Good Several alternative systems were tried with a view to removing Old Days," the particular care of the ship's surgeon on such ships injuted persons safely and expeditiously, but were all discarded as that carried guns (and only licensed Privateers fell within this category), impracticable until the introduction of the Neil-Robertson stretcher and he, almost certainly, having gone ashore to " stretch his legs," which is now carried as part of the standard equipment of aU Thame~ the poor unfortunate had to be taken to the barber on shore to be Police boats. bled a little more, if he had not already bled enough! (to be continued)

Uniform by Garrould The cut. style, and fine workmanship always distinguishes a Garrould Uniform from any other. Great care and attention is given to every detai I. We have such a wide range of scientifically graded stock sizes that 90 per cent. of our customers are able to obtain a perfect fit. Prices of Officers' Uniforms and other items mentioned in this advertisement sent on request. S.J.A . 0 R ESS for Officers and Ambulance Sisters. Made from good quality Sanforized-Shrunk material. Bodice unlined. 8.J.A. APRONS for Ambulan ce Sisters . Made from hardwearing linen -fi:lished ap ro n cloth. Price includes cross. Waists 26. 28. 30, 32. 34. 36. 38 ins. In Lengths 26. 28. 30. 32 Ins. S.J.A. B LOUSES for Officers and Ambul ance Sisters. In Ivory Tr icoline (4 coupons). Extra Collar (I coupon ). Sizes 13 ~ . 14. 14 ~ ins. Size 15 ins . Extra Collar. (Civilian coupons must be surrendered for blouses). S.J.A. HAT for Oft,cers and Ambulance Sisters. Box and postage extra. Badges obtainable only from H.Q. Hats stocked in s izes ;6t. 6i . 6t. 6 ~. 7. 7k. 7t. 7t. Storm Cap . Box and postage extra. S.J.A. CAP for Ambulance Sisters. 27 x 18 ins. or 28 x 19 ins. Embro idered cross on front.

ANATOMY &

PHYSIOLOGY, IN FIRST AID

Contiuued from Page 8

Always test the circulation in a limb after the ~racture is P'":t up. For the upper limb and claVIcle test radial artery at the wrist on the injured side. For the lower limb at the posterior tibial artery, midway between the lnternal malleolus and the tip of the heel on the injured. s~de. Fj.nally, never forget to support the illJured 1lll1b. Should the patient be ill the recumbent position, double the bandage over the end of a splint to pass it under the trunk or lower limb. Pass the bandages under the natural hollows of the body,. and then pull them gently into position for tymg. For the Trunk the broad bandage should be used. Pass it once round the trunk and fasten it by tying the ends on the side opposite to the fr~cture~ but if to secure a splint for a broken thigh, tie or fasten the ends over the splint.

(c)

For the Limbs the narrow bandage should be used. Pass it twice round the limb and tie the ends over the outer splint, or it may be more convenient to double the bandage at its centre, pass it under the limb, bringing the loop over the limb, passing both ends of the bandage through the loop in opposite directions, and tie them over the outer splint. This is called a Loop bandage. When applying bandages near a fracture, the upper bandage should be applied first. When securing an improvised round splint an extra turn of the bandage should be made round the splint to hold it in position, and prevent slipping of the bandage. Slings, when necessary, should be applied finally to steady and support the fractured bone. They also tend to relieve swelling and ease pain. Should symptoms of shock appear, these must be treated. N.B.-In all cases of doubt treat as a fracture. (to be continued.)

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A HINT TO HELP Queries will be dealt with under the following rules ; -Leiters containing Queries must be marked on the top left-hand corner . of the envelope" Query," and addre.r.red to "First Aid," 32, Finsbury SqllOT'e, London, E.e. 2; . 2.-AII Queries must be written on o~e sIde of,:he paper only. " ,.-AII Queries must be accompamed by. a Query Co,,!pon cut from the current i.r.rue of the Journal, or, In case of Querres from abroad, '" from a recent i.r.rue. 4.-The textbook to which reference may bl! made In thlJ. colum~ IJ the 39th (I937) Edition of the S.J.A.A Manual of FIrst AId 10 the IfJiured. I

Pressure on Aorta P. D. (Birmingham).-AI a recent first aid examination a friend of mine lI'as asked horp he lVOU/d apply pressure on the aorta. Do you consider Ibis a proper qUfJtion in a first aid examination? Tha11ks very much for help in tbis alld other queries. If the examiner was a doctor, I suspect that his question was misunderstood. There is no instruction in the Textbook with reference to the application of pressure on the aorta; and consequently such question is beyond the scope of first aid.-N. Corbet Fletcher. Examination Howler O. B. (Exeter).-In a recent exami11ation I asked olle candidate how she would treat a patient suffering from sl1'ychnine poisoning; and I was much amused when she replied: "During the convulsions I would give an enema and follow up with artificial respiration." Good! Next please! !-N.C.P.

ll'as atlet/ded 'Pith a fractllre, a point 1I1hicb is stres.red on page 108 of the Texlbook and cOlltradicl01]' to the treatment of the 1J!iuries specified in 01lr test. The result of this inquest was stalemate. Please give your ruli11g on tbis point. As the term signifies, the General Rules for Treatment ofHa:morrhage are laid down for general guidance; and first-aiders are expected to adapt these to the peculiar circumstances of any case under treatment. Por example, a compound fracture of both bones of forearm should be treated by raising the forearm, by controlling the fracture and by placing it in an armsling across the patient's chest. In the treatment of the combination of injuries named by you, the Textbook teaches that the limb should be raised in the cases of a fractured patella and also of a burst varicose vein of the leg . You would, therefore, be strictly in accord with the Tell.'tbook if you treated the injuries named with the lower limb in the raised position.N.C.P.

Treatment of Fractured Knee-Cap M. Y. (Whetstone).-The Textbook (in Rule 7, page 91) does !Jot make it clear whether with simple fracture of knee-cap we should apply the cold compress over the clothing or over the knee joint after removal of clothing. With this fracture the Textbook gives no instructions to expose the injured part; and with simple fracture we should not expect any such instructions. Consequently, 'while I question seriously any good effects, I take it as strictly correct to apply the compress over the clothing.-N.C.F. Inhalation Causes of Asphyxia

Jacksonian Epilepsy

J. B. (Chester).-Please tell me lJ)hich are the poisons which I/)ay act as

S. T. (Wellington, New Zealand).-Please tell me what is JJJtant by " Jacksonian Fits" from which a friend is said to suffer. It starts 1vith fixity of jaw. Then the patient reels, falls, goes into a state of stupor and final(y falls asleep. Later he wakens, gels up and walks alvayapparentlY all right? Jacksonian Epilepsy is so called after a Dr. Jackson who first described the condition. It is characterised by epileptic-like convulsions which always start at some definite part, tend gradually to spread, and are due to irritation of the motor area on the surface of the brain. In brief, it is an epileptic condition of which the active cause is often some old injury to skull and brain. In Jacksonian Epilepsy the patient may (or may not) lose consciousness whereas in true epilepsy sudden and complete loss of consciousness is the outstanding feature.-N.C.F.

inhalation causes of asph),xia. As the Textbook teaches, any fumes or poisonous gases may cause asphyxia by inhalation. Of the latter, carbonic acid, chlorine, chloroform vapour and sulphuretted hydrogen are good examples.-N.C.P.

.. FIRST AID" QUERIES and ANSWERS COUPON To be cut out and enclosed with all Queries.

March, 1948.

TROUBLE HEAL QUICKLY What a gratifying experience it is to find that the skin no longer irritates, and has become clear and heal thy again. Germolene has helped many a skin sufferer to get rid of his, or her, complaint ... and it is interesting to know why this should be so.

Simple Fracture of Finger

Advertisements with remittance shOUld be sent to First Aid. 32. Finsbury Square. London. E.C. 2. R.ate 3d. per word. minimum 4s. 6d. Trade:Advts .. 4d. per word. minimum 65. Box numbers 15. extra.

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N. I. (Bangor).-Please Jell me hOll' 1/'e should Ireat a sill/pie fracture of the iudex finger at the first joint. You should treat as for crushed hand as laid down on page 86 of the Textbook.-N .C.F.

F. B. (Dartford).-We are an industrial first aid sqf,(ad at the Dartford Mil/s, trained in St. John methods which we always use at our Practices. Tonight our exercise was to treat a patient suffering from a burst varicose vein and a fractured patella, the ifyuries being on the same limb. The case rl'as frtated as per Textbook; and at the subsequent inqf,(est (1 cantroNr.r,J' aroSf I'cgal'ding the raising of the limb Il ,bm hClemorrh'1ge

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The Gear Illustrated (A.B.C.D.) carries two stretchers on one side of Ambulance, leaving other side clear for sitting patients.

No. 646.-VOL. LIV.

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Editorial A Course in Advanced First Aid Anatomy and Physiology in First Aid News from all Quarters

D. Shows the same position as in" C" only with cushions and back rest fitted for convalescent cases.

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Editorial The Police Competition. WE are glad to note that after a lapse of eight years the Police National First Aid Competition has once more been held. As we report in another part of this issue, no less than 98 teams entered, and the standard displayed was quite as high as in pre-war times-" the work of the first few teams was almost beyond criticism" commented one of the judges, and this is praise indeed. Of course, we expect a high standard from police teams, for the police forces have always considered the ability to render first aid as one of the most important attributes of the pol iceman, and have taken pai ns to promote efficiency and to maintain a high level. Consequently there always has been a close association between the ambulance organisations and the police which has been of great benefit to both, and we were glad to read that the Home Secretary, Mr. Chuter Ede, referred to this when he presented the prizes at the National Competition . That relationship, he said, was a matter of gratification to both sides. "The work which each has to do in the respective spheres they cover is greatly helped by their general association, and particularly by such events such as those we have just witnessed ." He expressed thanks on behalf of the police to the St. John Ambulance Associa-

tion and hoped their association with the police would continue for many years to the increasing benefit of both sides, going on to say that he rejoiced that so many police forces should take a personal, sincere intel"est i'l the type of work demonstrated that day. I am su re," he decla red, " it is good for the men that detailed and inte ns ive study of this kind of work should be regarded as a matter of pride by the various forces." The Home Seuetal"Y did well to speak of the pride in achievement. for it is exactly 1hat , fostered by the stimulus of competitions such as the one he had witnessed, which pmmotes the high efficiency that is the aim of all of us. It is the great value of these competitions, especially the national events entered after the hard work and excitements of the eliminating rounds, that they do provide this necessary stimulant. The revival of the Police Competition will undoubtedly effect a renewed interest in first aid, and thus maintain the high standard fN which the police forces are justly proud. We congratulate them on organising once again the National Competition, and the competing teams on the fine show they put up. Long may the competition serve to engender enthusiasm for first aid among the fOI"ces, and may its success be always assUl-ed by the zeal and efficiency of the riva l teams. II

FIRST AID

A COURSE IN ADVANCED FIRST AID BY

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

The Special Sense Organs An important point in the treatment is to remember not to use water .u~til every particle of quick lime has been TH~ eye. is. classified as 0r:-e o~ the special sense organs smce It IS concerned wIth sIght and the sensation of removed. This 1S because when water comes into contact light. Other special sense organs of the body include the with lime, inte?se heat i~ geI?-er~ted. Irrigation, therefore, ear and the nose. Before describing the first aid conditions s~ould b~ car!1~d out w1th lIqUId paraffin, olive or castor which may affect the ear, there are a few other points about oil, . the lId~ bemg ~:rerted during this process. Particles of lime which are vls1ble can be brushed away with a wisp the eye still to be considered.. of cotton wool 0 the twirled up corner of a pocket handIr~igation oj the Eye.- Thi~ is a method of thoroughly kerchief. ba~hing the eye, far supenor to well-known eye bath. Further. irrigation can be car~ied out with a 10 per It mvolves the use of a glass vessel called an undine. The patient should be seated in a chair with his head ce?t. solutlOn of neutral ammOlllum tartrate, if available· thrown backwards and suitably supported; if more con- this ~as the effect of dissolv:ing particles of lime and reducing venient he may lie down. He should be instructed to scarrmg. The same solutlOn can be used in the form of open both his eyes and look downwards. The lids of drops. The services of a doctor should be obtained as soon as the eye to be irrigated are then held apart by the first and second fingers of the first-aider's left hand. Lotion from poss.ible sinc~ he wi~ be able to pick out with forceps the particles of lime which are adherent after instilling drops t~e undine is allowed to flow freely into the eye from a distance of from two to three inches. Sometimes it is of a local ana::sthetic such as cocaine. Acid and Alkali Burns.- These occur in laboratories and necessary to evert the eye lids for more thorough irrigation. factories where chemicals are used. The eye should be imme~ately ir~igat~d with a large volume of water unless an antIdote 10tlOn IS as quickly available. A suitable antidote solution for acid burns is biC1trbonate of soda 3 per cent., and for alkalis a weak acid lotion such as boracic. After irrigation, soothing drops of oil or liquid paraffin should be instilled. Exposure to .Excessive Light.-E~posure to intense light, e.g., the ele~t!1c ~r~ .or th~t used m electric welding, may pr?duce conJunct1Vltis, a disease which has all the characterIStICS. of the " red. eye" together :vith excessive watering and. ~tense sm.art11lg. ~s a .first al? measure, the eye can be 1r!1~ated WIth phYSlOloglcal saline-a solution of salt and ~oiled water in the proportion of half a teaspoonful to the pmt. Expos.ure of the uI?-protected eyes to bright sunlight as IRRIGATION WITH AN UNDINE. on looking at an ec.hp'se, or to the bright light reflected illustration from cc The Handbook of First Aid and Bandaging" from snow. may .similarly cause severe conjunctivitis, Belilios, Mulvany & Armstrong. ' known as eclips.e b10dness and sno~ b~indness respectively. By courtesy of Balliere, Tindall & Cox. Much ~~re senous IS when th~ ~e.tma IS ~ffected producing ~ co?ditlOn called photo-retmItls. This may result in If an undine is not available, a small jug or egg-cup can lmpaument of vision, which may be permanent. Rest to be employed. the eyes and the use of dark glasses are advisable. Irrigation is undertaken for conditions such as corneal Glr:zucoma.-:-This complaint was mentioned in the ulcers and coni.unctivitis, and occasionally after the prevlOus artIcle and is of importance to the first-aider in removal.of a foreIgn body; for these cases, it should only orde! to emphasize the necessity of referring to a doctor ?e.dor: e if ordered by a doctor. In an emergency, however, all al~ents of the eye except the foreign bodies which can 1rrlga~lOn may have to be adopted by the first-aider for be easlly removed. che~cal b~rns of the eye. The condition is due to increased pressure within the QUICk Ltme i~ the Eye.-This is a very serious accident ey~ball. . It causes a "r~d eye" accompanied by severe freq~ently sustamed by builders, labourers, etc. Extensive pam :vhich mar be S? m~ense that it causes vomiting ; bu~rung of the conjunctiva or cornea is liable to occur som~t1mes th.e illness 1S rrustaken for a "bilious attack," t~kin~. months to heal and often leaving a permanen~ partIcularly .sInce the patient's temperature and pulse rate disability. are often ra1sed.

FIRST The sight deteriorates rapidly and unless medical aid is speedily obtained bljndness may result. The Ear Anatomy and Pi?Ysiology.-The ear is divided into three parts called the outer, .middle and internal ears respectively. The outer ear cons1sts of the ear flap or pinna which is repute~ to act rather like a trumpet, directing waves of sound mto the ear channel or external auditory canal as it is called technically. This canal is about It inches long and i inches in diameter ; it leads inwards to the ear-drum which is a thin, semi-transparent material like parchment. ' The ear-drum separates the outer from the middle ear thus when a foreign body such as an insect enters th~ external auditory canal, it can travel no further inwards than the drum. The middle ear is a small chamber situated within one of the bones that form the base of the skull. Within it are three small bones arranged to form a chain extending across the cavity from the drum to the internal ear; these bones ~re called the malleus, incus and stapes respectively. The rruddle ear contains air which reaches it through a small tube, the eustachian tube, leading from the back of the nose. Thus there is air on either side of the drum which is therefore kept taut. The internal ear consists of the cochlea and the semicircular canals which latter are not concerned with the functions of hearing but with the maintenance of balance. The cochlea is a channel wound spirally round a spike of bone ; it contains a fluid in which are bathed the endings of the nerve of hearing.

f 1

TER.NAL AUDITORY CANAL

HA11-l OF OSSICI..E.S

?EMl CI RCULAR CANALS

..kEN ESTRA OVAlI.s

: DOLE tAR.

TYMPANIC. ME.MBRANE. DIAGRAMMATIC SECTION THROUGH THE EAR.

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made to lie down and turn his head on to the unaffected side during this process. The removal of all other foreign bodies must be left to the doctor. E.ven what ~ppears to be a simple case may end up. by bemg .very difficult because the foreign body often ~lips furt?er mwar.ds dire:tly it is touched. Moreover, there IS a co~slde.rable. rlsk d:l!mg re~o:ral .of damaging the drum, espec1ally m children m whom It IS situated relatively near the surface. A child sh.ould be preveI?-ted from touching the ear. A go~d plan IS for the first-a~der to give the child a toy to carry ill one hand and hold 1ts other hand while taking it to a doctor. Earache.-This common ailment is generally due to the formation,. within the middle ear, of an abscess caused by germs which have entered through the eustachian tube. If unt~eated, the. abscess may burst through the drum producmg a runrung ear, or worse still, extend into the mastoid-the bony knob behind the ear. It is ess~ntial, therefore, that every patient should be r~ferred WIthout delay to a doctor since it is possible to disperse the abscess by drugs like penicillin and M. & B. If it is impossible to obtain a doctor, the patient should be advised to sit up and to hold hot applications such as a ?ra~ bag to the ear. Warm drops of almond oil may be mstilled but any first aid remedy is very inferior when compared with medical treatment. Hamorrhage.-Ha::morrhage from the ear may result from several causes. If there is any question of a head injury, it should be assumed to be due to a fractured base of the skull which has at the same time torn the ear drum. Rupture of the ear drum may also be caused by a severe blow on the external ear or may follow a loud explosion. Accompanying earache, slight ha::morrhage may indicate that an abscess in the middle ear has perforated the drum. A less serious cause is a small wound of the pinna or external auditory meatus. It is obvious, therefore, that all cases of hremorrhage from the channel of the ear require investigation by a doctor. The only first aid necessary is to apply a light pad over the pinna and secure it by a suitable bandage. The object of this treatment is to prevent germs entering and setting up sepsis. For the same reason, if the bleeding is likely to be due to any causes in which the drum has been ruptured, the patient should be advised to lie down and incline his head towards the affected side in order to encourage the blood to flow outwards rather than to drain backwards towards the middle ear.

Illustration from" The Handbook of First Aid and Bandaging," Belilios, Mulvany & Armstrong. By courtesy of Balliere, Tindall & Cox.

P.C.'s First Aid Work Commended THE first aid rendered by P.e. Studden, a 24-year-old Constable of the Plymouth Force, to a naval airman whose legs were severed when he was struck by a train at Devonport, has been warmly commended. P.e. Studden was off duty when he heard shouts from a railway embankment. He reached the scene by climbing a 6 ft. wall and crawling up a steep bank. When he found the injured man he ran back to his home, telling a civilian to 'phone for an ambulance, and returned with a sheet and some sticks of firewood. With these he made tourniquets. Surgeon-Captain Keating, of the R.N. Hospital, said that the first aid work had undoubtedly saved the man's life. "Under any circumstances first aid work of this kind would have been good, but considering the difficulties under which it was done it was excellent."-Police

When a sound is produced, e.g., a noise, waves of vibration (sound waves) travel through the ajr like the ripples on a pond into which a stone has been thrown. These waves impinge upon the ear-drum, causirlg it to vibrate; the vibrations are carried across the middle ear by the chain of bones. Finally, movements are set up in the fluid of the cochlea, where they are picked up by the endings of the nerve of hearing and carried to the brain. Foreign Bodies.-The only foreign body in the ear that the first-aider is allowed to deal with is an insect which can often be floated out by filling the external auditory canal with olive oil or liquid paraffin. The patient should be Review.

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ANATOMY AND PHYSIOLOGY IN FIRST AlB by J. WELLS, M~R.C.S., L.R.C.P. the first aid treatment of fractures it will be well to Compression of the Brain divide them into those which can be treated by A condition produced by pressure of blood clot, depressed bandages onlY and those which require splints and bandages to bone, foreign body, brain tumour or brain abscess on the give them full support. brain substance: this is a very J'erious condition. A. Fractures which are Treated Without Splints SIGNS AND SYMPTOMS OF COMPRESSION 1. Fractured Skull. (Compare with those of Concussion, above.) z. Fractured Base of Skull. 1. Onset often gradual, frequently commences some 3· Fractured Spine. hours after injury. 4- Fractured Lower Jaw. 2. Headache and drowsiness, passing into unccn5. Fractured Clavicle. sciousness. 6. Fractured Scapula. 3· Paralysis of limb or limbs. 7· Fractured Sternum. 4· Pulse slow and full (in late stages rapid and weak). 8. Fractured Ribs, Simple, Compound and Com5· Breathing deep and slow, often stertorous. plicated. 6. Temperature raised. g. Fractured Humerus, Upper Third. 7· Pupils unequal and do not react to light. roo Fractured Pelvis. 8. No corneal reaction, if patient is unconscious. B. Fractures Treated with Splints, or Improvised Treatmmt : Splints and Bandages, if available . 1. Send for Doctor, if possible. 1. Fractured IIumerus, Lower Two-thirds, includ2. Lay patient down; if flushed and cyanosed raise the ing Elbow Joint. head. If pale lower the head. Undo all tight clothing z. Fractured Fore-arm, Radius and Ulna. around neck and chest. 3· Fractured Bones of Wrist and Crushed Hand. 3· Dress wound, if one exists. 4. Fractured Femur. 4· Arrange for transport, with patient in recumbent 5· Fractured Patella. position, to hospital or nearest house for shelter 6. Fractured Tibia and Fibula. until ambulance arrives. 7· Fractured Tarsal Bones. 5· Keep patient absolutely quiet, in darkened room. 8. Crushed Foot. 6. Cold applications to the head, if possible. Extra Fractured Skull warmth to body and limbs, if available. Fracture of the Vault of the Skull is usually caused by 7· Patient must not resume mental or physical activity direct violence, e.g., a blow or fall on the head with sufficient without consent of doctor. force and weight to break and sometimes drive the bone Fracture of the Base of Skull inwards, so causing pressure and injury to the brain itself. Generally caused by indirect violence, a fall on the head, This is called a Depressed Fracture. The fracture may be a fall on the feet from a height, or lower part of spine ; a line or crack of the bone with no depression of the bone. may be caused by a severe upward blow on the lower jaw, SIGNS AND SYMPTOMS OF FRACTURED VAULT OF THE SKULL the force of the blow travelling through the jaw-joint to 1. Concussion or stunning, which is usually a sudden the base of the skull. loss of consciousness accompanied by failure of the SIGNS AND SYMPTOMS OF FRACTURED BASE OF SKULL heart's action. The period of concussion or uncon1. Insensibility may come on immediately or may be sciousness may last for a minute or so, or may last delayed. for many hours or days. 2. Blood may issue from the nose or ears, or may cause 2 . Signs of injury to the scalp. also a bloodshot eye. 3· Pupils dilated and equal. 3· Blood may be swallowed and later vomited. 4- Sometimes depression of bone, i.e., depressed 4· Pupils unequal,do not react to light, no corneal reaction. fracture. 5· Breathing stertorous. DANGERS OF FRACTURE OF THE SKULL 6. Paralysis of one side of body. I. Injury to brain, causing death or subsequent paralysis When a bone of the Base of the Skull is fractured there of a limb or limbs. is bleeding. Being inside the skull this blood cannot escape 2. Bleeding into the skull, causing compression of the and a blood clot is formed oflesser cr greater size, according brain by a blood clot. to the amount of blood which escapes from the injured 3· Prfssure on and injury to the brain by depressed bloodvessel into the skull. It is the blood clot which causes bone; depressed fracture. the Compression and therefore gives rise to these definite . ~ . 4· Co~pound ~racture, through wound of scalp. signs and symptoms. 1 reatment If there IS a scalp wound with haemorrhage :_ Treatment of Fractured Base of Skull :_ I. Apply sterilized dressing to wound, and a ring pad Treat as for Compression of the Brain, as outlined above. to the scalp to arrest the h~morrhage. Fractured Spine 2. Apply general rules and principles of treatment for The Vertebral Column may be fractured either by direct or insensibility. indirect violence. A heavy weight falling on the back, 3· Treatment for concussion and compression. falling from a height on to the back, acr.oss a bar, or upon

FIRST

an uneven surface, are examples of fracture of the spine Now pass long poles, line props or pitch fork by direct violence. . . handles through the loops on each side. Tie the Examples of Indirect Violence causrng fracture o~ the spme. free ends of the bandages over the poles. The Falling on the head, causing a broken neck, that 1S, fracture patient is now ready for lifting and placing on the of cervical vertebra. The fracture tak.es pla~e at ~o:ne stretcher or the substitute for a stretcher, such as a distance from which the force or impact 1S applied. D1vrng door, shutter or board, which is long enough, wide into a swimming bath with the water too s?allow and and strong enough to carry the patient. striking the head on the floor of the bath, causrng fracture If five bearers are available : of cervical vertebra. . First decide who shall give the orders. Two should As the spinal cord passes down the sprnal column as stand on each side of the patient facing each other. far as the second lumbar vertebra and gives off hom ~he On the word of command being given grasp the cord the anterior and posterior roots of the nerves which poles firmly with hands well apart a~d on the o~der supply the body.and limbs 'V:'it? ~ot~r and .sen~ory nerves, _ being given, slow1y and evenly ralse the patIent it will be apprecIated that this rnJury 1S of vltallmpor.tanc~, sufficiently high to allow the fifth bearer to push the as from the injury itself and also ~y careles~ handling rn stretcher under the patient. first aid treatment, complete paralysIs ?t the lim~s, bladder and rectum may occur, and last untIL th~ patlent fina~y Iffour bearers are available : dies. With the fracture of a vertebra there 1S often a partlal Lift the patient as above and ~hen, when the .order dislocation of the vertebra and the spinal cord may not be is given, move with short slde paces, until ~e completely severed. The para~ysis following r;nay be patient is directly over the stretcher, care havlng partial and not complete, but w1th c~r~l~ss handling ~nd been taken to place the foot of the stretcher as close treatment this may cause complete divls10n of the sprnal to the head of the patient as convenient, before cord, with complete and lasting paralysis. proceeding to lift. Treatment of Fractured Spine : . If onlY three bearers are available : . If cervical fracture or dislocation, the patIent m~st be p~~ced One bearer should stand on each side of the panent and moved -to shelter, if necessary in the suprne posltlOn, facing one another. On the word of command being i.e., in the face upward position. If dorsal or lumbar given they sto.op down and firmly grasp the P?les, vertebral fracture or dislocation, patient must be moved the hands well apart, opposite shoulders an~ hips ; and placed in the dorsal position, that is face downwards. the third bearer faces the teet and firmly gnps the 1. In all cases at once warn patient to lie st.ill. end of each pole. On the order be~g given they 2. Fasten the feet together with a figure of elght bandage, then slowly and evenly raise the .pat1~nt. and move tied beneath the soles of the feet. Apply broad with short side paces until the patlent IS directly over bandages round the knees and thighs. These the stretcher, care having been taken to place the ~oot bandages are very important as they tend to keep of the stretcher as close to the head of the pan~nt the spine fixed. .. . as convenient, before proceeding t? lift. On reac~g 3. If a doctor is not easily available remove the pa?-~nt shelter with the exception of treatlng shock, nothing to shelter as follows : If unconscious and the pOSitIOn furthe: is to be done until the arrival of a doctor. of the fracture is doubtful as to whether it is a cervical or dorsal fracture or dislocation, move To TRANSPORT A CASE OF SPINAL INJURY IN THE FACE patient in the supine position, i.e., face upward. If DOWNWARD OR DORSAL POSITION stretcher is used, short transverse boards must be I. Prepare and blanket a stretcher which must not be placed across it to make the. whole bed of stretcher boarded. rigid. Blankets smoothly laId should be 'p~aced on 2. Fold and roll two blankets, which must be rolled this. If the patient is in ~y other p~SltI~)il tha? firmly and be as wide .as stretcher. . . supine, with all the help. aVa.11able, roll him mto this 3. With great care, and Wlth all the. ~s~lstanc~ availabl.e, position, especial care bezng taken to support the head roll and support the pa~ent on his s1de, belng ~ertaJ.? and neck while this is being done. The foot of the stret~her to keep him steady and Immovable when once ill this should then be placed as near the h~ad ~f the pan~nt position. f as convenient, having placed the panent ill the supme 4. Turn the stretcher on to its side, close to the- front? position. the patient's body, place the rolled blanke~s 1f If sand is available sand bags can be made. by position, one across the front of the .pa~lent s tying the leg of a stocking near the ankle ~nd filling shoulders and the other across the fro~t of his hips. , with sand for about nine inches and then tymg above. 5. Hold the stretcher in close contact WIth the p~nent s Mter placing a pad four inches thick under th~ neck body, and carefully turn th~ .stretcher and 'panent as and then placing the sand bags one on each side of one into the correct posit1on for carrymg. .The the neck the fractured cervical spine will be rendered turcing of the patient on to his face may be aSSIsted immobil~. Now pass looped broad bandages from by the bearers pulling on the edge of the blanket alternate sides under the natural hollows of the body under him. . (the neck, loins. ~nd knees), and without jerking work 6. Turn patient's head slightly to one sIde and support them into posltlOn under : it on a pillow. . f (a) The Head. 7. On reaching shelter nothing, wi~ the exc~pnlon f 0 (b) The Shoulder Blades. treating shock must be done, until the arnva 0 a (c) The Buttocks. doctor. (d) The Thighs. (to be continued.) (e) The Calves.

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News From All Quarters HUNGERFORD Ambulance Brigade as a token of appreciation The winners of the Frank Grey Challenge for all she had done for the Divisions in Cup at Oxford on February 24th wele all Windsor. members of Hungerford Ambulance Division, County of Bristol S.].A.B. The team was captained by H . BRISTOL NORTH No. I (Prince of Wales's) District Bennett and the award was for FIrst A Id The first post-war 'Dinner was held on WATFORD Competition in Class II of the London" B " March 15th and was well supported by The 1948 March Hare's Ball was held at No.2. Ambulance Division of the Western members, their wives and friends. Guests the Town Hall on March I Ith, when four Region of British Railways. included Corps Officer Pearce, Corps Officer hundred dancers enjoyed an enchanting Harding and Corps Supt. W. Carter. MAIDENHEAD evening. . The Div. Supt. H. ]. Pullin made a presentaOn Saturday, Match 20th, teams from The halls were a profuslOn of flowers tion on behalf of the Division to Div. Surgeon which gave the whole Ball an atmosphere of Maidenhead Ambulance and Nursing Divisions Dr. D. S. Maunsell for his valuable services carnival contagious with gaiety. A gaiety competed with .i\mbulance and. Nursing to the Division. caught by the music o~ Neil McCormack and teams from High Wycombe Corps 111 answer BRISTOL A his Orchestra and qUlcklv spread to every to a challenge received a short time ago. On Thursday, February 12th, His Grace dancer on the floor as they rustled by, Lit The competition took place at the Health the Duke of Beaufort, K.G., County President, only by the coloured darts of light swirling Centre, Wycombe Rye, High Wycombe. The accompanied by Her Grace the Duchess of about them in the darkened hall. The fever Maidenhead party included Div. Surgeon W. Beaufort, presented the Jubilee Certificate to pitch of tropical frivolity was reached when Brodie Moore (Ambulance Division), Div. the Bristol "A" Division, Bristol No. I Corps, an exhibition "Samba" given by MISS Surgeon D. ]. T~rnbull (Nursing D.ivisio~), which can trace its existence continuously Christmas, her partner and pupils set even Div. Supts. G. Kirby and Mrs. e. Bllck WIth since February, r89I. Ambulance Officer the stiffest hips swaying irresistibly to their officers and members of adult and Cadet. Lane, who has been a member of the Division Divisions. The first aid tests were set and rhythm. Perhaps the greatest attraction of the March judged by County Surgeon Lt.-Col. S. Hunt, without a bxeak since April, 1902, was Hare's Ball was its friendly charm whIch was M.B. (Midland Area, Bucks), the Home presented with his sixth bar and Private G. N. due to the personal care with which Mrs. Nursing (for Nursing teams only) judged by Iles, who joined the Division in March, I90I , is still a member of the Brigade, was also Gough, its organiser, considered every detail Nursing Officer Mrs. Taylor (of Beaconsfield) and present. with the thoughtfulness of a hostess enter- and Individual Tests set and judged by Corps His Grace the Duke of Beaufort, in making raining her own guests. The Watford Division Supt. Miss N. Sale (of Aylesbury). Competiis very fortunate in having such a friend to tion was very keen and the results were : the presentation, warmly congratulated Supt. whom they are indebted for yet another £100 Nursing Divisions- High Wycombe team, Wilmot on the fine record of his Division 18g marks; Maidenhead team, 149 marks. over the past 57 years. towards their Building Fund. County of Durham Ambulance Divisions-High Wycombe team, HACKNEY CHILTON COLLIERY The 58th Annual General Meeting of the 15 6 marks; Maidenhead team, 145 marks. The Division suffered a great loss in the Division was held on 15th March at Divisional READING death, on February 24th, of the Divisional Headquarters, and was preceded by the On Monday, March 1st at the Ambulance Surgeon, Dr. Mathew Hunter. presentation of an electric clock to ex-Staff Hall Chatham Street, Reading, the officers Dr. Hunter was associated with the St. Sergeant A. E. Ferguson to mark his retire- and 'members of Reading Town "B" ment from the Division last year after 49 Ambulance Division under Div . Supt. E. F. e. John movement for over thirty years, and was one of the pioneers of the above Division in years' continuous service. Harvey, organised a concert, the pro~eeds of Mr. Ferguson joined the Division in 1898 which were given as a present to thelt oldest 1928. A well known class examiner in first when it was known as "The Children's member, Pte. William Smith. During the aid he was made a Serving Brother many Homes Division," and Dr. F. A. Tunstall interval, the County Commiss~oner (Mr. years ago. Officers and men from the surrounding was the Divisional Surgeon. He was promoted e. A. Poole) handed to Pte. Srruth a wallet to Sergeant in 1920, Staff Sergeant in 1933, containing £10 lOS. od., a token, said the Divisions attended the funeral on February and was admitted to the Order in the grade Commissioner, of the love, esteem and regard 27 th , and County Officer W. Mather, Dean Bank, tepresented the County Commissioner, of Serving Brother in 1935. He also served with the Army Medical Service during the of8 his fellow members on his completion of Mr. Stanley Embleton. 4 years' service with the Brigade. Boer War and World \X'ar No. I, and holds On Tuesday, March 16th, a Social and DROYLSDENS.E. Lancashire the Service Medal of the Order with six Dance was held by members of Reading West Bars. The Cadet Nmsing Di vision held their 7 th The clock, which bore a suitably inscribed Nursing Division under Div. Supt. Mrs. F. birthday week-end on February 2gth-March plate, was handed to 1\1r. Ferguson by Winterbourne, in celebration of their fourth 1St. On Sunday they attended morning Ambulance Officer Fisk who joined the birthday. The Annual Awards, which included worship at St. Mary's Church with members Division in 1894, and is still serving in the labels, pendants and medallions, were presented of the Ambulance and Nursing Divisions, by County Officer H. F. Skidmore. Brigade Reserve. On Thursday, February 26th, at the South and on Monday a Birthday Party was held County of Berkshire Reading Community Centre, members of when about 130 Cadets, parents and friend s BRACKNELL spent an enjoyable time in games and dancing. On February 25th the members of the Whitley Nursing Div ision under Div. Supt. Area Cadet Officer Charlesworth made Ambulance and Nursing Divisions held their Mrs. A. Clarke, held a competition for the various presentations, including the Grand Annual Dance in aid of Divisional Funds. Gamage Cup The winner was Ambulance Priors Badge to Cadet Corporal Joan Among the large number who attended were Sister Mrs. R. Evans and the runner-up, Darrington. the County Vice-President, Lady Denham, Ambulance Sister Miss Jean Clarke. The cup A Bring and Buy Sale, organised by the County Superintendent the Han. Mrs. Leslie will be held for twelve months. Cadets, realised £3 I8s. 6d. for the National Gamage, Div. Surgeon R. E. S. Turner and WINDSOR Children's Home and Orphanage, Edgeworth, Mrs. Turner and fifteen members of the On Friday, February 27th, a Pantomime, near Bolton. Royal Borough of Windsor Ambulance and Mother Goose, was given in aid of the funds County of Lancashire Nursing Divisions. During the interval, of the Royal Borough of Windsor Divisions. MERSEY DOCKS & HARBOUR BOARD the County Superintendent presented Hon. The show was produced and all arrangements At a formal dress parade of the Division at Membership Badges to Mr. H. Wheeler and made by Miss Danbury, and the cast was Mr. Allen Hambling in appreciation of all composed of local people and pupils of Miss the head offices of the Mersey Docks & Harbour Board on March 18th, Mr. L. they have done for the local Divisions, and Danbury's School of Dancing, among whom a bouguet of carnations was presented to Mrs. were several Nursing Cadets. Mter the show, Leighton, Engineex-in-Chief to the Board Gamage. The proceeds of various Draws and County Superintendent the Hon. Mrs. Leslie and Vice-President of the Division, presented an Auction held during the evening amounted Gamage presented Miss Danbury with an to this year's winner, Honorary Sergeant J. Campbell, the "A. G. Curry" Cup. Mr. to £26 2S. 6d. Hon. Member's Badge of the St. John Leighton was assisted by Mr. J. D. J. Saner,

THE ST. JOHN AMBULANCE BRIGADE.

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his Assistant and Co-Vice-President, and by transport cases by members. Practices during London Midland Region Mr. Charles Ree, Assistant General Manager, the year showed a good attendance. The Cheshire Lines Committee Final was and Mt. T. E. Williams, the Boatd's Supervisor She expressed appreciation for the very held in Liverpool on March 4th, the trophies of Labour Matters. interesting and instructive lectures from the The Cup is awarded on a points basis for Div. Surgeon, and the support and co- and prizes to the three teams gaining the highest marks being presented by T. W. public duties performed, drill attendances, operation of members. Royle, e.V.O., M.B.E. , Deputy Chief Regional flag day attendances and first aid tests, and is Officer, London Midland Region, the chair West Riding of Yorkshire competed for annually. Great credit is due being taken by Gerald Leedam, O.B.E., to Sergeant Campbell for his success in the BRADFORD CORPS O.St.J. The Judges being Dr. W. Duncan face of keen competition from other members. The annual competition for the "Gadie and Dr. G. L. Love. Results were: (.vLaxiCampbell has been with the Board's Division Cup" for men was held on February 14th. mum 316.) I, Liverpool Central, 267; 2, for twelve years. Tramways Division won and City Division orthwich, 237; 3, Hanford, 229t; 4, On the evening of the 23rd March 150 were second . The cup, and saving stamps, Stockport, 228; 5, Manchester Central, 225 ; Dock Board first aid men attended a supper were presented by Mrs. Chester, wife of the Chester, 209t; 7, Huskisson, 20gt; presided over by Mr. R. J. Hodges, the Corps Surgeon. Dr. R. Chester and Dr . H. 6, 8, Brunswick, 155. General Manager and Secretary, after which Hughes were Judges. Mr. W. H. Hall, General Ambulance Secrethe men were presented with the awards which On February 28th the Girl Cadets held their tary, repotts great progress in the Ambulance they had gained in recent examinations. The competition when the winners were City Centre work, classes and team test instruction evening terminated with a team competition Cadets, Eccleshill were 2nd and Ashley 3rd. by the members being exceptionally keen. for a Shield presented by the Board . The The annual Midland Area W.R.Y. ComEastern Region competition proved a very keen one and petition took place at Belle Vue Barracks, Results of the Great Eastern Final Comresulted in a win for the team from the Bradford, when teams from Leeds, Selby, Harbour l'.1aster's Department, comprised of Castleford, Halifax, Pudsey and Bradford petition, held in London on March 17th, Mr. R. Roache, Leader, and Messrs. Dignam, took part, the results being: 1st, Tramways were: (possible marks, 225.) I, March "A", Rylands, Armstrong and Davies . The test Division, Bradford; 2nd, City D ivision, 179; 2, Bishopsgate "A", 160; 3, Bishopswas staged by the Mersey Docks and Harbour Bradford, the winners going forward to the gate" B ", 158 ; 4, Stratford Printing Works, Board (Ambulance) Division under the County Competition to be held at Hudders- 15 8 ; 5, Wivenhoe, 14 6 ; 6, Stowmarket, 141. March "A" team will therefore represent direction of Superintendent Clucas. field on June 5th. the Eastern Section at the Group Competition The awards and the First Aid Shield were Judges were Dr. R. Chester and Dr. R.T. presented by Miss Hodges, and Doctors W. Rushton, and following the Competition to be held at Marylebone on 14th May. Duncan and D. Osborne Hughes vexy kindly Dr. Chester said that all the teams had done POLICE NATIONAL FIRST AID acted as judges and subsequently gave valuable well, there being very little difference ~ the COMPETITION, 1948 criticisms of the work to the teams. marking. Dr. W. N. West-Watson, Assls~ant The position in which the teams were The event was honoured by the presence Commissioner, spoke, and the Jutland Shield placed by the Judges, Dr. A. e. White Knox, of Dr. W. Murray Cairns who has devoted a was presented to the winners by Mrs. West- of London, and Dr. H. S. Taylor-Young, of lifetime's work to first aid with the St. John Watson. Salisbury, in the Final Competition at the Brigade and Association. Borough Polytechnic, London, S.E.1, on BRITISH RAILWAYS Divisional Superintendent W. R. Clucas 12th March, was as follows: (Maximum London Transport Executive (Railway) has received the honour of admission as marks obtainable, 480.) I, Brighton Borough Centre Serving Brother of the Order of St. John as Police, 393; 2, Metropolitan Police (Y from 27th February, 1948, the date of His The allllUal competition for the Challenge Division), 382; 3, Birmingham City Police, Majesty's Sign Manual. Supt. Clucas has 5'hield was held on 6th March at the Baker 3 17 ; 4, West Riding Yorkshire Constabulary, been with the Mersey Docks & Harbour Street Offices. NIt. A. J. Webb, Chairman, 310; 5, East Suffolk Police, 285 ; 6, SunderBoard Division nearly ten years, having presided, and was supported by l'vL:. H. S. land Borough Police, 282; 7, Manchester previously been with the West Derby Gordon Chief Welfare Officer; Mr. A . Bull, City Police, 279; Devon County Con(Ambulance) Division. Staff Officer; Dr. L. G. Norman, ~hief stabulary, 233; 9, Glamorganshire ConMedical Officer ; and Dr. Wybourn, ASSIstant stabulary, 228. County of Somerset Medical Officer. Over 200 witnessed the TAUNTON At the distribution of prizes at the conIn the British Railways (W. Region) Inter- competition, the results of. which were: clusion of the Competition the chair was Divisional Ambulance Contest held at Ply- 1St Acton Works, 296t (pOSSIble 400); 2nd, ta ken by The Lord Wakehurst, K.e.M.G., mouth on 24th February a team of foUl' Operating Manager's (Railways) Metropolitan and the prizes were presented by the Right members of the Division again succeeded in Line, 260i; 31d, Acton Works, 232; 4th, Han. J. Chuter Ede, M.P., Secretary of State for Home AHairs. winning the Dennis Boles Cup, an award Chiswick \'{Iorks, 195 . The Judges were which they have held since before the war. The trophy was presented by the Lord Mayor Dr. Maurice 11. Scott, of Plymouth . Taunton has a fine record and Dr. Abraham and Dr. last year reached the Finals of the G.W.R. Olive S. May. held at Paddington. Western Region A successful Social was held on 24th. February in aid of Divisional funds. Aml;m- SWANSEA DOCKS lance Officer T . Parratt was M.e. and Nurs111g Mr. E. V. Swallow, Supt. Lynch was responsible for the ample Dock l'.lanagel', presented refreshments. An orchestral and vocal a number of awards to concert under the direction of Dr. Crichton members of the Swansea ivIacGa.ffey, was given at the Empire Hall on Docks Class and also 26th February in aid of the local Ambu lance medals and cenificates to and Nursing Divisional funds. Messrs. A. Swaffield and County of Worcester W. Morris for exceptionHILL AND CAKEMORE ally efficient first, aid ren~ The Annual Meeting of the Division was ered. Mr. W. A. C. held on March 15th, when Acting Div. Supt. Morris Assistant Dock Mrs. Walker presided ov~r a gathe:ing whIch ManaO'~r presented gifts included Corps Supt. MISS Fearn~Ide, Corps to theble~turer, Dr. L. W . Treasurer Miss Wakefield, Acong Corps Hefferman, and the SecSecretary Miss D ye, Alea Cadet. Officer. Mrs. retary, Mr. F. Saunde~s, Lamb. Presidents Mrs. Uglow, MISS LeWIS and on behalf of the class, 111 appreciation of the servMrs. Newell-Roberts. The Txeasurer, Mrs. Hadley, reported a ices which these t\vo gent!l1r. J. ChuteI' Ede, Home Secretary, hal1~s Ol'er Ihe . Cballel/ge Clip lo successful year and the Secretary, J\r[.iss lemen have rendered to Sgt. McLean oj th~ Brighton .B.orou/Ih Poltce Force, wInners oj the PolIce Downing, reponed seventy. attendances at the movement in this area National First Atd CompetItIon since 1939. homes of patients, one first ald case and two for a number of yea.rs .

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THE ADMINISTRATION OF MEDICINES BY

AGNES E. PAVEY, S.R.N. Diploma 111 Nursing (University of London)

T is not only to the sick that medicines are administered,

rectum, as enemata, whilst certain substances are rubbed

into the skin. for they are used to promote health Idisease. It is important to know why a medication is given so For example, vitamins A and D given :n cod a~d p~event

~re

and halibut liver oil, or in capsules, to bUIld up resistance to infection and to prevent rickets. Preparations of mixed vitamins are widely advertised and many people take them in the hope of compensating for dietary deficiencies. Vaccines and sera are injected to protect individuals from succumbing to various infections, insulin is used to promote appetite and, in mou~tainous inland districts., iodine is given to prevent go~tr~. The more ext.ens1ve use of medicines, however, 1S ill the cure of disease and the alleviation of distressing symptoms that accompany illness of any kind. In home nursing, as in hospitals, it is important to see that the patient receives his medicines in the right dosage, at the right time and in such a way that the best results are achieved. The Care and Custody of Medicines Bottles must be kept tightly corked, for medicines containing volatile substances may become stronger or weaker if left uncorked. Any change in colour, odour or consistency should be noticed and should be reported to the doctor on his next visit, so that a fresh supply may be obtained. Doses of medicine should not be poured out until they are required, especially should the last dose in a bottle not be poured out and left until wanted. When a specially prescribed medicine is discontinued it is wise to empty the bottle and wash it out. The medicine should never be kept for another occasion or be given to another member of the family. This has been known to happen with such medicines as cough mixtures, sedatives and tonics, with disastrous results. All drugs are poisons, but when given in medicinal doses they may correct certain functions of the body that have been altered by disease. When, however, they are given to a person with a different alteration in function their effects may be most undesirable. Certain drugs, such as sleeping tablets and pain-relieving substances, need special care with regard to their custody, for overdosage may have fatal results. They must be kept in a safe place and must not be accessible to children or to any irresponsible person. A careful watch must be kept upon the amount in the bottle or the number of tablets, and if any are missing the fact is at once noted and enquiries made. Substances intended for external use should never be kept with medicines that are to be taken internally, for the former often contain poisonous ingredients. Methods cf Administration Most ordinary medicines are given by mouth and these may take the form of fluid mixtures, tablets, pills, powders, capsules and lozenges. Some drugs are given by inhalation, some are injected under the skin, a few are given into the

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and the bottle held with the label uppermost. Then the cork is replaced and the dose in the measure glass is checked by with the instructions on the label. If dilution is required water is added and the glass is given to the patient, who J. A. COOK may, after taking the medicine, appreciate a sweet or a (continued from March issue) drink. Linctuses and syrup cough mixtures should not be The stretcher is composed of a series of slats secured to a canvas diluted for thus they lose much of their effect. They act bed and shaped so as to form a complete set of splints for the chest best if they arc sipped very slowly.

FIRST AID AND THE THAMES POLlCE

The Giving of Oils Doses of oily substances may need to be prepared before taking them to the bedside. It is not so much their taste as their slimy texture that people find unpleasant, and this is particularly true of castor oil. For children, castor oil may be beaten into hot milk, when it become:; emulsified an d almost undetectable. This is an exception to the rule that no attempt should be made to disguise medicines for chil dren in articles of food, for this often engenders a permanent dislike of that food. Another method of giving oils is to warm a medicine measure by placing it for a few moments in hot water and then to pour in one or two teaspoonsful of orange, lemon or other fruit juice, seeing that all parts of the glass become wet with the juice. The dose of oil is poured in and more fruit juice is added. If the patient swallows the dose at one gulp he will taste nothing but the fruit juice. If available and the patient prefers it, whisky or brandy could be used instead of the fruit juice.

that it may be given in the right manner and at the right time, its effects can be observed and untoward results guarded against. For example, if the desired effect is to increase perspiration care must be taken to prevent chilling ; clean night attire must be at hand and perhaps warm towels with which the patient may be rubbed down. If to promote sleep, all physical needs must be attended to before the medicine is given and, thereafter, quietness and the absence of bright light is essential. Because of the depressing effects of narcotics on the vital centres, the patient must be watched and the character of his sleep noted, and also his condition on awaking. Some drugs act best if given undiluted, others need to be given with water or be followed by a hot drink, some should be' given before food, others after meals. No attempt should be made to disguise the taste of some of the bitter tonics, such as quinine, nux vomica and gentian. They should be given fifteen to twenty minutes before a meal and not be diluted, for they owe their stimulating effect upon appetite to their bitter taste; but drugs that might unduly irritate an empty stomach are usually given after meals, and so also are alkalis that reduce an overacidity of the gastric juice. Medicines containing iron, iodides or any other drug that might stain the teeth or leave an unpleasant taste in the mouth should be taken through a straw or a glass tube, the teeth should be cleaned and the mouth well rinsed out after the medicine has been taken. Slow-acting aperients, such as cascara and vegetable laxatives, are given at night whereas those having a rapid action, such as the various laxative salts, are best taken with a copious drink on awaking in the morning.

Medicines in Dry Form Pills, powders and capsules are handed to the patient in a teaspoon and he is given a drink; or powders and unpleasant drugs may be put into rice paper cachets which are handed to the patient in a spoon containing a little water, for they are much easier to swallow when moistened. Some tablets, especially aspirin and some of the sulphonamides and barbiturates, act better if they are crushed before being swallowed. They are then given in the same way as a powder. Many patients find difficulty in taking sulphonamides on account of the nausea and vomiting that may follow. This may be overcome by giving about a quarter of a teaspoonful of sodium bicarbonate in a little water about ten minutes before the tablets. A teaspoonful of glucose may be added with advantage in many cases.

The Giving of Medicines by Mouth Every nurse should know how to make a medicine as acceptable as possible to a patient. A small but attractive tr-ay must be provided and this could have not only the medicine and the required measure glass but also a small jug of water or fruit drink. A fluid medicine should be poured out in the patient's presence and one should develop a definite technique in doing this, ensuring accuracy and avoiding any staining of the label. The bottle should be taken in the right hand and the label read to refresh the memory with regard to the dosage and any other instruction, and then, with the first finger on the cork, the bottle is slowly inverted several times so that substances in the mixture that may be of different weights are uniformly mixed. The measure is held between the thumb and forefinger of the left hand, the little finger of which encircles the cork, draws it out and continues to hold it. The dose is then poured out with the measure glass held at eye level

Sedatives and Sleeping Draughts With regard to the administration, though not the dosage, of sedatives and sleeping draughts, a good deal is often left to the discretion of the nurse, for people vary in their response to such drugs. This is specially true of the barbiturates, such as phenqbarbitone (luminal). This mar induce sleep in a very short time in some people whilst its action may be delayed for many hours in others. A word of warning about leaving such tablets within the patient's reach may not be amiss. In several recent cases of death fro m overdosage with these drugs it has been suggested that, in some people, the drug affects the memory before it induces sleep and that the patient forgets that he has taken his tablets and so takes another dose. The administration of all drugs that induce sleep must be timed correctly, so that they act early in the night, for if the patient cannot get to sleep for some hours he already feels that he has had a bad night and his mental state is not then conducive to sleep.

and lower limbs, but leaves the hips and shoulders free. The bed of the stretcher is strengthened by two iron bars that traverse the entire length of the stretcher and large straps are permanently fixed with which the splints are secured and the patient immobilised. \.t the foot of the stretcher are two rope stirrups into which the patient's feet are placed if he is not suffering from an injury to the lower limbs and which prove invaluable when slinging him vertically through narrow hatches or up narrow companion-ways. A head-strap is algo provided which, being adjustable, keeps the patient's head secured to the stretcher and eliminates the risk of injury should he be, or become, unconscious whilst being raised or lowered. As used by the Thames Police, the stretcher is modiEed somewhat in that two lines are secured to the stirrup-ring in place of the standard ONE. These permit of a diamond-shaped sling being formed by passing the lines on their respective sides through the uppermost pair of handgrips (rope loops), and through the head-grommet (a large bound rope ring at the head of the stretcher). This avoids abrasion of the patient's head, which can easily be caused when lifting with only one line, and also ensures that the stretcher is raised more vertically with less resultant swing a great asset when the small hatch through which the patient may ha\'e to go is high off the deck and the swing of the stretcher cannot be controlled. It is a general rule with the Thames Police that, once a patient has been placed on the stretcher, he is not removed from it until he arrives at hospital, as it has been found that the feeling of support given, together with the warmth sustained, helps tremendously in combating shock. \'(7hen not in use the stretcher is carried, correctly rolled and stowed, in the fore-peak of the Police launch, where it is readi!), to hand should occasion demand. As is natural with so much work on the River, cases of drowning were of frequent occurrence and it is on record that the hazardous task of " shooting" Old London Bridge claimed (he life of at least O"lE LIGHTER~L\""I EVERY DAY! Thus it came about that a comprehensive knowledge of the various methods of performing artificial respiration became part of the normal requirements of the Thames Police Service and the men were, from the earliest times, thoroughly trained in the efficient and expeditious pel-formance of the particular methods that were in use at various times. The introduction of the Schaefer method standardised artificial respiration which, owing to the peculiar nature of the ground on which it often had to be performed (i.e., shingly and muddy foreshores), was slightly modified, and is still practised, in the following way: ~\.s soon as

the patient is remo\'ed from the water his body is doubled sharply forward over the arm of one of the Police boat's crew (this tends to remove the water, mucous and mud that accumulates at the back of the throat), no time is lost by this as it is performed whilst the patient is being lifted into the boat or dragged clear of the water.

The patient's head is always rested sideways on one of his own hands to ensure that the mouth and nose are clear of the ground. The operator always kneels at the side of the patient, for reasons now made apparent by the latest teachings.

FIRST

As swimming became increasin gly popular so did the number of operator who, having hastily removed the bulh holder to replenish cases of drowning, especially of young persons increase, and other the tube, saw the supposedly empty one leap o ut of t he instrument and discharge its contents w ith a loud hissing sound. remedies to assist in saving life were sought. This led, after many experiments, to the supply and use of the It must be emphasised that the administration of C0 2, by this or " Sparklets " resuscitator for the administration of C02 in conjw1.ction any other method, is only supplementary to the performance of with artificial res piration. The" J" size hand instrument, without artificial respiration and delay in the supply of the former must never an y attachment, was eventually selected as being the most suitable. stop the prompt and continuous application of the latter. (It is the It was small, compact and would not rapidly deteriorate in the damp practice in Thames D ivision that, w hen only one O fficer is present, atmosphere in which it had to be kept. Teak boxes were made by the artificial respiration is immediately commenced and maintained and Thames Division's shipwrights in which the instruments, together no C0 2 is used .) with six tubes of C02, were conveniently carried. The instruments It has been found in practice that w hen a person has been revived were never returned to the box loaded to ensure that no delay was with artificial respiration after immersion in the River Thames his occasiuned in use. A peculiar statement to make, bUl one easily _breathing re-commences very slowly and weakly, and has to be understood when it is realised that tubes left in the instruments may continually watched in case of relapse. When C0 2 is used in conleak, or be accidentally emptied by the action of the boat turning the junction, however, and the patient revives, the breathing usually valve key. KnOJIJil1g that the instruments were empty instead of thinking commences in gasps, he often vomits, struggles to get away from the that they were full was, therefore, the obvious method to adopt. In use the nozzles of the instruments are held at a distance of about one instrument and rarely shews tendency to relapse. (O ne unfortunate old lady who had been rescued from the River, after having tried to inch from the patient's nose and, on each inspiration movement, a drown her sorrows therein, on being brought round by means of whiff of the gas is given. Care has to be exercised in keeping the nozzles of the instruments artificial respiration and C0 2 accused her rescuers of trying to gas her I) higher than the bases, otherwise the C0 2 freezes. This peculiarity, In the foregoing article I have endeavoured to give you an insight in the early days of use, led to many an otherwise full tube being into the .6rst aid methods of the Thames P olice, a service that is so discarded in the belief that it was empty, often to the dismay of the little known outside the immediate environs of the River Thames.

The Medicine Chest By FRANK BERRY, PH.,C. Atropine This is a substance belonging to the complex nitrogen-containing organic compounds known as alkaloids. It is obtained from Atropa Belladonna (Deadly Nightshade) and several other allied plants of the same botanical family. These plants grow profusely in Europe and in some parts of this country. The free alkaloid occurs as white needle-like crystals and is only slightly soluble in water. For internal use, the water-soluble salt, atropine sulphate is generally used and this also occurs as colourless crystals or white crystalline powder. Atropine first stimulates and then depresses the central nervous sys tem and paralyses the endings of the parasympathetic nerves which supply the heart, glands, and unstriped muscles. In consequence of these properties the drug is of great value in reducing secretions, especially the saliva, bronchial secretion and gastric juice. It quickens the heart rate and is of value in treatment of poisoning by those drugs such as muscarine, morphine, pilocarpine and aconite, which slow down the heart's action. An injection consisting of atropine in conjunction with morphine is frequentl y given before the administration of a general ana::sthetic, the atropine ser ving to reduce bronchial secretion and maintain stimulation of the nerves controlling cardiac rhythm and respiration. By reason of its action on involuntary muscle, atropine has proved of great value in the treatment of dysmenorrhoea (painful menstruation), urinary incontinence, whooping cough, colic, and bronchial asthma, and has also been used with varied success in efforts to prevent seasickness and other forms of travel sickness. Atropine is extensively used in ophthalmic practice. Small quantities applied to the eye, in the form of drops (I to 8 grains per fluid ounce), ointment (0.25 per cent.), or eye-discs (each containing 1/5000 to 1/5 00 grain) dilate the pupil and temporarily destroy the power of accommodation, thereby facilitating examination and ensuring rest. Atropine is given internally in doses varying from 1/250 to 1/60 grain, although much higher doses aJ;.e given in t he treatment of Encephalitic Parkinsonism.

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Atropine met hybrornide and Atr opine methynitrate, are complex preparations u sed for similar purposes to Atropine, but being less toxic. The latter substance, more commonly known as Eumydrin, is widely used in ophthalmic practice and in the treatment of congenital pyloric stenosis of infants. Atropine and its salts are very poisonous drugs belonging to the deliriant group of poisons and death has occurred after taking as little as grain. Children are less susceptible to Atropine than are adu lts. Symptoms of poisoning include dryness of the mouth and throat, difficulty in swallowing, skin hot, dry and flushed, often with a rash resembling scarlet fever, pupils dilated, and vision defective. The patient becomes delirious and excited with an unsteady, staggering gait and often complains of frequent desire to pass water although quite unable to do so. Treatment should include administration of an emetic, followed by hot, strong coffee. The patient should be kept warm and every endeavour made to keep him awake. Artificial respiration may be necessary. B.A.L. (British Anti-Lew isite) This is a complex substance developed by British scientists during the recent war. It was introduced as an antidote against the vesicant Lewisite and for that purpose was issued in ointment form. The use of this substance has now been extended to the treatment of dermatitis and other complications and toxic symptoms which frequently develop during prolonged periods of arsenic, bismu th, or gold therapy. It is also proving valuable in treatment of poisoning due to mercury and several other metals. Until its therapeutic possibilities had been carefully assessed, this product was issued only through the Medical Research Council but now that the value of the compound has been established, arrangements have been made by the Ministr y of Supply for general issue by approved manufacturers. B.A .L. is now available in ampou les containing 5 per cent. of the substance in a suitable vegetable oil an d is administered by intramuscular injection.

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American clin icians state that any undesirable reactions following administration of B.A.L. may be prevented by pre-medication of the patient with Ephedrine Sulphate. Balsam of Copaiba This is a thick, yellow or brownish coloured, oleo-resinous liquid obtained from certain large trees which grow in Brazil. It has a characteristic smell and a bitter, acrid taste. It is used as a carminati ve and antiseptic and particularly in treatment of inflammation of the genito-urinary tract. The usual dose is 20 minims administered as capsules or in mixture form combined w ith Sandal Wood Oil, Cubebs or Buchu .

120 YEARS' EXPERIENCE

in supplying first - class dressings for the med ical world.

Balsam of Peru This is a pleasant smelling, treacle-like balsam o btained from certain trees which grow in Central America. It has anti septic properties and is used in ointment fo rm in the treatment of some skin diseases and as a wound dressing . Balsam of Tolu This is an aromatic, semi-solid balsam obtained fro m trees which grow in South America and the West Indies. It has useful antise ptic properties and is an ingredient in Friar's Balsam. In the form of syrup or tincture it enters into the composition o f many cough mixtures. (to be continued. )

Letters to the Editor FIRST AID TRAINING IN MATERNITY WORK D E AR SIR,

I congratulate you on your Leader in February FIRST Am : I should like to make my affirmation very clear to your motion proposed. Training in maternity work is not only desirable but necessary, not only to women, but certainly only to advanced students. I would suggest that training should be thorough and complete. One has only to read the daily Press to notice the cases of premature and sudden confinement in public places and vehicles-these have largely been attended by males-policemen, 'bus drivers, etc. Some years ago I asked a Divisional Surgeon for information regarding the emergency treatment of such cases, his reply was evasive. When will the profession trust the common sense and capable ability of first-aiders ? Doctors like A. D. Belilios should be encouraged in eyery way in their splendid teaching. Yours, etc., BASIL H. TAFFS . (35 )lears' Ambulance Service.) London, S.E.6.

Miscellaneous A dv ertisements. Advertisements with remittance should be sent to First Aid, 32, Finsbury Square, London, E.C. 2. Rare 3d. per word, minimum 4s. 6d. Trad e Advts . 4d. per wo rd , minimum 6s. Box numbers 1s. extra.

250 Concert Tickets, 8/6. Posters, Memos, Rubber Stamps. Sam-

ples free. "A" Tices, II, Oaklands Grov r., London, W.I2. HO W to Stop Smoking. Save Money. Safeguard health. Thousands cured. Send stamp for Booklet of World Famous Remedy. Stanley Institute Ltd., (Dept. 75) 265, Strand, London . R U PTURED ? FOR G ET IT! Use Brooks Rupture Applian.cethe new discovery. Wonderful! No lumpy pads, no spnngs, du rabIe, cheap. Binds and draws parts together quickly. Sent on t rial. Catalogue free . Address: Brooks Appliance Co., Ltd., C718A) 80, Chancery Lane, London, W.e. 2. (718 A) Hilton Cham bers, Hilton Street, Stevenson Square, :Manchestet, I. R EAL LEATHER CUFFS AND ELBOWS. Cuffs 2 6 set, Elbows z/6 set. Post paid, state colour required. Cash returned if not satisfactory. Clayton Leathercrafrs, Sutton-in-Ashfield, otts.

DEAR SIR,

Re first aid in maternity cases, I do not consider that this is a subject to be taught to first-aiders. The average first-aider is a working man who has a day's work to do, when he takes up his studies after work he has enough to study in his little Black Book and Home Nursing. If he can have enough knowledge to be able to do justice to these two subjects, he can deal with the majority of the cases which he is called to until relieved by " Medical Aid." Those w ho have the time or leisure to be able to study these deeper articles are really beyond the first aid stage and may even think of nursing as a career. I still think that a little knowledge is a dangerous asset. Yours, etc., R. HILL. London, E.I6.

.. FIRST AID "

QUER IES and ANSW ERS COUPON

To be cut out and enclosed with all Queries. April. 1948.

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Queries and A.ls,,;rers to Correspondents Queries will be dealt with under the follOlving rules : I.-Letters containing Queries must be marked on the top lefthand corner of the envelope "Que?)"" and addressed to " First Aid/' 32, Finsbury Square, London) E.C.2. 2.-AII Oueries must be written on one side of the paper onlY. 3.-AII Queries must be accompanied by a "Ouery Coupon" cut from the current issue of the Journal) or) in case of Oueries from abroad) from a recent issue. 4.-The Textbook to which reference ma)' be made in this column is the 39th (1937) Edition of the S.J.A.A . !vlanual ~(Fi,:rt Aid to the Injured.

Fracture of Spine F. J. (Allerton Bywater).-In recent times 1ve have taken part in various ambulance competitions and on several occasions we have had a fractured spine as the team test. fPe have a/nltrys applied traction to the head and feet when turning, lifting, or loading the patient on to the stretcher and until last S aturdtry this had been satisfactory to eZle,)'one. On this dtry) however) we were pulled over the coals and had marks deducted for not keeping up traction all the time from finding the fracture) until the patient 1vas loaded on to the stretcher. The necessity for applying traction to the head and feet of the patient arises as soon as any attempt is made to move the patient in any way. You will notice further that you are told in the Supplement to Textbook (page 10) to warn the patient to lie still. In my opinion, therefore, if no movement of the patient was being made, you were quite right in not applying traction to head and feet.- . Corbet Fletcher.

Examination Howler M. B. (Cambridge) .-In a recent examination I asked one candidate how he would treat a man who had slashed his throat with a razor and sustained an incised wound (rom u,ohich blood was spurting. He replied promptlY-" I would at once applY a tourniquet round the patient's neck! " Good! Next please! !-N.CF.

Use of Antiseptics F. J. (All~rton Byw~ter!.-Also we are divided in opinion 1'egardzng the appllcatlOn of antiseptics to wounds. Should this onlY be done in a house or ambulance room and not in the street or down a coal-mine) etc. Your opinion regarding both the.re queries 11)iII be very much appreciated by our ambulance team. The instr~ctions on page 23 of tbe Supplement to Textbook are qUlte clear and should be strictly followed in the treatment of wounds which must be protected from risk of infection.

EMERGENCY TREATMENT

OF SKINBe prepared INJURIES for an emergency and

keep Cuticura Brand Ointment in your First Aid Kit. It brings instant soothing relief to cuts, burns, skin lacerations-prevents spread of infection, quickly heals. Obtainable at all Chemists and Stores.

Incidentally, there is little fear of septic infection in a coal-mine consequent on the facts that the coal has been so long underground and that septic germs cannot live without nourishment. - .c.F.

Wound of Abdominal Wall

T. H. (Barwen).-The Textbook tells us on pages 130 and 13 1 ,

when we have to treat a wOllnd of abdominal wall, that, if the 1votltld is vertical1ve should la)' patient flat on his back with lower limbs straight. If, however, the 1vofmd is tratlS'I-'erse and 1JJhen there is no protrusion of bO}'}Jel lve must raiJ'e head and shotllders and drazv patient'S knees 1vel/ up) 1'phicD position closes the wound. When, h02JJever) the b012'ei protrudeJ lve are still to raise head and shoulders and to draw the knees tip lvhether wound is vertical or transverse. Our competition team maintains that if lve do this lPith a transverse lvound through lvhich bowel protruder we would nsk strangfllation and other iJ!juries of the bowel. We thank )'ou in anticljatiolt ofyour favourable reply to our qtlery.

The object of the instructions in the Textbook is to draw the lips of the wound together when there is no protrusion of bowel. Should, however, there be protrusion of bowel it would, of course, be undesirable to take any action which would tend to close the wound on the bowel. For this reason the Textbook tells you to keep the patient in the bent position when there is protrusion with verti cal or transverse wound of abdominal wall.-N.CP.

Treatment of Hremorrhage F. C (Leytonstone).-Readi~g throtlgh the Queries and AnnverJ section of the February ifsue of "First Aid" I came across a point that is to my mind a very important one) and one lvhich has not apparently been given atry thotlght in the teachings of the Supplement. I refer to the qHery razsed by E. J. (Newtol1m, fWalc1s) re the treatmet!t of h(lJmorrhage. The 1vriter 1vas presumablY critiCising the use of the indirect method of h(lJmorrhage control n01V out of date with the nelV treatment af n01V taught in the Sttpplement. According to the 1vords of the Book the writer IS correct il1 condemning the marking sheet for including marks for application of the indirect method for controlling the h(lJmorrhage when the method of direct pressure with the thumb should be used. However) that 7S the written word, but is it fair to criticlse on such slender evidence? ff7hat 1vas the motive behind the indirect method? I had recent experience of a similar competition and the first-aider ,vho applied the indirect method (temporarilY) was doing a great service to the patient. In this case the patient had fallen from a table) got his leg caught in a chair in falling and had sustained a fractured tibia accompanied ,vith arterial hmmorrhage 1vith bone protrusion. Being confronted with that case one had to act quickly, treating the lvotlnd lvhilst the leg 7:lJas still trapped in the chair 1Nas out of the question. The limb could not be

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exposed until the chair was ~·emoved) and the first aid material lvas on the IVery . ObVlous!y) the onlY IVery to save the chap from deteriorating into a state of sel'ere shock lvas temporari!J, to control the htemorrhage by pressure on the femoral artery in the groin until the c~air had bee~ remov~d, the limb exposed and the wound exammed for foreign bodzes, signs of fracture. Having diagnosed the ir!fury) pressure lVaS then momentari!J' relaxed to note the type of bleeding (although this l1Jas obvious the marks on the sheet can onlY be obtained b asking about the flow) etc., ~f the blood), hOlJ/elJer) antiseptics 7'vere prepared and the zvound dressed all in a space of a couple ~f minutes. This method if approach to a serious injury did save quite a c011Siderable amount of blood. In stich a cose I feel that a doctor is quite right in giving consideration to the first-aider lvho still remaills practical e1)e12 though I"JJords are changed in the general teachings. I feel that the use of indirect pressure in certain COJ'es siJo1l1d be permitted in future editions because otherwise b the time that obstructions, if present, have been remoJ)ed) the limb exposed and examined the patient 1vill houe lost quite a quantity of blood that may actuallY cause the patient to lose his life. I refer main{y to the i,,!juries one might meet in leg cases. H/'ith apologie.r for taking up so much of your valuable time I thank 'you for a very interesting and enlightening reading each month in the Query Column of" First Aid."

The Supplement to Textbook refutes your criticism which is not justified by the facts because, if you look up Rule 12 on page 26, you will see that indirect pressure may be applied to the carotid, subclavian and femoral pressure points when it is impossible to apply direct pressure successfully on wound for the arrest of arterial hremorrhage.-N.CP.

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(r.) If an individual2vho holds certificates) etc.) issued b.Jt the Association automaticalb' a member of the Association or must he applY for membership ? (2) Is he entitled to wear the Association badge ? If so) how is £t to be obtained ? I thank yotl for the help received through the columns of " First Aid." (1) Yes, p rovided that he/she has passed a re-examination within the last five years. (2) Yes . If he/she has complied with the condition just named, he/she can wear the badge of the Association w hich can be obtained on application to t he Manager of the Stores D epartment of the Association.-EDlTOR.

L ay Lecturers C S. (Maryport).- I have been a regular reader of " First Aid" for many years and e11)O)' reading the J ournal immensefy . I 1JJOU/d venture to ask your ad7Jice on a problem which is puzzling me. Among my duties as Senior Surgery Assistant (Admiral!)l) at this Depot, I have just completed the instruction of a dass of thirty 1vorkmen in first aid ill accordance with the St. John Textbook and Supplement. I 11Jottfd milch like the members of this dass to take an examination and 1vonder h01V this can be arranged) and h01V I can keep up the interest of my dass. Also, I 1vo1lld like to applY for the Lcry Instructor Cert~ficate . Unfortunately for you and your efforts, there is no regulation by w hich your class of workmen can take the official examination as they have not attended a course of lect ures given by a doctor. In these circumstances, I can only suggest that you continue with your first aid practice until you can obtain the services of a qualified practitioner w ho will give the official course of lectures. The issue of the Lay Instructor Certificate ceased last year.-N.CP.

Treatment of Crushed Hand A . K. (Cheadle Hulme).-At a recent Divisional Practice we ')JJere discussing the treatment ~f crushed hand. It is customary when putting up fractures of the extremities to secure the upper part of the splint first . In crushed hand, however, on Foreign Bod y in Stomach page 86 of the Textbook we are told-" To secure the splint applY a bandage, crossed in the manner of the figure-of-eight, F. A . ~Bulawayo,. Rhoc..lesia).-U~Tith reference to the query ~h,ch w~s p,ubltshe.d ~l1der the above heading i11 the January to the hand and wrist) and a second bandage round the forels~ue of F~r~t Aid, I note that jour replY seems to conflict arm." LV'0', Sir) do we reverse the order in this case? It wzth the opmwn expressed fry Dr. Belilios in his artide in was suggested that with this ir!fury there would be very the ~,:,gust/S5ue of " First Aid." He advises against the considerable sl'IJelling of the hand) and that the application of admtl1lstratzan of cottomvool sandwiches because) as he serys, the forearm bandage first would tend to increase this swelling ~he co~tonn:oo!. TIla.:}' 1vrap. round the foreign boefy and fry ~ b.J1 causing a partial constriction} whereas} the application 1I1creasmg /./s szze zmpede zts passage along the intestine and of the figure-of-eight bandage first would tend to promote even causing an obstruction. At the same time I notice that drainage. IVil! you be so kind as to give us your opinion . you qualify your reference to cottomvool sandwiches 1vith the Meanwhile} thanking you for your continued help . 7vord "perhaps ." The poilZt is an interesting om on Strictly speaking, the figure-of-eight bandage round the which you mcry like to offer further comment. MeaJ2JJ 'hile, hand and wrist gives full support to the injured part and I thrmkyou in anticipation ofyour kind attentiolt. takes the place of the bandages applied above and below Y?U know that the !ext book states that nothing should fractures of the limbs. Nevertheless, as the upper end of the splint is not under control and liable to be displaced, be glve.n ~y the n:o uth 1n cases of foreign body in stomach ; a narrow bandage is recommended to be applied round an~ this lll~ truct~on m us t be acted upon in all cases for splint and forearm to keep the splint in position.-N.CP. which m edIcal a1d can be obtained w ithin a reasonable time. As I stated in my p revious reply, if the arrival of ~xp~rt help i~ likely to be ~o ng del.ayed, other steps may be Badges of Association and Brigade Justified. Of these there IS no dIspute with reference to A. \Y./. (Batley).- I understand that there are separate badges stodgy foo d but there is. som e dou bt .as to the e fficiency for members of the S .J.A.A. and S.J.A.B. H ence my f1vo of the cottonwool sandWIches . Por thIS reason I includ ed queries which follow : the word" perhaps" in my previo us reply.-N.C.P.

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Send Now for FREE Booklet Every proficie nt First Aider understands the Structure of the body ; but do you appreciate the VItal role played by the glands of Internal Secretion-the Ductless Glands? Endocrinology and t he Science of G land Therapy reveal that the gland secretions or hormo~es, wh ich circul ate throughout the blood stream, determine the mental and physical character istics-the height, weight, temperament and health of the individual. Glan.d Regeneration , which goes straight to the root of phYSIcal , mental and nervous weakness and which has abund a n ~ ly proved. its remarkable rejuvenating power, is now available; an ,nformative booklet" Essence of life" touc~ es all aspects of this important subject and has been speCially written fo r the layman. Send for it NOW! a~d functions

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MAY , 1948.

No. 647.-VOL. LIV.

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PRINCIPAL CONTENTS Editorial A Course in Advanced First Aid-Unconsciousness The Medicine Chest News from all Quarters

3 4 6

Anatomy and Physiology in First Aid T he Care of the Aged in the Home Queries and Answers to Correspondents

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Editorial The National Health Service

As we write, the final details of the scheme are still being

o n 5th July next the National Health Service begins to operate. Controversy on detail an d political issues have tended to cloud the enormous importance of this great measure, the principal of which has the support of all the community . It is appropriate that the Service shou Id commence in the year when the centenary of the first Public Health Act is being celebrated. 1848 is a landmark in public health because the Act that was passed in that year recogn ised that the health and sanitary circumstances of the people were the responsibility of the governing authority, an'd the impetus it gave to the struggle of the sanitary reformers led to great improvements later in the century and the inauguration of local health services. The great benefits t hat followed have had wide social significance, and improvement has contin ued on increasing scale . We have no need to look back to 1840 to see how considerable has been the progress made in public health services. Even in the last thirty years vital figures such as maternal mortality (in London it has dropped from 3.11 per 1,000 bi rths to 1.23) an d infant mortality (108 per 1, 000 birt hs to 40) show how efficient ly the health services have been bu ilt up . Now, t he in ception of t he National Hea lth Service promises th at a uniforml y high standard of service shall be available to every man , woman an d child, regardless of" insurance .. or any other scheme. A comprehensive health service will be t he right of all, an d everyone is ent itled to use an y or all of the services with no question of qualification .

contained in the special leaflet on the new Healt h Service now being distributed is somewhat provisio nal. But there can be no doubt th at the new service wi ll be ben efic ial, and will represent in future years as important a landmark in pub lic health as that of 1848 which is be ing celebrated to-day. Some fe ars have been expressed , of course, of the possible dehumanising of medi cal care under state control, and no doubt vigil ance will be necessary to avoid the worst features of Bumbledom, but the doctors have shown themselves well able to take care of that aspect. As far as our read ers are concerned there will be no changes in the services they undertake. Howeve r perfect our health an d med ical services the first aid of the injured will always remain a vital cause. As far as we are aware the only provis ion in the new Act which affects fi rst-aiders is t hat which provides an ambulance service with no charge to the patient. Local autho ri ties will be respons ible, and the ambulance can be ordered by a doctor, or by anyone, of course, in an emergency. No doubt when the proposed Health Centres are built. increased facilit ies will be available to the ambulance and nursing organisations for training and other activities. But that is to anticipate. For the present we are cont ent to pay tribute ~o t~e importance of 5th July, 1948, we feel sure that It WI.II always be an outstanding date in the history of the publIC health services.

out between the docto rs and the Minister of A NEW era in public health will be opened when hammered Health , with the consequence that some of t he ad vice

A COURSE IN ADVANCED FIRST AID BY

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

UNCONSCIOUSNESS SO far in this series of articles, unconsciousness has not been considered. It is a complicated subject and one that is often equally difficult both for the doctor and the Erst-aider, there are so many possible causes and the patient, of course, is unable to help either by giving a history or by describing his symptoms. Some cases such as epilepsy and infantile convulsions are easy to recognise ; others require a comprehensive examination before a diagnosis can be made. The object of the next few articles is to increase the Erst-aider's knowledge of those forms of unconsciousness that he had already studied, and also to introduce him to other complaints which are not described in standard text books. The left Hemisphere of the Cerebrum. Notice the division into areas by the groves called fissures. Vision is at the The Erst point to realise is that unconsciousness is only a back of the brain. symptom or to be more correct only a sign-it is not a dis~ase; it is a sign of a complaint just as loss of power is a Sign of a fracture and fixity a sign of dislocation. Unconsciousness, therefore, is a sign of an injury or ailment that has affected the nervous system. The nervous system is divided into two parts (r) the ::::%:::::::o===-<~WHI TE MATTER central nervous system, (2) the autonomic nervous system. CONTAINING The central nervous system controls all the muscles of NERVe. FIBRES the body and is the seat of all sensations such as touch heat and pain and also of the intellect, emotions, reaso~ and will. It consists of the brain, spinal cord and the nerves. In act~on it can be well ~ompared to a telephone service to which every cell and tIssue of the body is a subscriber. The brain is the main exchange and is made up of numerous cells to which fine strands called nerve fibres are attached . Cross Section of the Brain. these cells and their Ebres can be compared to the tele~ Notice the bundles of nerve fibres originating from the grey phonists. matter and converging on the spinal cord. From Belilios, Mu~vany & ArmstlOng, Handbook of Elementary Anatomy and The brain itself is divided into four main parts: (r) the PhYSIOlogy. By courtesy of BaUlere, Tindall & Cox. cerebrum, (2) the cerebellum, (3) the pons varolii, (4) has two wires connected to his house. Of these two fibres the ~edulla ob.longata .. ~ach <?f these parts has separate one is or:- "uP. line" whi~h carries messages (impulses) functlOns and IS also diVided lnto two distinct halvesto the bram, while the other IS a " down line" along which one for ~ach ~ide of the body, although the division is messages are conveyed. only ObVI0US m the cerebrum. Some of the functions of The messages conveyed to the brain are mostly in the the various parts of the cerebrum will be learnt from a nature of sensations hence the nerves and Ebres along quick glance at the accompanying diagram. It should be oted that each half (hemisphere) controls the opposite which they pass are called sensory Ebres; those Ebres which come from the brain usually carry impulses causing SIde of the body. the movement of muscles, and are called motor. The .nerve Ebres of the brain become grouped together The autonomic nervous system is a branch of the central according to their functions into bundles called tracts and ner~ous system and controls the action of those organs le~ve the skull to form the white matter of the spinal cord; :vhlC~ are not ~nder the control of the will, e.g., the heart, this .can be ~ompared to .the ~runk line of the telephone mtestmes, respuatory organs, etc. The autonomic nervous serVIce. At !ntervals dunng Its passage down the spine system co?sists of two parts, t~e sympathetic and paranerves are gIven off from the spinal cord. These nerves sympathetIc systems and every mternal organ receives a pas~ towards the individual. parts of the body distributing nerve supply from both, one serving to increase and the theIr fibres. so that every tlssue is provided with at least other to check its action just like the accelerator and brake two Ebres Just as every subscriber to a telephone service of a motor car.

FIRS T

FIRST AID

AID

Finally, in this brief description of the anatomy and health of the patient; it may, for example, disclose that physiology of the nervous system, it must be emphasised he has been suffering from diabetes or high blood pressure, that the brain is the seat of the mind which includes the diseases in which unconsciousness is liable to develop as emotions, intellect and will. Study of the mind- a complication. psychology-is ~n enormous .subje~t and of great inte~est (b) Examination for Injury and Poisoning.-Head injuries and importance m everyday life. LIke the body, the trund are common causes of unconsciousness hence careful is liable to many disorders which are called psychogenic or examination must be made of this region. A scalp wound functional to distinguish them from physical ailments. or bruise may provide a valuable clue to a head injury; CAUSES OF UNCONSCIOUSNEss.-One of the chief worries on the other hand it may have been caused as the patient that confronts a Erst-aider when he meets a case of uncon- fell unconscious. sciousness either in reality or from the opposite side of the No examination of an unconscious patient is ever examination table is to remember all its possible causes. complete without examining the ears or nose to discover The only satisfactory way to remember a difficult subject a discharge of blood or cerebrospinal fluid (pale, watery such as a list of causes is to have a system or a method of fluid) which indicates a fractured base of the skull. classification and this is a sign that the first-aider himself The examination should not be stopped at the head. possesses a neat an~ tidy brain: ~itho.ut such a system, the Strictly speaking, every part of the body must be included, average first-aider In an exarrunatIon IS only able to recall for the unconsciousness may be due to severe shock caused, for example, by a fractured pelvis. a few of the many causes of unconsciousness. There are many methods of clarifying these causes. The possibility of poisoning must always be considered; One of the most satisfactory is to divide them into two It is a much more common cause than is usually supposed. groups-direct and indirect. direct cause is one in w~ch The Erst-aider must therefore smell the breath, examine the patient becomes unconsclOUS as a result of an a.ffec.tIon the lips and the mouth for stains and look for clues such which acts directly on the nervous system. An lIIdirect as a bottle, pill box and empty glass near the patient. (c) Special Plzysical Signs.-Examinatio~ ?f the eyes is cause is one which affects in the first place some other system of the body and only ultimately the brain. T?e essential; they must be exposed by liftlng the upper indirect causes form a very blg group, but they can easily eyelids. Subconjunctival hremorrhage (bleeding into the be recalled if the student thinks in turn of each system of white of the eye) is easily recognised and suggests a fractured base. the.body. The pupil may be small, larg~ or unequal: ~ute 'pupils When classified in this manner, the chief causes of called "pin point" sugge.~t e:ther narC?tlc p01s~rung or unconsciousness work out as follows :bleeding in the pons varolli, di~~ted pupils <?ccur It;l shock Direct: and poisoning from the delinants. Pupil~ which are (r) Head Injuries Ca) Concussion of the brain. unequal in size suggest damage to the bram caused by (b) Fractured vault of the skull. hremorrhage or a fractured ~k~. . (c) Fractured base. The Erst-aider should notIce if the pupils respond to Cd) Compression of the brain. light, which means become smaller ~hen the eyes are (a) Cerebral hremorrhage and (2) Illness opened or a light shone into them: Failure to respond to thrombosis. light usually indicates deep unconsClousness.(coma) wheth~r (b) Epilepsy. (c) Other disease of nervous system. the pupils be large or small. Another SIgn of coma 1S absence of the corneal reflex which is tested by gently (3) Psychogenic Hysteria, etc. touching the front of the eye while the upp.er li~ is ~ept (a) Narcotics. (4) Poisons raised. If the reflex is present, the low~r li.d will b~k. (b) Deliriants. This test should never be done unnecessarily smce touching (c) Prussic acid, etc. the cornea, particularly unless done very carefully, may Indirect: damage the eye. . (1) Circulatory System Hremorrhage, shock, fainting, Two other signs affecting the eye~ n::tay be of 1ID:portance, collapse. namely a squint and conjugate deVI~t10~. A squmt means (2) Respiratory System Asphyxia and all its causes. that one eye is out of parallel. wlth :ts fellow, ..u~u~y Infantile convulsions caused by (3) Digestive System turning inwards or outwards while conJuga~e devlat10n 1S worms, indigestion,' etc. present if both eyes are directed towards o?-e Side of the body. (4) Glandular System Diabetes. Insulin poisoning. Other special signs indicating an ~ffectlo~ ~f .the J?-ervo~s Urremia. (5) Renal System system include paralysis, convulslOns, ngl~ty, mcontlHeatstroke, sun stroke and heat (6) Skin, etc. nence and alterations in the pulse and ~reathing: The.se, exhaustion. INVESTIGATION OF AN UNCONSCIOUS PATIENT.-Diagnosis however, will be considered with the ailments m which of the more obscure cases of unconsciousness is made by they are found. PRINCIPLES OF TREATMENT.-Certain principles <?f trea~ (a) taking a history, (b) ~xamini~g for. injury and poisonin~, (c) looking for the speClal phYSIcal Signs liable to occur m ment can be applied in every case, even before a diagnosis has been made. Many of these are in~luded ~ the general affections of the nervous system. (a) The Hirtory.-This is obta~ed from relati?ns, rules of Erst aid since they include 1millediate treatment for priority conditions such as. asphyxia and hremorrhage, bystanders or friends who have wI~nessed the case smce undoing tight clothing, ensurmg an adequ~te supply of s its onset. They may be .able to ~escnbe the sympto:n a~d fresh air and sending for a doctor. T~e~ POllltS, how~ver)' signs before the first-alder arnved and most part1~~ally call for special consideration-th~ pOS1tiOn of the patient, to state whether there is any question of a head mJ~ry. The history may also throw some light on the preVIOUS the giving of fluids and observation.

1':

FIRST

(r) Position.-In many cases of unconsciousness, particularly coma, the tongue tends to slip backwards into the throat causing difficulty in breathing. This is readily recognised because a gurgling sound develops and the patient's colour changes to cyanosis. The obstrucrion can be easily prevented by keeping the patient's head turned to one side and if difficulty occurs pushing the lower jaw forwards from its angle. Most cases of unconsciousness are nursed initially flat on the back. If, however, there are marked signs of shock, the head and shoulders should be kept low and the feet raised. A flushed face suggests compression of the brain, cerebral hxmorrhage, etc., and is an indication for raising the head and shoulders.

•AID

FIRST

(2) Pluids.-The textbook rule, which is very sound, is never to give fluids or food to an unconscious patient owing to the risk of causing asphyxia. Moreover, it is generally quite unnecessary to make any attempt to give drinks. There are certain cases, however, when the giving of fluid is of great value as will be seen in later articles, but this should only be done in the early stages of stupor preferably after testing for the presence of the swallowing reflex (movements of swallowjng). (3) Observation of the P atient. -This again is a general rule of first aid but is of great importance in the unconscious case owing to the risk of complications such as partial asphyxia, relapses and attempts by the patient to get up before he has fully recovered.

The Medicine Chest By FRANK BERRY, PH.,C.

AID

Supplementary Notes on the Principal Barbitur~tes . . Barbilone.-This is a white crystalline powder havmg a shghtly bltter taste. In cases of nervous insomnia and in insomnia associated with See Hexobarbitone Evipao See Phenobarbitone heart disease it is a valuable hypnotic. It is generally given in the form Gardenal Known in America as For insomnia or prior 3 to 6 grains of tablets each containing 5 grains. Tablets containing Barbitone 2 Hebaral to operation Ortal Sodium Sodium grains and Amidopyrine 4 grains are frequently prescribed for sleepSee Hexobarbitone Hexaoastab lessness due to pain. Soluble Barbitone Soluble.-As the name implies, this substance is much more See Hexobarbitone Hexaoastab readily soluble in water than is Barbitone and although its action is Oral essentially the same it possibly acts a little quicker: . . A rapidly acting hyp- 4 to 8 gmins Hexobarbitone Hexobarbital notic with an action It is generally given in form of tablets each contammg 5 grams. Cyclonal of short duration Evipan Hexobarbitone .-This occurs as a colourless, odour less and tasteless, Hexaoastab-oral crystalline substance. As a hypnotic it acts quickly but its effec~s .do 3 to 15 grains by intraA useful anaesthetic for Hexobarbitone Soluble Hexobarbital not last long. It is usually given in the form of tablets each contammg or intravenous short minor operaCyclonal Sodtum Soluble muscular injection tions about 4 grains. . . Evipan Sodium Hexobarbitone Soluble.-This is a bitter-tastmg, whIte, odourless Hexanastab Sedative for insomnia 2 grains lpral Calcium powder which should be stored in well-closed glass containers. SoluSedative and hypnotic 8 grains night before Ipral Sodium tion& intended for injection should be freshly prepared. . for pre-anaesthetic operation and 8 grains Soluble Hexobarbitone is very extensively used as a general amesthetlc two hours prior to medication ~naesthetic for surgical and dental operations of s~~rt ~uration. .Owing to th.e See Phenobarbitone fall of blood pressure which follows 1O)ectlOn of this substan~~ It Luminal See Phenobarbitone should always be administered with the patient in a recumbent poslaon Luminal Soluble Sodium and careful watch must be kept on the respiration. The anresthetlc See BarbitOne Soluble Medinal effect passes off completely in two to twenty minutes according to the Produces surgical aoaes- 5 to 30 grains by intraNarconumal amount injected. . . . thesia of long or . venous injection hite Pentobarbitone Soluble.-This is a somewhat bltter-tastmg, shon duration crystalline powder which should be stored in well-closed. con~ners. See Pentobarbitone Nembutal Soluble Solutions intended for injection should be freshly prepared .1mmedia~ely See Butobarbital Neonal before use. Soluble Pentobarbitone is one of the qwcker actmg Known 10 America as Narcotic and sedative I {- to 3 grains Noctal barbiturates, the effect of which is not so prolonged ~d subs~quent Nostal . .IS therefore Iess l'k given pnor to depreSSiOn 1 eIy. It's 1 frequently . A very valuable hypHypnotic, I i grains; Pentobarbitone Pentobarbital Sodium surgical operations as its sedative effect tends to reduce th~ amount ~f notic and sedative obstetric, 6 to 7! grains Soluble Nembutal . . d It is also of great value ill obstetnc prior to general surSodium iso-Amy tal general anrest bcac requIte . ..' d tetanus gical anaesthesia . . practice and in the treatment of strychni.n~ POIS0rung an. Pentothal See Thiopentone Phenobarbitone.-This is a white crystalline po~d~r WIth a sll.ghtly Soluble Soluble bitter taste. It is an extensively used sedative. SimIlar to Barbitone, Octal Sodium See Hebaral Sodium but has a more powerful action and is therefore given ~ so:ar ler dosage. Known in America as Useful hypnotic for 3 grains Peroocton . the treatment 0 f epilepsy in which It lessens the nervous insomnia It is largely used 10 'd Pernoston of the attacks but care has to be taken to aVOI frequency and severity Phanodorm "\

cyclonal

See Hexobarbitone

Dial

See Allobarbitone

The Barbiturates This name is applied to a whole series of chemical compounds derived from the organic substance Barbituric Acid. By introducing different chemical groups into the basic molecule over I,500 different barbiturates have been prepared, but not more than about twenty remain in general use. The Erst of these compounds to be used in medicine was the di-ethyl substitution product prepared in I902 and introduced under the patented name Veronal. This was soon followed by phenobarbitone patented as Luminal. The medicinal use of the barbiturates is chiefly for depression of the central nervous system. They are all effective sedatives and hypnotics, the hypnotic effect varying from light sleep to deep coma and lasting from four to eight hours according to the product used, the dosage given and the reaction of the patient. In the absence of pain, sleep is usually induced within half an hour. The patient generally wakens refreshed, but occasionally there is lassitude, headache, vertigo, nausea and diarrhoea on the following day. In some cases restlessness and excitement are produced. The barbiturates are also used to counteract the convulsions of epilepsy, strychnine poisoning and tetanus. In ordinary dosage, the usual barbiturates are of little value in sleeplessness due to pain and in such cases they are usually combined with analgesics such as aspirin or amidopyrine. Allonal and Veramon are proprietary products of this kind. If taken in excess, toxic symptoms develop including depression of the respiration and circulation, feeble heart action, lowered body temperature, sickness, headache, coma and collapse. There is usually marked cyanosis and often a rash all over the body. Bronchopneumonia often supervenes. These cases are sometimes mistaken for opium poisoning or uraemia. In less acute cases the symptoms may resemble those of encephalitis lethargica (sleepy-sickness) with constricted pupils, slurring speech and unsteady gait. Continued use of barbiturates may lead to addiction, but the seriousness of this problem is not to be compared with that caused by the true narcotics. In recent years the barbiturates have been prescribed with greater frequency and it is to be regretted that many persons regard them as h:l,rmless and gradually use them to excess. There is an ever increasing number of deaths attributable to barbiturates and the group now ranks almost second to carbon monoxide as a means of suicide.

Some of the short-acting soluble barbiturates such as Soluble Hexobarbitone, Soluble Pentobarbitone and Soluble Thiopentone nre injected intravenously as general anresthetics but the procedure is not without danger and should only be employed by experienced, skilled anres the tis ts. Treatment of cases of barbiturate poisoning should be in accordance with general principles. The patient should be kept warm by hot water bottles, warm blankets and friction of the limbs. An emetic should be given followed by free administration of strong black coffee. Copious drinks should be given in order to encourage elimination of the poison, but alkaline solutions should be avoided as they would tend to convert the free barbiturate into a more soluble and therefore more potent product. If the patient shows signs of going to sleep an endeavour must be made to keep him awake by speaking to him sharply and slapping his face, neck and chest with a wet towel. He should not be walked about and nothing must be done which might cause exhaustion. Artificial respiration may be necessary. The following list includes the more important barbiturates together with brief notes on dosage and usc. StalIdard NOllie

Aluratc Allobarbitone

Alterna/iue, Proprietary eroS! Refer'lIce

1\1dlJ/C or

Dial

Amy tal Amy tal Sodium

Barbitone

Barbital Veronal

Barbitone Soluble

Soluble Barbital Barbitone Sodium Medinal Veronal Sodium Butobarbitone Neonal Soneryl Soporigcne Phanodorn Phanodorm

Butobarbital

Cyclobarbital

Use Dose Hypnotic ond sedative I to 2 grains Sedative and hypnotic Sedati ve, to I grains; fox n~rvous insomni:t hypnotic, 3 grains For insomnia and prior Sedative, to grain; to operation hypnotic. I i to 5 grains IIypnotic and prclimin- llypnotic. 3 grains orally ary to surgical operation Sedative and hypnotic 5 to IO grains for insomnia and depression Similar to Barbitone 5 to 1 0 grdins but possibly quicker

t i It lO t !

in action

Sedative and hypnotic in insomnia and nervous conditions Action similar to that of Barbitone but of shorter duration

I to 2 grains

3 to 6 grains

Phanodoro

J See Cyclobarbital

Phemitone

Prominal Rutonal

Phenobarbitone Phenobarbital Gardenal Luminal Somonal

Hypnotic effect not marked but anticonvulsant properties make it a valuable anti-epileptic Hypnotic-sedative and aoti-epileptic

Similar to phcnobarbiPhenobarbitone Soluble Phenobarbital tone but possibly Soluble Phenobarbitone Sodium quicker in action Luminal Sodium Gardenal Sodium Somonal Sodium See Phemitone Prominal See Phemitonc Rutonal For simple insomnia Sandoptal A rapidiy acting hypnotic with action of short duration

Seconal

Somonal

See Phenobarbitone

Somonal Sodium

See Phenobarbitone Soluble

Soneryi

See Butobarbital

Thiopentone Soluble

Pentothal Sodium

Veronal

See Barbitone

Veronal Sodium

See Barbitone Soluble

t to 6 grains

i to 2 grains

t to 2 gr2ins

habit formation. . . It may be administered as a pleasantly flavoured EhxIt or more usually in tablet form. " . . hi h Phenobarbitone Soluble.-This is a bitter-tastmg, "\.\-hite powder w c should be stored in well-closed containers. . '. " . . . '1 to that of Phenobarbitone but belQg readil) I ts actlOn IS Simi ar . .., Solutions for this soluble in water it may be given by lllection. urpose should be freshly prepared. . p Thiopentone Soltlble.-This is a water soluble, .y~llo:\·, C~St~~L~: odour. Solutions for 101ectlon S ou power lUti d WI'tb a ct..-··acteristic

frc;th~~ :rq.e:~d;Cting barbiturate particularly valuable for ptod~cinblg

3 grains I i to 3 grains

. when inh a1a ti on methods are unswta e general anresthesia espeCially . . . as i.n operations on the face or mouth. ., d b lOtravenous m)ecLike Soluble Pentobarbitone it is adnurustere Y . . d . s the same cautlOn as tion of a 5 per cent. solution an req~e H exobarbitone Soluble. (to be conttnued.)

.. FIRST AID" t

Has rapid anaesthetic I to 2 grains by inLCavenous inje .tion action useful for minor operations

QUERIES and ANSWERS COUPON To be cut out and enclosed with 0/1 Queries.

May, 1948.

• AID

FIRST

News From All Quarters the concert a presentation was made Service Medals to Div. Supt. A. G. Kirby THE ST. JOHN AMBULANCE to.Mter Supt. (R.) Webb by Mrs. E. M. Davies, and Cpl. H. Bradley. Widow of a past Superintendent. Supt. W. G. READI G Forward explained that Mr. Webb had recently BRIGADE. On the occasion of the v isit of H.M. The transferred to the Brigade Reserve and he

gave a brief outline of his acrivites for the King on April 7th, public duties were covered by members of the County and Reading Corps Brigade since 1914. No. 1 (prince of Wales's) D istrict under the direct su pervision of the Coun tv The Commissioner paid respect to the EASTER_ AREA mem?ry of Dr. Stanley Davies, whom he Commissioner (Mr. C. A. Poole) assisted by The first residential Conference of Ambu- descnbed as one of the finest lecturers on the Assistant County Commissioner (Mr. lance and Nursing Cadet Officers was held at first aid it had been his pleasure to "listen to. F. A. C. Jarvis) and County Superintendent Canvey Island, Essex, on loth and I Ith April. He spoke also of Mr. Webb's untiring efforts the Hon. Mrs. Leslie Gamage. Two hundred personnel were on duty but only a few minor The Conference commenced with a demon- on behalf of The Order." Finally, on cases needed treatment. . stration by Mr. E. C. Claxton (Hon. Organiser behalf of the rank and fitc he presented Supt. A First Aid Competition held on Match of the" Casualties Union ") assisted by Mrs. Forward with an engraved cigarette case, as \\lhiteley. It was proved that not" make-up" a token of appreciation of past services and 24 th, between Divisions of the Reading Corps, was won for the second year running by the but acting and staging took precedence in best wishes for the future. team from Reading Great Western Ambulance correct and faithful demonstration of casualties DAGENHAM Division. ' followed by " make-up" and planning. On Saturday, April 24th, members of the On April 24th, teams from Divisious in A visit to the First Aid Station manned by No. 94 Dagenham Ambulance and No. 60 members of the Canvey Island Nursing Nursing Division gathered to celebrate the Reading Nursing Corps competed for the Dr. Howitt Cup. The First Aid Tests were Division followed. 21st year of the No. 94 Division. District Following diruler Miss Cunard spoke on Officer E. Howard (founder of the Division) set and judged by Dr. J. V. Shemilt and the « Organisation of Programmes for Cadet and D.iv. Supt. G. Ware were present. Home Nursing Tests by Corps Nursing Officer Mrs. V. M. Crofts. Correctness of uniform Meetings." The history of the Division was outlined was judged by County Officer Miss D. K. T~e remainder of the .evening was occupied by Mr. Howard and Mr. Ware. Gibbins. The winners-for the third year iu by unpromptu entertauunent, dancing and Mr . and Mrs. Ware were presented with a succession-were the team from Reading games. silver pencil and bouquet respectively by South Nursing Division. The Cup was Th~ Conference continued on Sunday Mr. S. Kirk in appreciation of their efforts morrung at 9·45 a.m. preceded by a short on behalf of the Division and Mrs. D. B. presented by the County Superintendent, service conducted by Cadet Officer A. C. Howard was presented with a bouquet by who gave each member of the team a clinical thermometer. This team will enter Hunt of Fairbairn House Division. l\1:rs. Deacon in appreciation of her efforts for the County Competition to be held on Sunday's first speaker, Mr. Richardson of in the early days. May 15th. the Central Council for Physical Recreation On April 20th, members competed for the quickly pu~ his audien~e at ease by showing Dorothy B. Howard trophy at their head- THEALE On April 8(h and 9th members of Theale how phYSIcal recreatIon, whilst proving q~art~rs. The team test was judged by benefiCIal to the body and mind, was indeed Disttlct <?fficer E. Howard, whilst the theory Nursing and Cadet Divisions gave two cona pleasure and not a torture as was often test was Judged by the donor of the trophy, certs in aid of their funds. The amount raised thought. Mrs. D. B. Howard. The winner was Pte. was £II 8s. od. The programme consisted County Surgeon Dr. S. Margaret Thomson R. Spanton with Pte. S. Kirk a very close of sketches and songs by members of the three Divisions. followed with a talk on competition training. second. Then followed an interesting and useful talk on WALLINGFORD County of Berkshire "Routine Examination and Compilation of A competition was recently held for the BRACKNELL Marking Sheets." Gamage C;up b~~~en members of WallingT~e Dedication Ceremony was held on ford. Nursl11g DlvlSlon . The test, which was Following Dr. Thomson, Mr. F. Hodgson, the Youth Orgaruser fo r Essex Education Apnl 4th of the new Ambulance which has a written one, was set and judged by County Committee, spoke on "Youth Service" bee~ pres~nted to the Bracknell Divisions by Officer Miss D. K. Gibbins and resulted in a and the Child Welfare Officer for Ilford, Mr. th~Ir P~esldent, the Seventh Marquis of Down- tie between Ambulance Officer Miss B. E. E. s. Jenkins, spoke next on " Mental Health." shIre, 10 rem~mbrance of his Step-mother, Benford and Ambulance Sister Miss M. E. The last lecture of the Conference was on Evelyn MarchlOness of Downshite. Follow- Brett who will each hold the Cup for six " Co-operation" by the Chief Officer for ing the service at Holy Trinity Church, which months. The Cup was presented to the Nursing Cadets, Miss V. Cunard, who firstly was c,?nducted by the Bishop of Reading winners by Div. Supt. Miss A. .M. Rolls. thanked the officers of the adult Divisions for (the Right Rev. A. G. Parham), the choir, WINDSOR attending and for their co-operation and clergy and congregation proceeded to the Two courses of lectures on First Aid to the \~ent ~)O. to say that by co-operation she would courtyard of the Easthampstead R .D.C. offices Injured have recently been held at HeadgIVe It Its fullest meaning in its application, where the Sub-Prior, the Earl of Clarendon, quarters. The lectures for the Ambulance not only to the very necessary liason between K.G., P.c., G .C.M.G., G.C.V.O., LL.D., Division and members of the Police were a~ult and Cadet Divisions, but of co-operation accepted the ambulance on behalf of the given by Div. Surgeon E. C. Malden and Order. After the Dedication, the Sub-Prior WIthIn the Cadet Divisions themselves. those for the Nursing Division by Dr. A. After summing up, the Chairman thanked p~esented the Insignia of Honorary Serving the lecturers for their valuable assistance SIster of the Order to Div. Superintendent Jones. The results of both examinations were rs . M. K. Green (Bracknell Nursing Divi- 100 per cent. pass. The Examiner for the Miss Cunard for her presence for the whol~ week-end, the adult officers for their support slOn~; and Grand Prior Badges to Cadet Ambulance members and Police was Dr. from Slough, and for the Nursing and the members of the Conference for their M~r:~ Carter (Reading South Nursing Cadet Williams, members, Dr. Stoneham. close attention, all of which had gone to make DIVISIon) ~nd Cadet Rona Champ (Reading . An additional course of lectures is now being what had obviously been a very successful West NurslOg Cader Division). gIven to the members of the Police by Dr. D. week-end. MAIDENHEAD . Belfr~ge,. which will again be followed by an On Saturday evening, April 3rd, officers examInation. NEW CROSS and members of Maidenhead Ambulance B irmingh am C ount y On Saturday, 17th April, the Di\rision held a very succes~ful social at their headquarters Division entertained the officers and members YARDLEY of Maidenhead Nursing Division to a Social when the Co~ssioner, Major A. C. Whit~ On February 14th the Ambulanca and Kr;ox, Dr. King-Brown, Dr. Roe, D. IO. and Danc~. During the evening Div. Surgeon Nursing Divisions held their fourth annual WIckens and Corps Officer T. R. l\.fa~on W. Brodie Moore presented his Badge of social, when the chief guests were Div. Surg. Offi~e to the newly appointed Divisional Dr. A. Beauchamp and Cadet County O fficer attended. PreSIdent, Capt. F . C. Armitage, and Long Sr. ]. G . Billington. C(

FIRST Dr. Beauchamp presented the awards gained by the Ambulance Division during 1947. This was followed by a presentation to Div, Supt. L. A. Black and Mrs. Black on the occasion of his transfer to Coventry and imminent resignation from the Division. N. /C. CORPS "A" Nursing Cadet Corps "A" held a very successful Musical and Drama Evening on Wednesday, March 31st. The programme included a One Act Play by Divisional Officers, several items from members, and the first public performance by the Nursing Cadet choir . The aim of the Corps is to supplement the routine work by cultural activities and to give the members interests other than first aid and home nursing.

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annually by Nursing Divisions in N,W. Surrey, has been won by the Airscrew team, with Horsley B second. The Shield, given by Mrs. Gristock, wife of Corps Supt. Gristock, of the \"qest Surrey Headquarters, is to encourage 1urses to enter for competitions-the conditions of test being made as realistic as possible-{lnd it is hoped will do much to stimulate interest in nursing and ambulance work, which has declined since the war. County of Worcester DUDLEY The Dudley and District Corps recently held its eliminating round for the" Dewar" Shield in etherton. There were two competing teams. The results were announced as follows : Dudley-Team Test: I24 marks; Individual Tests: 77 marks; Uniform: 38t marks, a total of 239i marks. Stourbridge-g6, 94, 38 i, a total of 228i marks.

9 competition are shown belmv, Horsham No. I winning once again for the ninth year in succession, although on this occasion Waterloo No. I were only a short head behinda matter of 5 marks. These two teams are now eligible to compete in the Inter Regional Competitions, also being held at the Borough Polytechnic on 26th r-1ay, 19+8 . "\fadeS

I. Horsham No. I 41 3 2. \'\faterloo No. I 408 3· Exmouth Junction No. I 39 1 4· Ashford Works "A" 35 8 5· New Cross Gate... 357! 6. Basingstoke "A" 353t 7· Exmouth Junction No.2 34 6 t 8. Hove "A" 3-Ft 9· Eastleigh NO·4··· 299 10. Ashford Motive Pmwr '" 29 2 i II. Eastleigh NO·3... 284! 12. VictOria 264The general remarks of all who "'itnessed the competition, and the approximate number of visitors during the course of the dav was in the neighbourhood of 800, was surprise at the realism of the scenes portrayed. For example, in the case of the Team Test which occurred in a dock, an actual replica of a ship was berthed alongside, and a sound track of dock noises had beeu specially recorded and was played behind the scenes during the test. The conclusion of this most interesting event was when everyone assembled for the prize-giving, which ceremony was presided over by Mr. John Elliott, Chief Regional Officer; and supported by Mr. W. P. Allen, C.B.E., of The Railway Executive; Mr. R. 11. T. Richards, Deputy Chief Regional Officer; Mr. O. W. Cromwell, Chief Officer for Labour and Establishment ; Mr. and 1Its. A. E. Hammen, Commercial Superintendent and his \,ife; ~Ir. J. H. Chitty, Welfare Officer; l\It. E. Mathews, Station :\Iaster, Waterloo; and ;.It. and ;\Irs. E. S. ~Ioore. A Social Evening was held by (he 100'3 Bricklayers Arms Division on Saturday, April 3rd, at St. Giles Hall, Camberwell. Proceedings commenced with a First Aid Quiz for the" 1Iiles "Cup. This was followed by a Team Display of First Aid. Presentations were then made by the ;'Iayor of CamberwellCouncillor G. Burgess---and he recalled some of his own experiences as a first-aider on the old S.E. and C.R. He then presented the " Miles" Cup to the winner-Pte. F. Stark, and afterwards presented an eight-day striking clock to the retiring Hon. Div. Treasurer, Mr. G. Miles. Mr. 1Iiles replied and said how sorty he was to see so few new faces.

County of Leicester EARL SHILTON A. AND N. CADETS A variety concert held on April 8th raised an amount in the region of £20 in aid of the recently inaugurated Headquarters Fund. The play won for the Cadets a place in the HJLL AND CAKEMORE .D. finals of the Youth Drama Festival. The annual inspection of the Hill and CakeGIPSY LANE more ursing Division was carried out by On April 21St the Ambulance and Cadet Corps Supt. Miss Fearnside. All members Divisions gave their Arumal Supper and and probationers were present. DemonConcert for the Old Aged Pensioners. Wel- strations of stretcher drill, practical work, comed by the President of the Di vision, 124 first aid and home nursing were given. old folk sat down to supper. Corps Supt. Miss Fearnside afterwards congratulated the Division on the attendance, County of Lincolnshire appearance and general efficiency shown, BOURNE also the satisfactory order of the books. The Arumal General Meeting of the Division was held at Headquarters on Monday, HALESOWEN April 19th. At the Eighth Annual Meeting of the Councillor Friend presided, and presented Nursing Division, Div. Surgeon Dr. Newton Mr. E. W. Judge, former Superintendent, presided and those present were Corps Supt. with a tankard, and former Div. Surgeon Miss Fearnside, A./Corps Secretary, Miss Dr. Galletly with a cigarette case. Dye, Area Cadet Officer Mrs. Lamb, Cadet Both officers were connected with the Supt. Miss Bidmead, Cadet Officer Miss Coley, Division since it was founded 16 years ago. Cadet Officer Miss Wood (Brierley Hill), Dr. S. Johnstone, President Its. Corbett, the County of Somerset Rector and Mrs. Davies . BATH CITY The Secretary (nIts. Price) reported that Members from all the Bath Divisions were 43 drills and practices had been held, which on duty at all the concerts, theatre per- had been fairly well attended. Thanks were formances, etc., organised in connection with due to Dr. Newton, who had given a very the Bath Assembly and Festival of the Arts instructive course of Erst aid lectures. The held from 21St April-1st May, I948. The Division were also fortunate to have urse Bath Divisions also were on duty in the Crew, District Midwife, who at present was streets amongst the crowds throughout the giving a course of lectures on Home Nursing. visit to Bath of H.R.H. the Princess Margaret Two new members had been enrolled. Memon the 1st May, the final day of the Assembly. bers still manned the Medical Comforts Depot The Ambulance Cadet and Nursing Cadet for I hour each night and assisted with ocher Divisions provided a guard of honour at the case visits, and distributing of parcels to the entrance to the Pump Room when Her Royal aged. A successful Jumble Sale had been Highness arrived to inspect the Roman held, realizing a good profit. Div . Supt. Miss Baths during the course of her visit. Knowles organised a Book Drive for HalesThe Arumal Inspection for Bath and owen, and collected several hundred books for neighbouring Divisions will be carried out the hospitals. Members attended the Annual on the Recreation Ground, Bath, during the Inspection and Church Parades. Dances had " Anatomy & Physiology in First Aid " afternoon, 20th June, 1948. All members of been held which were a social and financ:ial April 1948 the Brigade then staying in, or visiting Bath success. The Treasurer (Miss D. Fox) reported on that date, will be welcome visitors. a successful year, and a favourable bank We regret that slight errors occurred in the last issue in connection with the placing of balance. TAUNTON patient on stretcher, and are indebted to a In the County Ambulance Competition held reader for drawing our attention to them. B RITISH RAILWAYS at Bridgwater on 24th April, a team representUnder the heading "If jour bearers are ing the Taunton Division was successful in Eastern Region winning the Lewis Lovill Memorial Challenge The Company's :~I'Ieritorious First Aid available " in line four the word "FOOT" Cup. This award is held annually by the Service Award has been granted to Mr. should read "HEAD," and in line five the winning team of those entering for the Dewar Prentice, Storesman of the Engineer's Depart- word "HEAD," "FEET." Shield, in the County of Somerset. ment at Stratford. Under the heading" If only three bearer! are Mrs. Geoffrey Luttrell, Lady County available" in line nine the word "FOOT" Southern Region President, presented the trophy. should read "HEAD," and in line ten the FINAL CO~IPETITION, 1948 word "Head," "FEET." C ounty of Surrey The above competition was held at the We apologise for any confusion caused by The Erst competition for the "Kathleen Borough Polytechnic, Borough Road, S.E.I, Gristock" Shield, to be competed for on April 2nd, and the results of a very keen these mistakes.

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ANATOMY AND PHYSIOLOGY IN FIRST AID by J. WELLS, M.R.C.S., L.R.C.P. Fractured Lower Jaw SIGNS AND SYMPTOMS Pain, loss of power, irregularity of the teeth, crepitus, bleeding from gums and difficulty in speaking and moving the lower jaw. Treatment : 1. Appliances required: Two narrow bandages. 2. Place the palm of the hand below the injured bone aDd press it gently against the upper jaw. The upper jaw then acts as a support to the fractured lower jaw. 3. Apply centre of narrow bandage under the chin, carry both ends upwards and tie on the scalp above forehead. 4. Apply centre of a narrow bandage in front of the chin, carry both ends backwards and tie at the back of the neck, below the occipital protuberance which prevents the bandage from slipping. 5. Tie both ends of the bandage on the same side together. 6. Should the patient show any indication of vomiting, remove bandages at once, turn the head to the sound side and support the jaw with the palm of the hand. \Vhen vomiting has ceased re-apply bandages .

even pressure on the fractured ribs and is less likely to become displaced. 3. Place the arm on the injured side in a large ann sling: this is also important to remember, ~.s movement of the arm moves the shoulder girdle and ribs.

Fractured Ribs with Complications, that is, when an internal organ is injured. SIGNS AND SYMPTOMS 1. If the lungs are injured, blood may be coughed up and expectorated. This is bright red and frothy, owing to its being mixed with air from the lungs. 2. If the liver or spleen is injured the signs and symptoms of concealed haemorrhage may appear, these are : (a) Pallor of face and lips, skin cold and clammy. (b) Giddiness, faintness and rapid loss of strength, especially when in the upright position. (c) Breathing short and laboured, accompanied by yawning and sighing. (d) The pulse becomes rapid, weak and thready and may not be felt at the wrist. (e) Patient pulls at the clothing round the neck, throws his arms about and calls for air (air hunger). (/) Finally, patient may become insensible.

Fractured Ribs SIMPLE FRACTURE Treatment : The sixth, seventh, eighth or ninth are the rib or ri~~ Appliances required: A large arm sling. Cold usually fractured. The fracture may be caused by indirect compresses. violence, forcing the fractured ends in an outward direction, 1. Treat as for hcemorrhage from an internal organ. or by direct violence, forcing the fractured ends inwards, and 2. D o not apply bandages round the chest. sometimes injuring the pleura) lungs or other internal organs. 3. Lay patient down with his body inclined to the The liver on the right side reaches as high as the upper injured side, and supported by cushions in this border of the sixth rib, and below reaches to the costal position. margin. The spleen on the left side is in close relation to the 4. Loosen the clothing, give ice to suck and apply an 8th, 9th and roth ribs posteriorly and so is liable to be ice bag or cold compress to the seat of injury. injured by fractured ribs on the left side. 5. Place the arm on the injured side in a large arm sling. SIGNS AND SYMPTOMS OF A SIMPLE FRACTURED RIB N.B.-When applying a cold compress it is well to I. ~harp cutting pain ~round the site of injury, especially get another ready before changing, so that if a deep breath 1S attempted; the breathing is the patient does not have to wait while short and shallow in order to move the fractured another is prepared. bone as little as possible. Treatment of haemorrhage from an internal organ : '1 'reatment : 1. Remove patient to hospital in the recumbent position 1. Appliances required: Two broad bandages. or the position suited to his injury, taking care at the 2. Apply two broad bandages round the chest, firmly same time to lessen by all the means possible the enough to afford support, with the centre of the effects of shock. first bandage immediately above and that of the 2. ~f the seat of the hremorrhage is known, apply an second bandage immediately below the seat of the !c~ bag or cold compress over the painful and pain. The lower bandage should overlap the upper illJured organ or area of injury. bandage to half its extent. 3. Give nothing by the mouth, except in hremorrhage The bandages are to be tied. with reef knots, rather from the lungs, when ice to suck or sips of cold ~o .the front on the opposite side of the body. This water may be given. 1S lffiportant to remember, as the ribs lie obliquely from above downwards. Their direction and Fractured Sternum (Breast Bone) posicion can be well seen on the skeleton. SIGNS AND SYMPTOMS If a towel is folded to about eight inches wide 1. Pain in chest. this can be passed under the body and the to wei 2 . DiHiculty in breathing. can be fastened by four or five satety pins down the 3· Shock. The nearer any injury is to the cardiac area, front of the body. This, in my opinion gives more the greater is the resulting shock, as a rule.

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Treatment :Fracture of Humerus Appliances required: None. The bone may be fractured :r. Undo all tight clothing about the chest. 1. In its upper third. 2. Place patient on his back, supported by cushions in 2. Near middle of shaft. his most comfortable position and remove him to 3. At its lower end, involving the elbow joint. hospital or shelter. SIGNS AND SYMPTOMS OF FRACTURED HUMERUS 3. Treat for shock if necessary. The general signs and symptoms of a fracture arc present. Fractured Clavicle (Collar Bone) Treatment : Frequently caused by a fall on the shoulder or out(a) IV-hen the fracture is in the upper third oj the bom. stretched hand. Can also be caused by a direct blow on Appliances required: Two triangular bandages. the bone. The patient usually supports the arm on the 1. Apply ~ broad bandage, with its upper border injured side at the elbow, and inclines the head to this level with the top of the shoulder. Pass it side. The outer fragment of the fracture is usually the round the limb and body and tie in the axilla lower, owing to the weight of the arm pulling it down, on the opposite side of the body. the upper fragment being pulled up above the lower 2 . Apply a small arm sling, to support the injured fragment, owing to the sternal end of the sterno-mastoid limb. muscle being attached to the inner end of the clavicle. (b) When the Humerus is fractured near the middle of the shaft The other end of the sterno-mastoid muscle is attached to of the bone. the mastoid portion of the temporal bone. Appliances required: Three bandages and three splints . SIGNS AND SYMPTm1s. General signs and symptoms are r. Place forearm across the chest at right angles to the arm. present. 2. Apply a small arm sling. If, after taking off coat and waistcoat of patient, when 3. Apply splints, reaching from the shoulder to seated on a chair, you stand behind him and place your the elbow, on the front, back and outer surfaces right and left index fingers and middle fingers on the sternoof the arm. clavicular joint, the clavicles can be felt along their entire 4. Secure splints by bandages, first above the length to the tip of the shoulder joint, by moving the fracture and secondly below the fracture . fingers of both hands along the clavicles at the same time. 5. If splints are not available, secure the arm to the Should there be any difference in the two bones, this will side of the body, by two broad bandages. easily be felt by comparison; while the patient is in this (c) When the fracture is near) and involves the elbow joint) position, all the borders of the scapula and its spine can be whether of the humerus or forearm . felt in the same way. This points out the importance of comThis fracture is attended by much swelling, and it paring the sound side rlJith the injured side) when examining the is often difficult to make out the exact nature of the patient for fractures. injury. Treatment of Fractured Clavicle ; Treatment : 1. Appliances reqtlired: Two triangular bandages, and Appliances required: An angular splint, four bandages a good pad three inches thick and two inches broad and an ice bag or cold compress. to place in the axilla. r. Make an angular splint by tying two splints together, at the level of the elbow joint, the one reaching from 2 . Remove coat and unfasten brace on the injured side, the axilla to beyond the elbow j oint, and the other to prevent pressure on the fracture. long enough to reach from beyond the elhow to 3. Place pad in axilla, this will act as a fulcrum to pull the finger tips. Be sure that the upper splint does not the fractured bone into position. press up too high in the axilla, for fear of pressing 4. Apply a St. John sling. The tips of the fingers of on the axillary artery. As the length of arm and the hand on the injured side should be placed well forearm vary so much in different people, it will be up on the opposite shoulder. found useful to first make the angular splint to fit the 5. With the second broad bandage secure the injured sound arm, afterwards turn the splint over and it limb firmly to the side. This is passed round the will then be found to fit the injured limb, without, elbow and trunk and levers out and draws back the as often happens, to have alterations made to it to shoulder, the pad in the axilla being the fulcrum. make it fit. 6. Be sure to ascertain if the pulse is present at the 1vrist after 2. Apply the angular splint on the side of the flexed dealing with fracture. If the pulse cannot be felt, limb, which shows the less injury. relax bandage round the body until it can be felt. 3. Secure splint by bandages :7 . Finally, tighten the St. John sling. (a) Round the arm. (b) Round the forearm. Fracture of the Shoulder Blade (Scapula) (c) Round the hand and wrist as a Egure of eight This is a rare fracture. bandage. Examine the scapula as recommended under fractured (d) Apply a small arm sling. clavicle. (e) Apply a cold compress or ice bag over the Treatment ; fracture to reduce swelling. Cold constricts Appliances required: Two triangular bandages. bloodvessels, and therefore lessens the amount Apply the centre of a broad bandage il~ t.he axilla of the of blood going to the injured part and so injured side, cross the ends over the un:n)ured ~houl~er, reduces the swelling. and tie them in the axilla. Support the injured 11mb 1n a

St. John sling .

(10 be continued.)

(Please ttlm to page 9.)

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THE CARE OF THE AGED IN THE HOME BY

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

A S the years increase and old age appro~ches num~rous authority upon life by reason of his long experience, but

physical and mental changes occur in the ordinary as senility develops any peculiarities of temperament that course of nature. These result from degeneration of the have previously been under control become unrestrained, arteries and other tissues, and even if no definite disease and suspicion, jealousy and egotism are common. They is present, a very thin line separates the natural infirmities feel, because they do not quite understand what is going of old age from a state of chronic invalidism. How far on, that people are trying to deceive them or cheat them such invalidism is inevitable and to what extent it can be and sometimes they believe that they have become very avoided or delayed depends, in some measure, upon .the poor and they deny themselves even necessities such as degree of understanding and the wisdom of the management food, warmth and clothing. The mental confusion may be worse on waking in the morning, probably because of of the aging person by those around him. lessened blood supply to the brain during the night, but Physical Changes These are manifested by a wrinkled skin, a shrunken later in the day and towards the evening they have periods hody and a gradual failing of vision and of hearing. when they are almost normal, and it is difficult for those Declining strength makes for slowness in movement and who see them only at these times to realise their true state. a tendency to unsteadiness . The increasing brittleness of Ultimately, mental deterioration may progress to the stage bones may predispose to fracture, whilst changes in the of complete dementia, the patient behaving like a totally skin may lead to a sub-acute eczema, a scaly eruption or the helpless and incontinent baby; or he may become quarreldevelopment of warts. Most old people have some latent some and violent, resenting any interference and losing all physical defect, such as chronic infection of sinuses, an old idea of time or place. He may wander about inadequately gastric or duodenal ulcer, a valvular defect of the heart, clothed both by day and by night, and he may believe that chronic bronchitis or asthma, a tendency to rheumatic he is back in the home of his youth and that his parents are joints, varicose veins or ulcers, or an enlarged prostate still living. Senile persons who have been extremely gland. These can gradually undermine health and finally fastidious about the cleanliness of their persons and their result in an illness that renders the person bedridden for homes sometimes cease to take any interest in these things, the remaining period of life. It is important to remember, refusing even to wash or to change their clothes and however, that the aged have only managed to survive becoming wet a.Q.d dirty in their habits. because of their tenacious hold on life and that few lazy General Care of the Healthy Aged Person or self-indulgent persons ever reach old age, so that one The best place for the old person is in his own home and often finds surprising powers of recovery from illnesses surrounded by his own belongings, provided that he can in old people. be made happy there and receive the care and attention he needs; he should lead an ordinary life in the community Mental Changes Failure of attention and of memory may be the first to which he belongs. In fact, there is often no alternative indications of an aging mind. The habits and attitudes owing to the acute shortage of institutional accommodation, become fixed and there is an inability to absorb new ideas. so that in many homes at the present time there is an elderly The aged person becomes fussy and is apt to be upset by relative, and it is sad indeed if he comes to feel that care is trifles. The emotions are shallow and the old person is grudgingly given, that he is in the way or is an economic easily moved to tears or to anger, but these are not of long burden upon the family. He needs security, approval and duration. Any alteration in the routine of his life may affection, and he must be made to feel that he is still needed. cause distress, although he is often quite convinced of his An old person should have his or her own room, with ability to manage his own affairs and also those of others, writing materials, radio, matches, ash tray, books, magazines and he resents being" looked after." However, he usually and anything else he desires. The room should be warmer lacks the capacity for making decisions and his judgment than is necessary for younger people and the lighting may be impaired, which makes it easy for unscrupulous must be good. people to exploit him. His mind cannot keep pace with Personal Cleanliness current happenings and he tends to live in the past. Old Most able-bodied old people follow the habits of their people are often very lonely, for most of their contem- lifetime and, at least whilst their mentality is unimpaired, poraries have died or have moved to other parts and they like to keep themselves clean, but as the skin is dry and he cannot form fresh ties of sufficient strength to keep them perspires but little a daily bath is less essential than for engrossed with the present. They often obtain happiness younger people. Gentle rubbing of the skin after the and satisfaction from talking about " old times" and of bath is beneficial, for it stimulates the circulation and helps those whose memory means more to them than anything to avoid pressure soreness. The hair or scalp should be in the present; and they may become annoyingly garrulous. washed weekly. A dry shampoo could be given if the The elderly person frequently", feels himself to be an head is greasy and a hair tonic rubbed in. Old people should

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be encouraged to take a pride in their appearance, and if an for an old person to have a bowel action only once every unpleasant looking old woman can be transformed into a two days. It is unwise to fuss about this for old people dainty old lady she will be a much more agreeable and tend to become "bowel conscious"; but chronic concomplacent member of the hou sehold. stipation must be avoided for it often leads to sleeplessness Clothing and irritability. Because of poor circulation it is important that the Exercise and Occupation extremities should be kept warm. During the winter, long Old people should be encouraged to be up and about and woollen stockings and woollen or fur-lined gloves give to take daily exercise in the open air. This helps to keep comfort, and woollen underclothing can be worn with the muscles and joints flexible and avoids the feeling of advantage during most of the year, warm slippers being ~oldness of which old people often complain. During worn in the house. Old people should be encouraged to mdement weather they should do deep breathing and take an interest in themselves. They are usually much more stretching exercises. When walking, an aged person often pleasant companions when they feel that they look nice has a better posture if he carries a cane or stick. As far as than when their shabby clothing puts them at a disadvantage. is possible, old people should occupy themselves usefully, For example, even a very old lady likes a hair-wave and a doing any little jobs in the house or garden that are within little make-up, and an old gentleman appreciates an their power. This not only helps to fill the time but it attractive shirt, tie or sweater. provides interest and makes them feel that they are still useful and even necessary. They should be helped to Nutrition Like children, old people eat better if they are entertained develop hobbies that keep them occupied, and this often and the food looks attractive. Because of defective or involves mental as well as physical exercise. It creates artificial teeth they eat slowly, but one must be sure that opportunities for conversation and may widen their circle mastication is not painful on account of ill-fitting dentures. of acquaintances and even become remunerative. When They often have fixed ideas regarding the foods they like old people become cantankerous and malicious it is often and those that do or do not agree with them. They seldom because their lives lack interest and useful occupation. eat too much. If they do it is usually because they are Rest and Sleep An old person's chair should be comfortable and have thoroughly bored and find eating an agreeable method of passing the time. It is a modern view that many of the arm rests, for when the elbows are supported the shoulders smaller physical dis3.bilities of old age are indications of a are thrown back and the chest is expanded. Leg rests are vitamin deficiency. For example, spongy, bleeding gums desirable so that the legs can be horizontal when the body and tender muscles may be a minQr degree of scurvy and is resting. In general, aged people require less sleep than will improve if more fresh fruit or ascorbic acid tablets younger people, six hours each night being sufficient. are given. \Xlatery or chronically inflamed eyes and ocular Sleeplessness at night is often due to sleeping too much fatigue may be due to lack of vitamin A. This is found in during the day, probably because there is nothing else to milk, cheese, butter, egg yolk, liver, the fat of meat and fat do. A little alcohol or a glass of warm milk at bedtime fish such as herrings, sprats, salmon and sardines, and it may help to induce sleep . can be manufactured in the body if its precursor, carotene is taken. This is present in tomatoes, carrots and all leafy vegetables and yellow fruits. Lack of the vitamins in the B complex may give rise to digestive disorders, constil?aANIMAL AMBULANCE AS MEMORIAL tion, nervousness, irritability and ill-defined aches and pams Members of the Women's Legion are anxious to raise a memorial in muscles and joints. Wholemeal bread, yeast, liver and kidney are good sources of these vitamins and so are to their three gallant officers, one commandant and two senior officers, " Bemax" and "Marmite." Undoubtedly, the best way who gave their lives in the service of their fellow men and women on to secure an adequate vitamin intake is to give a varied and the night of September 15th, 1940. The memorial-and there could well-balanced diet, but this may be supplemented by cod be no better nor finer one-is to be a motor ambulance for small and halibut liver oil and by laboratory preparations of animals which will serve the East End of London where the members of the Legion worked for so many years. vitamins. This will bring help, night and day, to those unfortunate animals With regard to fluids, tea is often found to cause less indigestion than coffee, and if old people are .accustome~ to injured in street accidents, and help the poor people who cannot so take alcohol in moderation it is usually a mlstake to With- often afford to pay fees for the care of their pets. The ambulance will draw it. Aerated fluids may cause flatulence and should be be given to the People's Dispensary for Sick Animals (p.D.S.A.) Those who have read that excellent and touching book" They Also avoided. Smoking . Serve," by Dorothea St. Hill Bourne, will remember the many stories This often gives so much enjoyment and comfor~ that 1t of the bravery, devotion and gallantry shown by animals during the would be wrong to restrict it, even if it appears detr1ment~l bombardment, sp this ambulance will not only be a memorial to the to health. For example, smoking may aggravate a chromc brave women who gave their lives but also to the many animals who bronchitis or gastritis, but it may prove one of ~he greatest suffered during the Battle of Britain. It will cost £800 and contributions, however small, will be gratepleasures left in life and affords rchef from loneliness. fully acknowledged by the Hon. Secretary, "Women's Legion Excretion Elderly people do not always feel pain from retention of Memorial Fund," c/o P.D.S.A., 14, Clifford Street, London, W.I. In a world where so often cruelty and violence seem rampant surely urine, but this may lead to paralysis of the bladde~, so they should be encouraged to pass urine .at regular mtervals. this wOlk of recognition for what is past, and of mercy and kindness On the other hand, they should not yIeld t.o ev~ry urge.or for the present and future demands our generous support. Yours faithfully, the capacity of the bladder may become Impaued. With Fasona, Italy. NAO IT JACOB. less diet and particularly less" roughage" it is quite normal

Letter to the Editor

FIRST

AID

QUESTIONS

Queries and Answers to (jorrespondents referred to on page 22 of the Supplement to Textbook. In the disease to which you refer (and to which the name " h~mophilia" has been given) the clot does not form. Consequently, there is no natural method of closing the wound. The importance of this condition is that the patient must be removed as quickly as possible to hospital where suitable remedies are available; and in the meantime you should apply direct pressure as taught in the Supplement.-N. C.F.

Fracture of Spine J. K. (Chesterfield).-Would you please clear this problem up for us. Rule 8, page 12 in the Supplement, for transporting a fracture of the spine, reads that we must place a folded blanket beneath the calves to lessen pt'essure of the heels on the stretcher. Does this mean for all cases of fracture of the spine or just for cases of cervical i1'!juries for 1vhich rule 7 lcrys down instruction? Please rep!J at the earliest opportunity as 1ve should like to have our problem cleared up before we meet with it in competition or in reality. This instruction applies to all cases of fractured spine, because, as stated in the Supplement to Textbook, it aims at preventing undue pressure on the heels of the patient.N.C.F.

Action of Creosote G. W. (\Vimbledon).-The Press recentlY reported a case of a young child fal/ing into a drum of creosote, being taken to a nearlry hospital for treatment and apparent!J sufferi!1g no injury other than staining of the skin. My first aid colleagues cannot agree on the appropriate treatment if they were cal/ed upon to render first aid in such a case, particular!J as regards the eyes) ears and mouth ; and we should appreciate your advice. I should like to add that we are all avid readers of your replies to queries and regular!J discuss them at our first meeting after the publication of FIRST AID. We await your replY with interest and thanks. Use of Tourniquet Pure creosote is a powerful antiseptic and deodorant. Its action resembles that of phenol though it is less irrita.ting H. W. (Bath).-Sinct' receiving the Supplement to Textbook, we have tried to forget that a tourniquet ever existed! Please and less poisonous. Applied to the skin, creosote produces tel! us if we are wrong, as in a recent competition I intentionburning followed by numbness. Treatment would be as alb left the tourniquet unused. Later I was very annoyed for a burn as laid down in Chapter XV of the Textbook. to note that marks were awarded for temporary brachial On the other hand, commercial creosote, such as is used to preserve timber, is practically non-injurious, and the flexion and to find at foot of marking stood a note which read-" Arterial haemorrhage in this area practical!J case quoted by you probably falls within this category. The stains resulting from contact can be removed by alwcrys requires pressure on brachial artery and perhaps a washing in the usual way. - N. Corbet Fletcher. tourniquet." Was not this ruled out lry the Supplement? Your kind rep!J will be much appreciated. Examination Howler You do not give details of the injuries which had to be L. R. (Charlton Park).- In a recent examination I asked one treated, and it is therefore difficult to understand the candidate what he would do if he was called to a patient who reason for the decision that pressure must be applied to had sudden!J developed a large hernia in the groin. Without the brachial artery. According to the Supplement, when any ~esitation) he replied-" I would at once app!J an it is impossible successfully to apply direct pressure, then e~a~ttc bandage round the swelling and tie it tightly ! " the pressure point is to be used. I assume, therefore, Thts statement caused a loud gasp of astonishment from all that the case with which you had to deal was an example within hearing ! of this group.-N.C.F. Good! Next please! !-N.C.F. Burns from Cap Lamps Bleeding Without Clotting J. J. (Ripley).-As a party of first aid workers at a local E. F. (Dowlais, Glam.)-Recent(y I came across a man zvho colliery we have a query to set before you. had a capillary haemorrhage from a 1})ound of his thumb, During recent weeks we have had to treat a number of and who told me that his blood would not clot. I have since patients 1vho have sustained burns from cap lamps which lea~ned that patients who are thus affected are in dread for contain a battery content of cat-Is tic potash and lithia; and tketr /z'tJes. W~uld you,. through your valuable journal, please we have come to the conclusion that the main effect is that gzve me some tnformatzan about this unusual weakness and of a caustic alkali. Since) however) we know so little about also tell me what is the correct first aid treatment? the chemical content of these pozsons we should like to have hen b.loo~ escapes from the body a substance is formed your views on the treatment of these injuries. We thank which aSSIsts 1n the formation of a clot; and this clot is you in anticipation ofyour ear!J replY.

ANSWERED

ABOUT

THE HUMAN BODY by

Queries will be dealt with under the following rules : I.-Letters containing Queries must be marked on the top lefthand corner of the envelope "Query," and addressed to " First Aid/' 32, Finsbury Square, London, E.C.2. 2.-AIIQueries must be written on one side of the paper onlY. 3.-AII Queries must be accompanied lry a "Ouery Coupon" cut from the current issue of the Journal) or) in case ofQueries from abroad) from a recent issue. 4.-The Textbook to which reference mcry be made in this column is the 39th (1937) Edition of the S.J.A.A. Manual of First Aid to the Injured.

AID

The Body as a Whole; Skeleton; Muscles; Respiration; Circulation of the Blood; Symphatic System; Digestive System; Various Abdominal Organs; Urinary System; Nervous System; Brain; Genital Organs; Embryo; Skin; Special Senses, Touch, Light, Hearing, Smell, Taste; Internal Secretions; Death; Bibliography; Glossary; Copiously Illustrated

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SHE STUDIED WITH CLOUGH'S . and passed with honours. HYGIENE, January 1948. 11th March, '48. Dear Miss C ...• - , May I take this opportunity oj tha'lking you attd my teachers /()1' all the assistance I received in passing my General H ygiene Diploma? I have already passed the name oj y() IIr Cali ege r01~nd my colleagues and have no doubt that you will soon have a jew more studults jrom our hospital. Thanking you ngaill jor all yOltr work in co,mection with me. I remain, YOttrsjaith/l'Uy, M. R.· _ .. ,S.C.R.N. Postal Tuition :-

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There should be no leakage from those batteries, and what you report rather points to t.he ~ecessity for a more frequent examination of the battenes m order to ascertaln if there is any sign of leaka~e. . . Cases of burns from the liqu1d which merely oozes from the batterr should not result in serious injury, and the probabilitY is that, when. the patient .is brought to rou, the cause is no longer actn-e and that It becomes merel) a question of the treatment of a burn of the firs.t degree. In these circumstances the treatment of the resultmg burns would be as laid down in Chapter XV of the Textbook, pages I78-I79.-::\'C.F.

AID

FIRST

AID

Asphyxia

J. B. (Taunton).-At a recent Diz'isional Practice the following queJ"tion was put to the members : "Yo" are called, alolle, to a gas-filled room. Lpon entering, ),Otl find two men IJ,ing on the Jloor. ~-o. I IS deddedIJ' C)'anosed and has) of course, stopped breathing, n'hile ~"'o. 2 (whose "ps are chen]' colom'ed) has just stopped breatbing. The hearts of both are still beating. Your informant has disappeared and there is no help whateL'er aI'ai/able. Which patient would 'you treat fint and why, ? " One school of thought favoured attending to No. I patient first on the ground that the worst case should receiz'e priorifJ' as a few minutes' de/a)' might cause the death of thiS patient and '.:\-0. 2 patient could probablJ' Stlrl'il'e while 1'\-0 . I IS being treated~ The second school suggested that jYo. 2 patient shotlld be treated first) since a fm, minlltes' artificial respiration would) in all probabilifJ', mabie natttral breathing to be re-started. He could then sojely be left n'hile attention is paid to ~"'o. I. Further) if ~ro . I is dealt with first, artificial respiration tJ/try have to be continlled for an hour or more-P9ssibf)' lJJithout success-during which time '.:\TO . 2 may also die. As no agreement could be reached as to which patient . should be treated first) the members sltggested that )'our advice be sottght. On beha{f ~f the Division I offer in advance our sincere thanks fa)" ),our assistance in solving this knotty problem .

Fractured Neck of Femur R. R. (Coulsdon).-Tf7ill J'Of{ pleaJ'e tell me ]vhat J'ou adl//se 1J;ith r~lerence to the treatment of fractured neck of femur particularb when this is accompanied by a large swelling. In a couple of cases of )l'omen ]vhom I hal'e attended) it has been impossible to put ot! a long split!t. Further, n'e have been told bj' a doctor who took charge of the patients not to attempt it. fPe had to take these cases to hospital) and although n'e tied the legs together) this did not seem to iTJImobilize the fracture enough. We would be glad of )'0111' t'iews on this inju,]' and its treatment. It seems clear that the surgeon at the hospital considered that the swelling at the hip joint made the use of the long splint inadvisable. Should you .meet with anot~er and similar case, you should treat ill accordance with the On the statement of facts your first duty is to get both instructions on page 9 of the Supplement to Textbook ext, it is extremely reading into these that no splinting facilities are either patients out of the gas-filled room. would find a patient who had ceased to unlikely that you al'aifable or adlJisable.-'::\.C.P. breathe and ret had a cherry coloured complexion. \\1hilst this colour of the face remains, there must be some breathing, Fracture of Spine A. J. (Burnley).-I have recmtly read a vel]' interesting book although this may not be immediately discernible and on which deals with the treatment of fractures and was written removal to fresh air the tendency would be for the breathing by a surgeon. In the section which ICl)'s down the tnatment to improve. On the other hand, the patient with the of irifuries to the spinal coltimn) the following two statements cyanosed face is likely to die in a short time unless immediate steps are taken to restore the breathing. 11y are made ;"(I) It is improbable that the cord) having escaped advice, therefore, is that you, as first-aider, should call for damage from the force of the accident, can be damaged help after getting both victims out of the gas-filled room later, either by canying the patient with his spine flexed (taking out the second first), and this done that you should or b] the pressure of a displaced fragment of bOlle. This concentrate on the first patient.-•. c.F. is an important fact and implies that it if immaterial h01IJ patient is transported after the accident. Bleeding from Palm of Hand "(2) Further damage from the pressure of bony fragments or from moving the patient is unlikely if the cord G. D. (Liverpool).-At Divisional Practice to-night we had an arg,Hment over " Bleeding from the palm of the hand." has withstood the force of the accident." Some said that the method of treatment is as laid dOJvn Of course) I re(llise that these statements are not from a 01'1 pages I22, I23 of the Textbook, but I claimed that book for first-aiders but in view of the surgeon's opinion with tJJis has been cancelled by the Supplement to Textbook) the reference to transport of spinal injuries I shall be grateful for J'our comments. treatment being pad and bandal[,c. Also) the Supplement does 110t state that a St. John sling is to be ured, although it The book from which you quote was written by a surgeon does sqy that the limb is to be elevated. for surgeons, and it is probably correct in its statement Please give your ruling on our problem. that, during the transport of a patient with a fractured spine under the care of a stirgeon, it is immaterial how the You are right when you say that the special instructions patient is transported after the accident. When, however, for treatment of bleeding from palm (which figured in the instructions are given in a first aid manual they have to be Textbook) are now cancelled by the Supplement which so worded that, eyen when the patient is being treated by favours direct pressure. evertheless, I think that I should a first year student, there is little risk of causing complica- make use of the fingers by making patient clench his fist tions during treatment and transport. over the dressing and then by applying a narrow bandage Purther, first-aiders are advised to restrict their reading to keep the fist clenched. This done, I should ap ply the to first aid manuals and periodicals, because, as the Text- St. John sling, simply because this enables you to carry ott book states on page IS, their duties end where those of the instructions of the Supplement to elevate the bleeding the surgeon begin.-K.C.F. part more effectively than the other slings .- l .c.P.

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*HANDBOOK OF FIRST AI D AND

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A. D. Bel ili os, M. B. , D. K. Mulvany, F. R. C. S., K. F. Armstrong, S. R. N. THIRD

EDITION

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FIRST

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AMBULANCE GEAR

No. 648.-VOL. LV.

The Gear Illustrated (A.B.C.D.) carries two stretchers on one side of Ambulance, leaving other side clear for sitting patients.

JUNE, 1948.

Entered at ] [ Stationer.l' Hall

PRICE FOURPENCE [5/- PER ANNUM, POST FRltIt)

PRINCIPAL CONTENTS

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

Editorial A Course in Advanced First Aid -Diabetes and Insulin Poisoning The Medicine Chest First Aid as Practised at the Close of the I9th Century

A. Shows the two stretcherd 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.

4 5 7

News from all Quarters

Anatomy and Physiology in First Aid

The Care of the Chronic Invalid in the Home Queries and Answers to Correspondents

NOTICE TO READERS.

D. Shows the same position as in " C" only with cushions and back rest fitted for convalescent cases.

FIRST AID is published Monthly. The Annual Subscription is 55. post free single copies 4d. . Its aim. a.nd objects being the advancement of Ambulan<;e and First ~id Work in all branches. the Editor invites Readers to send Articles and Reports on sublects pertaInIng to the Movements and also welcomes suggestIOns for PractIcal Papers.

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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There are now two kinds of Elastoplast First Aid Dressings. The fabr ic Elastoplast you have kn own for years and anew, plastic skin dressing. Both provide immediate First Aid for all minor cuts and scratche s. Being elastic they readily mould to all part s of the body and allow free movement of JOJnl S and knuckle s Both are fle sh-coloured.

a~,.<"~

Waterproof Elasto~~ plast - the new dress~ ing - has been introduced 'YI' more especially as protection ()n when the wearer is working in 'rp contact with water, grease or oil. <''SS It has a non-catch surface and does I not fray at the edges. I

blgJElastopla~t FIRST AID DRESSINGS-FABRIC OR WATERPROOF BOTH IN

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S~pt0nal ANTISEPTI'Cf, OIN.TMENT For Works, Factories and Ambulance Outfits.

Septonal cleanses and heals wounds with amazing rapidity. Prevents and arrests inflammation. A safeguard against blood-poisoning. Possesses extraordinary styptic properties. In liquid form Septonal is supplied in 16 oz. bottles at 3/-. quart 6/-, ! gallon 9/6 and 1 gallon bottles at 17/- per bottle, and in concentrated form in 2 oz. bottles, for making up 1 gallon. at 14/- per bottle. Septonal Antiseptic Ointment This ointment is most useful for boils. minor injuries and skin troubles. Available in t lb. jars at 2/6, ~ lb. 4/6 and 1 lb. 8/- per jar. Make sure you include Septonal in your ambulance outfits. We hold stocks of Surgical Bandages, Dressings, Lint, Cotton Wool and all First-Aid requisites. Be on the .. safe" side-Septonal will meet every First-Aid need.

THE I. D. L. INDUSTRIALS LTD. t, ST. NICHOLAS BUILDINGS, NEWCASTLE-ON-TYNE, t.

Editorial The Princess Royal's Tribute ONE of the most important events of the British Red Cross SOCiety took place recently when the Finals of the Stanley Shield Competition were held in London. Teams have been competing against each other in eliminating rounds throughout the country, and last month those who had successfully earned the right to represent their counties met in this national first aid competition. Some excellent first aid work was seen and the standards of all teams were high. The results of the competition are given elsewhere in this issue, but our interest lies in the remarks of the Princess Royal, Commandant-in-Chief of the SOCiety, who made the awards. Describi ng her recent tour of Germany she said that it was due to the combined efforts of the British Red Cross and other health services that a major epidemic had so far been avoided in Germany. "This seems to be almost a miracle," the Princess Royal went on, " in view of the terrible devastation on towns such as Hanover and Hamburg. It is a devastation that has to be seen to be believed. The complete destruction of huge areas is really quite horrifying." The Commandant-in-Chief said that she was deeply impressed with the spirit with which members of the Red Cross in Germany were imbued, and with the efficiency which translated that spirit into effective action. Throughout the British Zone there seemed to be a great spirit of co-operation between the military authorities, the Control Commission, and the welfare organisations. This tribute to the efficiency and skill of a devoted band of workers in Germany is very just, and will be echoed by all who have seen anything of

the Red Cross activities on the Continent. We would add that this fine spirit is not confined to the British Zone, for the International Red Cross embraces the whole of Germany, and a vast field of activity is opening up in Eastern Germany which at first was perforce neglected. It has become possible to send relief supplies to the sorely tried inhabitants of this area, and the Russian occupation authorities have not only conse nted to this welfare work, but have also shown great understanding of its need. For example, the Zone can now send ailing children to Switzerland for a stay of three months, a first convoy has left the Berlin district, so we are informed in the" News" of the International Committee of the Red Cross, and other transport will be leaving districts, where, as in Berlin, undernourishment is rife. Some indication ofthe work that is being done there is given in the current issue of the" News." We can not do better than to quote the last paragraph. " It is now three years since the cessation of hostilities. Yet in Eastern and Central Germany, the distress created has become still more acute. For reasons we cannot go into here, reconstruction has been almost entirely suspended; new and crushing burdens have been laid on the populations whose standard of living has become extremely low. Help from abroad quite certainly relieves a great deal of distress. It is also doubtless of great moral assistance; the people understand it as a token of fellowfeeling, a sign that they are not forgotten abroad. This is one reason why the relief work undertaken by the International Committee of the Red Cross deserves every kind of support."

FIRST

FIRST AID

A COURSE IN ADVANCED FIRST AID BY

A. D . BELILIOS, M.B., B.S. (Lond.) D.P.H. (Eng.) Diabetes and Insulin Poisoning

IT is converuent to begin this article by a brief descrip- is passing an abnormal quantity of urine wruch causes him

tion of the pancreas which is one of the more important glands of the body. It is situated behind the stomach in the upper part of the abdomen where it stretches across the back of the cavity. In shape it is rather like an ox-tongue and is about 7 in. in length. Its base lies on the right side, fitting into the curve of the duodenum; its tip extends on the left as far as the spleen. The pancreas has two distinct functions . In the first place it produces a fluid called the pancreatic juice ; trus is carried along a channel, the pancreatic duct, and emptied into the duodenum. Trus pancreatic juice is of importance in the digestion of food but otherwise is of no interest to the first-aider unless he is also studying home-nursing or elementary anatomy and physiology. The second function of the pancreas is to produce a substance called insulin which is absorbed direct into the blood stream where it circulates. Insulin controls the use of starchy foods such as sugar and glucose in the body ; its presence in the blood is essential to allow the liver and muscles to store and burn glucose.

ORlflCE OF COMMON Bll..E Duer AND PANrnEATlC ouer

FJG. 76.-THE DUODENUM, PANCREAS AND GALL BLADDER.

From" A Handbook of Elementary Anatomy and Physiology," Belilios, Mulvany & Armstrong, by courtesy of Bailliere, Tindall & Cox.

The insulin is produced by groups of little cells called the Islets of Langerhans; if these cells become defective in ~heir action, insuffic~ent insulin is produced and the patIent d~velops the disease known as Diabetes often call~~ Diabetes .Mellitus, to distinguish from Diabetes InsIpIdus which IS a totally different complaint. J?iabetes. Mellitus generally develops gradually. The pattent notices that he is becoming increasingly trursty and

inconvenience through frequency of micturition. His appetite is usually increased but he loses weight and feels lacking in energy and disinclined to make an effort. The complaint is readily diagnosed by a doctor by examination of the urine wruch will be found to contain sugar. Diabetes is of importance to the first-aider on account of its complications which include boils, carbuncles, gangrene and diabetic coma. Sometimes the disease developes so gradually that the patient does not appreciate that he is suffering from an ailment until one of the complications arises. First-aiders who work in factories or other institutions meet many patients who attend the ambulance room to receive attention for boils. It m\lst never be forgotten that recurrent boils may be caused by diabetes and it is far more important for the patient to visit his doctor taking with him a specimen of urine than to buy blood mixtures and tonics from a chemist. Diabetic gangrene is a much more serious complication and generally only occurs in elderly patients who have neglected to follow their treatment conscientiously. The term gangrene means death of the tissues; it generally begins with the toes of one foot and .slowly extends upwards. It is often precipitated by a slight injury such as a scratch or a blister caused, for example, by wearing badly fitting shoes. The affected part at first appears inflamed but later develops a blotchy purple kind of colour which may later change to brown. Blisters may form and burst leaving a foul ulcer. Unconsciousne::is due to diabetes is called diabetic coma. It generally develops gradually. The patient complains of head~che, restlessness and digestive disturbances including VOffilt1ng. These symptoms are followed by increasing drowsiness which ultimately pass on to complete unconsciousness. The characteristic features of established coma include a quick and feeble pulse, a temperature that is below normal and slow, deep breathing in which the abdominal muscles are being noticeably used. There is an odour of acetone in the breath described as being like nail-varnish. The skin is dry and the pupils generally contracted. FIRST Am FOR COMA.-From the description that has been given, it is clear that most patients pass through a stage of threatened coma before unconsciousness becomes established. It is during this stage of threatened coma that fir~t aid is mo~t valuab.le. Liberal quantities of simple flUIds must be gIven to dilute the poisons which are setting ~p coma and to r.eplace l?s~ of fluid from the body. Water IS an ad~quate dnnk but It IS a good plan to add salt in the proportlOn of teaspoonful to the pint. If readily available a teaspoonful of bicarbonate of soda should be given in the drinks.

AID

Shock should be treated in the usual manner by keeping in his manner and behaviour, resembling one who is the patient quiet and keeping him warm by supplying intoxicated or suffering from hysteria. Ultimately unconr extra wraps and hot water bottles provided with covers sciousness follows. to prevent burns. Strong coffee is a valuable stimulant. The signs of insulin .coma are that the breathing is quick Needless to say the services of a doctor should be obtained and shallow but there is no odour of acetone in the -breath. at the earliest possible moment. The pulse is full and bounding and the pupils often dilated. When coma has become established, the first-aider can An important point to notice is that the skin is moist only continue to apply the general rules for the treatment through sweating. of unconsciousness pending the arrival of a doctor. The It must be emphasised that the symptoms and signs of medical treatment consists of giving insulin combined insulin poisoning are very variable, for this reason any with. sugar and extra fluids either by the rectum or through departure from the normal behaviour of a patient receiving a vem . treatment with insulin must be regarded with suspicion. MEDICAl:. TREATMENT OF DIABETEs.-The treatment of diabetes, prescribed by a doctor, consists of giving the Moreover, sometimes the warning symptoms are only of patient a regulated diet containing restricted quantities of short duration and unconsciousness rapidly supervenes. starchy and fatty toods. The diet must be adequate and FIRST Am FOR INSULIN Porso ING.-As would be well-balanced. Fortunately research has made it possible for expected, the antidote for insulin poisoning is sugar. diabetic patients to receive a diet which is not nearly so At the first sign, of any symptoms suggestive of insulin monotonous or uninteresting as might be anticipated. poisoning, two lumps of sugar should be given immediately In addition to a standardised diet, many patients have with a copious drink of water. In this connection it should to have one or two injections daily of insulin, a remedy be remembered that sufferers from diabetes are advised to derived from the pancreas of an animal such as an ox or a carry sugar on them for use in an emergency. The dose of pig. Insulin is a powerful drug and its use is subject to sugar should be repeated in fifteen minutes if the symptoms certajn important rules, the most important of which are persist. that the injections must be given twenty minutes before a The remainder of the treatment is very similar to that for meal and that the patient must take his meal at the correct diabetic coma, warmth and rest being most important. time and eat it all. Should he not do so, he must eat some If unconsciousness develops, general principles should sugar to make up the deficiency. If the patient fails to eat be followed. Ability to swallow should be tested by his meal at the proper time or takes an inadequate amount, turning the patient's head to one side and introducing a the amount of sugar in his blood will be reduced to a low few drops of boiled water between the gums and the level and in this event he may develop insulin poisoning, cheek; the water will then pass to the back of the throat, a condition called hypoglycremia (too little sugar in the and if swallowing is possible the characteristic movements blood); this may pass on to hypoglycremic coma. The of the throat will be observed. If swallowing is possible, the sugar dissolved in a small same condition may result from an overdose, if for example, a patient gives himself an injection of double strength quantity of water can be given in small doses by this method. The doctor will give sugar in the form of glucose, insulin by mistake. The symptoms of mild hypoglyca'mia include ~e~eral through the rectum or through a vein. First-aiders are likely to be worried that they will not be weakness, shakiness of the hands and knees, palp1tatt~:)fls and a sinking feeling in the pit of the stomach. The pattent able to distinguish diabetic coma from insulin coma. usually feels faint and ill and he sweats ; he may also com- Often the history will be of value for it may be known that plain that his sight is misty or that he can. see double. the patient has taken insulin and gone without his meal. Sufferers from diabetes are taught to recogruse the early In cases of doubt sugar should always be given because signs of insulin poisoning; somet~es they ~~e pu~posely it is so essential for the case of insulin poisoning and given an overdose so that they WIll be faffilhar W1t~. the cannot seriously harm a diabetic coma. In any case the early symptoms when they are no longer under supervls 1C?n. doctor on arrival will soon be able to counteract the effects In more serious cases, the patient may become peculiar of the sugar and insulin if a mistake has been made.

The Medicine Chest By FRANK BERRY, PH.,C.

For oral administration from 2 to 5 ounces are mixed with milk, Barium Sulphate This is a heavy, white, non-crystalline, non-poisonous powder, cornflour, or other suitable vehicle. insoluble in water and acids. It passes through the body unchanged, Several compound or proprietary rni.xtures are available, suitably and being opaque to X-rays it forms a valuable means of outlining the flavoured and sweetened, which only need addition of boiling water alimentary tract for X-ray photography. when required for use. Barium Sulphate for X-ray work has to be very carefully purified and For examination of the colon, a Barium Sulphate enema may be tested to ensure freedom from other soluble Barium salts which are adminis teredo poisonous.

FIRST

Bee Venom Based on the statement that bee-keepers are free from rheumatic diseases, bee venom is employed therapeutically in the treatment of many rheumatic affections, such as arthritis. Its action seems to be chiefly counter-irritant, and it may be used in ointment form, or as a series of injections with progressively increasing dosage. The venom collected at the end of the summer, is said to be most potent. Belladonna This is the name of a plant, which is widely distributed over Central and Southern Europe, and also grows wild in several parts of this country. It is intensely poisonous owing to the powerful alkaloids, chiefly hyoscyamine, which it contains. The true Atropa Belladonna (Deadly Nightshade) with its dark purple flowers and almost black damson-like berries should be carefully distinguished from the more common Solanum Dulcamara (Woody Nightshade) which has bright blue flowers and red berries. The leaves are the starting point in the manufacture of Belladonna preparations for internal use, while preparations intended for external use are made from the root. Belladonna is given internally to check the action of secretory glands, being much used for suppressing gastric secretion in certain types of digestive disorder and is often employed as a useful antispasmodic in treatment of intestinal colic and spasmodic asthma. It is given with purgatives in many pills and tablets to reduce the iendency to cause griping. Children tolerate the drug very well and large doses are frequently given in treatment of Whooping Cough, False Croup and Enuresis (Bed Wetting). Externally, Belladonna preparations find useful application in relief of local inflammation, pleurisy, lumbago, neuralgia and rheumatism. The chief Belladonna preparations are ; Dry Extract of Belladonna-dose i to ~. grain. Green Extract of Belladonna-dose t to I grain Tincture of Belladonna-dose 5 to 30 minims. Glycerine of Belladonna-prepared by addition of water and glycerine to Green Extract of Belladonna and frequently used for painting on boils and carbuncles to allay pain and inflammation. Liquid Extract of Belladonna-is prepared from Belladonna Root and forms an ingredient, along with such drugs as Aconite and Chloroform, in many well-known liniments for external application, examples being;Liniment of Belladonna. Liniment of Aconite with Oil (this is the well-known A.B.C. Liniment).

AID one of the first synthetic substances used to replace the natural ana:sthetic alkaloid cocaine. B enzedrine This substance, now known as Amphetamine, closely resembles Adrenaline and Ephedrine in its action, and is usually used by inhalation for relief of catarrh, hay fever, asthma and allied complaints. It constitutes the principal therapeutic agent in many proprietary inhalers, but care is necessary in its use, as overdosage often leads to restlessness and insomnia. Ben zed rine Sulphate This substance, now known as Amphetamine Sulphate, occurs as a white, odourless, water-soluble powder. In action it is similar to Adrenaline and Ephedrine and exerts a marked stimulant effect on the central nervous system. It has been used with some success in treatment of post-encephalitic parkinsonism and other depressive neuroses. It diminishes sleepiness, lessens fatigue, increases mental activity, and promotes a feeling of self-confidence and well being. The use of this drug is not without danger, overdosage may lead to collapse, and continuous administration may cause addiction. Several deaths have occurred as a result of using Amphetamine to stimulate mental activity, and it should therefore only be taken under strict medical supervision. Benzocaine This is a white crystalline powder used as a local anresthetic chiefly for dusting on wounds and injured surfaces. It is sometimes given internally to relieve the pain of gastric ulcer or carcinoma and is used externally in ointment form for treatment of burns, eczema and malignant ulcers. Benzoic Acid This occurs in white feathery crystals, and has definite antiseptic and preservative properties. It is occasionally used in expectorant mixtures, and as a urinary antiseptic in treatment of cystitis and allied complaints. Its local action on the throat leads to its use in voice lozenges, each of which generally contains t grain of the acid. In the form of Compound Benzoic Acid Ointment (Whitfield's Ointment) it is used in the treatment of ring-worm of the scalp and body. Benzoin This occurs in reddish-brown resinous masses having an agreeable balsamic odour. It has carminative and antiseptic properties. It is chiefly used as Compound Tincture of Benzoin, more popularly known as Friars' Balsam. Friars' Balsam, prepared by macerating aloes, benzoin, storax, and baham of tolu in go per cent. alcohol, is used externally as an antiseptic, styptic application to superficial cuts, and a teaspoonful to a pint of hot water, yields a useful inhalation for relief of bronchitis and acute laryngitis.

Belladonna is also used in form of Plasters, Suppositories and Ointments for relief of local pain or congestion. All Belladonna preparations are poisonous and accidental overdosage may lead to requests for services of a first-aider. Typical symptoms of Belladonna poisoning are: Heat and dryness of the mouth; extreme thirst and difficulty in swallowing; face and skin flushed and dry, often with a rash resembling scarlet fever; eyes sparkling, with pupils dilated and inactive to light; initially noisy Benzyl Benzoate excitement and delirium passing later into coma. This substance has the property of diminishing the contractions of Treatment should be in accordance with Textbook instructions for certain muscles, and has been used in treatment of diarrhoea, dysentery, Deliriant poisons, including administration of an emetic followed by asthma and certain types of colic. hot strong coffee. The patient should be kept warm and every Externally it has proved extremely valuable in treatment of scabies, endeavour made to keep him awake. Artificial respiration may be for which purpose a suitable solution containing benzyl benzoate, soap, necessary. water and alcohol is applied over the entire body with a small brush and allowed to dry. A second application is applied and also allowed to Benzamine Hydrochloride dry. The following day the patient takes a hot bath and has a complete This substance, also known as Betacaine Hydrochloride, is a local change of clothing. anresthetic less powerful in action and less toxic than cocaine. It wa.s This treatillent is described a.s safe, relia.ble and rapid.

FIRST

AID

First Aid as Practised at the Close of the 19th Century by

J. A. COOK. B EING an inveterate reader of old books as well as an a.rdent student of FIRST Am, my interest is always qUlckened whenever I come across in such books any reference to my favourite subject. Some of the home remedies as practised or recommended towards the clos~ of the 19th cen~ry make interesting and (to us more. Inform~d first-alders), amusing reading alth~ug~, parttcularly 1n respect to bandages and their applic~tton, some of the treatments have changed little. As an lnstance of the latter take the following passage from a book that was published about the year 18 90 : "BANDAG~s.-Ba-?-dages are strips of calico, linen, flannel, muslin, el~st1c webbing, bunting or some other substance, of vanous lengths, and from one to six inches wide, free from hems or darns, soft and unglazed. They are better after they have been washed. Their uses are. to re~ain dressings, apparatus, or parts of the body ill theu proper positions, support the soft parts, and maintain equal pressure." Which, as you can see, compares very favourably with the definition and uses as taught by the St. John's Ambulance Association and the British Red Cross Society. Another very favourable comparison was found in a periodical under the heading "Extemporised Splints" which read as follows : " When a person breaks his arm or leg and splints cannot be had directly, get bunches of straw or twigs, roll them up in handkerchiefs and, placing one on each side of the arm or leg, bind another handkerchief firmly around them; or make a long bag about three inches in diameter, or even more, of coarse linen, duck or carpet, and stuff this full of bran, sawdust or sand, sew up the ends and use this the same as the twigs. It forms an excellent extemporaneous splint. Another good plan is to get a hat-box made of chip, and cut it into ~uitable lengths; or, for want of all these, take some bones out of a pair of stays and run them through a stout piece of rug, protecting the limb with a fold of rug, linen, etc. A still better splint, or set of splints, can be extemporised by cutting a sheet of thick pasteboard into proper-sized slips, then passing each piece through a basin of hot water to soften it. It is then applied to the fractured limb like an ordinary splint, where it hardens as it dries, taking the exact shape of the part to which it is applied." Much of this advice still holds good and could profitably be practised by competition first aid teams. O n the subject of the" Application of \\1armth " I came across the following interesting advice : "To ApPLY D RY WARMTH.-For any part of the b ody. Warm some sand or bran and place in the patient's socks and lay it on the part; salt put into a paper bag does as well; or warm water put into a stone jar and rolled up in flannel." All of which was, and still is, good practice.

As to the contents of the First Aid Box the following " Useful Articles" were all that were considered necessary to have at hand in case of emergency and one was told to " Keep them in a dry place and replace them when stale" ! " Sticking Plaster. Bandages (old linen). Safety Pins. Whitening (in a tin). Carbonate of Soda (in a tin). Carron Oil (a pint bottle made of equal parts Linseed Oil and Lime Water; shake when using). Lime \'\later (made of unslacked lime, a piece the size of an egg, in a wine bottle of cold water). Ipecacuanha \Vine (well corked), or Ipecacuanha Powder. Salad Oil." The beginning of an article on the treatment of Scalds and Burns, published in a periodical of about 1895, rather surprised me, however, as the advice it contained so exemplified treatment of to-day, it read :"SCALDS AND BURl s.-\Ve cannot too firmly impress upon the mind of the reader that, in either of these cases, the first, best, and often the only remedies required, are sheets of wadding, or cotton wool--. The reason these articles are employed is the same in each instance; namely, to exclude air from the injured part ; for if the air can be effectively shut out from the raw surface, and care is taken not to expose the tender part till the new cuticle is formed, the cure may be safely left to nature. The moment a person is called to a case of a scald or burn, he should cover the part with a sheet, or a portion of a sheet, of wadding, taking care not to break any blister that may have formed, or stay to remove any burnt clothes that may adhere to the surface, but as quickly as possible envelope every part of the injury from all access of the air, laying one or two more pieces of wadding on the first, so as to effectually guard the burn or scald from the irritation of the atmosphere; and if the article used is wool or cotton, the same precaution, of adding more material where the surface is thinly covered, must be adopted; a light bandage finally securing all in their places." From here onwards, and where I have purposely excluded some words from the first paragraph above, however, the alternative treatments given when wadding or cotton ~ool are not available tend to make the modern first-aider shudder. lention is made of " chalk ointment," "violet powder," "flour," "pure lard" (with emphasis on t.he " pure "), and, horror of horrors, "treacle dusted wlt.h flour" 1 One is not told how the harassed doctor 1S expected to remove all these glutinous and, on.e must imagine, fermenting compounds in order to examlne and treat the injury. (To be cOJ/til/lIed)

FIRST

AID

FIRST

the Folkestone Ambulance and Nursing to any members who might be able to pay a THE ST. JOHN AMBULANCE Divisions, Hythe and Saltwood Nursing visit to the Island . Divisions. The Chairman, Mr. Councillor H. Lock BRIGADE. Kendell (president of the Addiscombe DiviCounty of Lancashire

sion) thanked Lt.-Col. Abela for his remarks, adding that the hectic war-time experiences of Malta and of Croydon provided a natural link between the two Divisions. He was very impressed by all he had heard, and was proud to have had the honour of being present on so memorable an occasion. Asst. Commissioner H. J. Wrigglesworth ably seconded the Chairman, adding that he was a very old friend of Lt.-Col. Abela. He had always held the Addiscombe Division in very high esteem, and was in a position to state that it was--and still is-one of the most efficient Divisions in the Brigade. District Officer E. ]. Prew, Officer-inCharge of the Addiscombe Division, added his personal thanks to the Commissioner, and assured him that all members were keen to make pen-friends with their brother-members in Malta . E. Riding of Yorkshire CORONATIO

CUP COMPETITION

The third annual open competition for the "Coronation Cup" by Hull and district teams was held in the Municipal Technical College, Hull, on May Bth. Results were : I.

2. 3· 4· 5· 6. 7· 8. 9· 10. II.

12.

Grimsby Docks (Rly.) Hull City Police ... Pontefract Colliery Dairycoates, Hull (Rly.) E. R. Police, H.Q. Division Hull Docks Division, S.J.A.B .... E. R. Police, Driffield Dock Engineers, Hull (Rly.) Hull Station (Rly.) D . S. Ladies, Hull (Rly.) E. R. Police, Withernsea York Yardmaster' s (Rly.) Maximum marks

The position in which the teams were placed was :-

News From All Quarters LANCASTER .D. The Lancaster ursing Division held its County of Berkshire On Saturday, May 22nd, at Reading, annual presentation of awards on lay 6th. Dr. William George, Div. Surgeon, received competitions were held between teams from Ambulance and ursing Divisions in the the second bar to his Long Service Medal. County. The winners of the Ambul~ce A presentation was made to the Officer-inSection were Team o. I from Reading Charge, Mrs. A. Topping, on her retirement Great \~'estern Ambulance Division, captained after being a member of the Brigade for 40 by Cpl. G. T. Davis, with II8t marks out of years. A Long Service Medal was presented to 140. The runners-up were Team TO. 3 from Bracknell Ambulance Division, captained by Amb. Sister Mrs. Bradshaw, and other awards Cpl. T. Brown, with 107 marks. The winners were 24 Labels and 17 First Aid Certincates. of the ursing Section were Team o. I C ounty of Leicestershire from Maidenhead Nursing Division, captained We regret to announce the death on May by AmbulanGe Officer Mrs. T. J. Bristowe, 17th of Hon. Sgt. C. Stadon, a member of the with I22-t marks out of 140. The runners-up Gipsy Lane Ambulance Division, Leicester. were Team NO.3 from Reading South Tursing He had been Div. Secretary from the date of Division, captained by Sergt. 1its. M. Essex, the formation of the Division and had been with II7l marks. a very active worker. In addition to his The trophies, which were presented to ambulance work he took a big part in the the winners by County Superintendent the activities of the Gipsy Lane W.M. Club. Hon. 11rs. Leslie Gamage, were the Didcot County of Oxfordshire Shield for the Ambulance Team given The Oxfords hire County Competitions for to the County in 1934 by Sir Felix Pole, and a new cup for the Nursing Team given the Furley Cup were held on May 8th at the by the County Superintendent who also gave Pressed Steel Company's Works. Teams from seven Divisions competed, a propelling pencil to each memb~r .o~ the winning teams. The team and IndiVIdual the Wychwoods, Oxford Nursing, Pressed tests were set and judged by County Surgeon Steel, Banbury, West Oxford, Clarendon A. Buchanan Barbour, O.B.E., assisted by Dr. Press and Oxford City. The Oxford Nursing Richard Body and Dr. W. D. Tate. Correct- Division was not competing for the trophy. It was the first time the competitions had ness of uniform for ambulance teams was judged by Assistant County Commissioner been held at the factory and the arrangements F. A. C. Jarvis and Corps Supt. F. W. Nash, were made by Supt. H. T. Bennett of Pressed and of the nursing teams by County Officer Steel Company Division and Dr. Weddell assisted by Dr. J. M. Muir. Miss D. K. Gibbins. The Pressed Steel Company's Division won READING On Tuesday, May 25th, at their Head- first place and the Furley Trophy for the quarters, 45, Blagrave Street, Reading, second year in succession, and the Banbury members of Reading Post Office Nursing Division team was placed second. The Division under Div. Supt. Miss G. E. Coombs, winners will go to Weymouth for the regional finals. held a competition for the Gamage Cup. This Amongst the officials present were the took the form of a Quiz which was set and judged by County Officer Miss D. K. Gibbins County Commissioner, Dr. C. Gardiner Hill, assisted by Corps Supt. 1liss E. C. Sudul. the Assistant County Commissioner, Dr. The winners were Cpl. Miss J. Startup (Capt.), Bevan, County Surgeon Briggs, and County Ambulance Sisters 1its. B. Green and Mrs. S. Surgeon Weddell, and Lady County SuperAldhous. The cup was handed to the winners intendent Fanshawe. by County Officer Miss D. K. Gibbins, who County of Surrey also presented Ambulance Sister Miss D. ADDIS COMBE Kinge with a medallion. Officers and members of the Committee of County of Kent the Addiscombe Division were recently FOLKESTONE privileged to welcome the Commissioner for The death is announced, with deep regret, Malta, G.c., Lt.-Col. V. U. A. Abela, M.B.E., of Div. Supt. J. Huntley of the Folkestone C.St.J., at The Cafe Royal, where experiences Ambulance Division, on 25th May after a and matters of mutual interest were discussed short illness. He was 53. during an excellent dinner. A member of the Division for over 35 years . This meeting was the otltcome or the Supt. Huntley was an enthusiastic worker. affiliation of the Addiscombe Division with He was a Serving Brother of the Order, and No. I Rabat Division of No. 4 Corps of the held the Service Medal with four bars. Brigade in Malta. The Commissioner expresThe funeral took place on 28th May, and sed his gratification of the opportunity thus was attended by County Officer Mrs. A. Jay, afforded to make personal contact with A./Corps S:lpt. Smith, Corps Officer L. B. Addiscombe, and was particularly impressed Easton, Corps Officer R. Moat, A. /Corps with the records, reports and evidences of Officer Miss M. Davis, Ambulance Officer W. the constant activity of his hosts. He gave Kitchin, A./Dvnl. Supt. Mrs. Hadaway, interesting details of the work being carried Amb. Officer Mrs. Williams and members of out in Malta, and extended a hearty invitation

AID

Marks 27 0 t 265! 24 6 t 245! 243 224t 221 21 7 215t 205 I9 B! 190

392

Individual winners were-No. I Bearer: 1st, O. F. Wilson, Grimsby; 2nd, F . A. Page, Hull City Police. NO.2 Bearer: 1st, J. Tolson, Pontefract Colliery; 2nd, A. J. Daly, GrilTlsby D ocks. No. 3 Bearer: 1St, H. Burton, Hull Station; 2nd, F. Mitchell, E. R. Police, H.Q. Division. NO.4 Bearer: 1st, G. Pimperton, Grimsby Docks; 2nd, A. E. Pinder, Dairycoates, Hull. No. 5 Bearer: 1st, F. Hancox, Pontefract Colliery; 2nd, M. Bielby, Dairycoates, Hull. The cup and prizes were presented by Mr. H. Jaram, Assistant Chief Constable, Hull, and the Chairman was Mr. L. Ballan, N .E. Region, British Railways.

11r. Trott, Centre Secretary, was in the Burrows, who was Chairman of the former chair. The layor of Kingston (Dr. Edith London, Midland & Scottish Railway. Oldfield) kindly presented the awards and The conteSt will be held in June and the 1. Southern Railway (Horsham) congratulated each one, with a special word Swindon "A" team will be eligible to compete. 2. London, Midland & Scottish for Mr. Jack Kingman, and praised the good BIRMI GHAM Railway (Camden "A") work done by first-aiders. Mr. E. J. Hancock, Goods Department, 3. London, Midland & Scottish Miss Diana Kingman presented a bouquet Hockley, has been appointed Divisional Railway (Wolverton Works) ... 433~ of carnations to Her \'{'orship the '\Iayor, \\"ho Secretary to the Birmingham Division in 4. London & orth-Eastern Railway thanked the Class. The Concert Parry was a succession to :;-'Ir. F. O verbur\", who has (King's Cross Loco) 42-d great success and enjoyed by all. Am~ong the retired from the Service. ' 5. Southern Railway (Waterloo o. I) 417 250 guests were the Kingston Nur ing FER DALE 6. Midland & Great Northern Joint Division; Mr. 1\. Barrow, District Secretary, Mr. Eyan Edwards, who is employcd in the (Melton Constable) S.R. ; Dr. Mailer, :;-'Iedical Officer, S.R., who Engineering Department, has been appointed 7. Great Western Railway (Newport praised the work of this class. The awards a County Officer of the St. John Ambulance High Street "A") consisted of nYe gold medals, four silver Brigade. He has dc\'oted nearly forty years' 8. London & orth-Eastern Railway medals, fi\' e bwnze medals and 4-8 labels. sen' ice to the mm'ement and has pre\"iously (Langwith Loco) The arrangements were made by Mr. S. WI. held the position of Sergeant, Di\-isional 379 Smith, the Secretary. 9. Great Western Railway (Swindon Treasurer, Divisional uperintendenr and Western Region "A") 351 Corps Treasurer to the Brigade. He was Maximum marks obtainable 600. The \'{!omen's First Aid Competition was admitted to the Order a' a en-ing BrOther in The distribution of prizes was presided over held in the Porchester Hall, Paddington, 1936 . by The Earl of Athlone, K.G. (BaililI Grand rccently, and the following is the result : Cross), and the Challenge Shield, the Corbet .Ifarks Fletcher Cup and prizes were presented by 1. S,,' indon "A" (Florence N. Lean Sir Cyril Hurcomb (Chairman of the British Cup and prizes) 227 * ., Swindon" B" (i\fabel i\.. Potter Transport Commission). Judges were: M. M. Scott, L.R.C.P., Cup and prizes) :215~ ST.\ lLEY SHIELD CO~lPETITIOL , 1941I.R.C.S., D. F . Barrett, 1tB., and \'(' . N. 3. Plymouth (prizes) ... 199 The Princess Royal, Commandant-in-Chief .j. . Gloucester... 197 Booth, 1.B., B.S. of the British Red Cross Society, presented ewton Abbot 192~ 5. the awards at the final of the Stanley Shield North-Eastern R egion I69~ Competition held in London on May 27th. The increased interest now shown in first 6. Birkenhead Goods Col. E. J. Selby, O.B.E., was the adjudicator The competition is a national one for aid was conlirmed by the larger number of ociety and is held entries in the district competitions in the in both the team and individual tests. The detachments of the orth-Eastern Region this year, when 37 subsequent presentation of trophies and prizes annually. It consists of team te ts in first aid, teams competed comFared with 26 in I9-P. was carried out by Mr. H. H. Phillips, and, in the case of ,Yomen, in nursing also, The competitions were well attended and some Assistant Chief Regional Officer, who was and individual oral and practical tests in firSt very effective staging was provided in the supported by Dr. Cavendish Fuller, Chief aid and nursing. Every County branch may ledical Officer ; Mr. A. S. Quartermaine, enter a team, and the final was the outcome of various districts. Particulars in regard to the district com- Chief Engineer; Mr. C. Furber, Commercial eliminating rounds which ",-ere held throughSuperintendent; 1Ir. H. R. W'ebb, Stores out the country. petitions are given below : Superintendent; Mr. S. G . \'{'ard, Assistant The competitors in the final were: MiddleDale of No. of Regional Staff Officer; Miss E. E. Brenan, sex, County of London, Deyonsbire, East Dislrict Competition T eams rntJllillf, TealJl Chief Welfare Supen-isor for \Yomen; ~Ir. Riding of Y orksbire, Hampshire, DenbighHull February IS Hull K. Griffiths, Asst. to Supt. of the Line; Mr. shire, City of Edinburgh. Dairycoates C. W. Powell, Divisional Traffic Superinten:;-'Ien's teams were: \\'anvickshire, Sussex, Starbeck Leeds March 3 5 dent; Mr. H. C. Kerry, Divisional Loco- Somerset, Che hire, Dumbarton. 1Iiddlesbr' Middlesbr' March 17 3 The results were as follows-Sial/II!}' Shield motive Superintendent; Dr. c. T. ewnham; Station Mr. P. Anstey, Ambulance Centre Secretary; (Men): I. Sussex, 730 marks; 2. Somerset, York Carriage Mr. J. A. Martin, Assistant Centre Secretary. 698 marks; 3. Cheshire, 652 marks. Stall/f)' larch 31 York 9 and Wagon The St. John Ambulance Association have Shield (WOWII) : I. Denbighshire, 735 marks; Works consented to hold for the first time this year 2. Hampshire, 715 marks; 3. County of ewcasde ewcasde April 10 5 an Inter-Railway Women's Competition on London, 701 marks. Central Stn. the same lines as the contest which is run for HIGHEST L'fDIYIDUAL .\lARKs-.lla1:garet Darlington Darlington April 21 7 the men. This year a team from each of the Gordan Harker Cup: Mr. J. E. Stedman District former group railways and one from the (Sussex) 135 marks. EN/pI rr'rell CliP: -"Irs. Engineers London Transport Executive will compete. J. Brumfield (Ea t Riding of Yor kshire) 130 Prizes will be awarded to all the teams taking marks. Lt.-Col. R. M. rr -'est Clip: 01r. J. R. Southern R egion The concert and presentation of the awards part and the winning team will hold for the Hammond (Sussex) 77 marks. Georgilla E. of the Thames Valley Ambulance Class was year a handsome new trophy which has been Morgan Boll'/: Miss.\1. Blyth (11iddlesex) 76 presented for this purpose by Sir Robert marks. held at Norbiton on June 1st.

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The Final of the Inter-Railway First Aid Competition was held at the Borough Polytechnic, London, on 26th May.

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FIRST

AID

FIRST

AID

SIGNS AND SYMPTOMS

Pain, swelling, loss of power, the leg becoming useless, irregularity of the patella. A gap may be felt between the broken fragments.

ANATOMY AND PHYSIOL06Y IN FIRST AID by J. WELLS, M.R.C.S., L.R.C.P.

pliO-is Fractured Forearm THIS may be only fractured r.adius or fractured ulna, or it may be that both bones In th~ forearm are broken. When one bone only is broken the SIgns and symptoms are usually: pain, loss of power i-?- the limb, swelling and irregularity of the bone. An Impacted fracture of the radius just above the wrist often results from a fall on the outstretched hand. In an impacted fracture the symptoms of crepitus and unnatural. mob~lity are absent. In g~e.en stick fracture of forearm In children, unnatural mobility and crepitus are also often absent, and these symptoms must only be sought after by a doctor.

male jJelvis

ischium J>O{/f/d !t~ameflt a;/;ich !;e!jJs (0 !lold ill (he nead

01 !emu!' at!he hi!!.. rTo//(t

. ou/letnarroaJ

Treatment :Appliances required: Two splints and three bandages. Treatment is the same if fracture involves one or both bones. female pelvis (r) Place the injured forearm at right angles to the arm, across the chest, keeping the thumb uppermost, and the palm of the hand towards the body. This position when putting up the fracture is important, as you now have the radius and ulna midway between pronation and supination, and so do not run the risk of any bony union between them, which would later prevent these important move- ""' o(;{l/ra(or IOtamefL ments of the forearm. (2) Apply well-padded splints on the front and back of ISchium . female pel vis. o(Jrte { the forearm, from the elbow to the fingers. Wider l!loll III (he mate (3) Apply two bandages, embracing both splints, first one above the fracture and the other round the wrist first and completed as a figure of eight Appliances required: Three triangular bandages, or two bandage round the hand and wrist. triangular bandages, one towel and safety pins, hot water (4) Apply a large arm sling. bottles, hot bricks or oven plates wrapped j n flannel Fracture of Bones of the Hand or Fingers: Crushed applied to the patient for warmth. Hand Treatment ; Usual signs and symptoms of fracture present. (r) Lay patient in whatever position is found to be most Appliances required: Three bandages and a well-padded comfortable, flex or extend the lower limbs as the splint. patient desires; if flexed support with pillows. Treatment : (2) Apply a broad bandage round the pelvis, in line with (r) Apply well-padded splint to the front of the hand, the hip joints, tightly enough to support the pelvis, reaching from the middle of the forearm to beyond but not so tight as to press any broken bone further the finger tips. inwards. A towel folded to about eight inches wide, (2) Secure splint by applying a bandage, crossed in the placed around the body, and fastened in front with manner of a figure of eight to the hand and wrist safety pins gives better and more even support. and a second bandage round the forearm. (3) Apply a bandage as a figure of eight round both (3) Apply a large arm sling to support the limb. ankles and feet and a broad banda/f,e round both knees. Fractured Pelvis Fracture of Femur (Thigh Bone) If after a severe injury in the region of the pelvis, the The femur may be fractured at the neck, anywhere in the patient has no sign of damage to the lower limbs yet is shaft or close to the knee. unable to stand or move the lower limbs without great SIGNS AND SYMPTOMS difficulty and pain, a fracture of the pelvis may be suspected. All the general signs and symptoms of fracture are usually The bloodvessels, nerves and organs such as the bladder, present, and an important sign is the position of the foot and intestines in the male, the bloodvessels, nerves, bladder, on the injured side, which usually lies on its outer side. intestines, -..,terus and broad ligaments which support the Shortening of the limb, due to the fracture, may be from uterus and ovaries in the female are in great danger of half an inch to three inches. This shortening can be being injured. Shock is usually severe and must be treated tested by measuring with a tape or piece of string, from the until the patient is placed under medical care. anterior superior spine of the crest of the ilium to the

internal malleolus, and compared with the uninjured side. Fracture of the neck of the femur, usually occurs in old people, and is of~en difficult. t? distinguish fr.o~ ~ bruise of the hip but If, after an mJury near the hip Jomt, the patient wh~n lying on the back cannot raise the heel from the ground, the neck of the femur is usually fractured. Shock is severe and must be treated. In people over 7 0 years it often happ.e ns that ~he fractured bon~ fails to unite. Owina to thIS the patient becomes bedndden and finally dies from hypostatic pneumonia, through having to lie in bed in the dorsal position. Treatment : Appliances needed: A long splint and eight bandages.

(r)

'111'\

(2)

(3)

Steady the fractured limb by holding the ankle and foot. Gently and gradually draw down the foot, bringing it into line with its fellow, and apply a figure of eight bandage round b?th ankles and feet, that is, first fix both feet by tymg them together. Pass seven bandages under the patient in the following order ;(a) The chest, just below the armpits. (b) The pelvis, in line with the hip joints. (c) Both ankles and feet. :rhis covers the first bandage, which tied both feet to gether. (d) Both thighs above the fracture. (e) Both thighs below the fracture. (j) Both legs. (g) Both knees, which .sh.ould be .a b1'oad bandage. Place a splint along the mJurcd SIde [rom the arm pit to just below the foot: The splint should be placed one inch below the axzlla) to preven t pressure on the axillary artery.

(4)

Secure splint by tying the bandages in the same order as placed. All bandages should be tied over the splint, except the fourth bandage, which should be applied as a figure of eight, around both ankles and feet, and tied under the sales of the feet.

Treatment :Appliances needed: A splint, a good pad 4 inches by 4

inches, four bandages. (r) Lay patient on his back, support the head and shoulders, well raised. This relaxes the extensor muscles of the thigh. (2) Straighten and raise the limb on a stool or hard cushion. This relieves the pressure of the tendon of the extensor muscles of the thigh on the patella, and tends to bring the fractured surfaces of the bone together, when applying bandage to the patella itself. (3) Apply the splint along the back of the limb, reaching from the buttock to beyond the heel. Place the pad under the hollow of the leg, just above the heel, in order to raise the heel from the splint. (4) Secure splint by bandages :(a) Round the thigh. (b) Round the leg. (s) Secure the foot by a double figure of eight bandage, round the splint, ankle, foot and splint, tying on the top of the splint, below the foot. (6) Apply a narrow bandage with its centre immediately above the knee cap, cross the ends behind over the splint, pass them again to the front of the limb, just below the knee cap and tie them. Be careful to feel for the edge of the patella above and below when applying this bandage, otherwise you may leave space for the bone to have unnecessary movement . This bandage, if properly applied should firmly fix the patella. (7) Apply a cold compress over the fractured bone, to lessen swelling of the joint. Fractured Leg This may consist of a fractured tibia or fractured fibula only, or may be fracture of both tibia and fibula. The treatment is the same in both cases. When both bones are fractured all the general signs and symptoms of fracture are usually present, when one bone only is broken deformity is not always seen, especially when it is the fibula only that is fractured, the fibula being attached to the tibia above and below, with an intervening space between the t,,:,o bo~es, just as a pin is fastened in a. brooch. If pre~sure IS applied to the fibula in its upper third, the bone WIll be found. to have a spring in it, if it is not fractured. Should the sprmg in the fibula be absent, a fracture of the bone may be assumed. Fracture of the fibula near the ankle joint is apt to be mistaken for a sprain. N.B.-If in doubt) treat as fracture.

Fractured Patella (Knee Cap) Treatment : The patella may be fractured by ; Appliances required; Two splints, five bandages. (r) Steady limb by holding ankle and foot. (1) Direct violence. (2) Draw foot gently and grad ua~ly ir:to its natural (2) Muscular action. . . position, and do not let go untIl spllnts have been It is more frequently broken by muscular actlOn, that IS, fixed. by the sudden contraction of the e~tensor musc~es of the (3) Apply splints on the outer and inner sides of leg, thigh and the patella fractur~d by the.1r tendon, whIch passes reaching from above the knee to beyond the. foot. over the patella to become mserted mto the tubercle of the If only one splint is available place on outer SIde. tibia. This sudden pressure by the tendon on the patella (Please 111m 10 page r6) is sufficient to fracture the bone.

FIRST

AID

THE CARE OF THE CHRONIC INVALID IN THE HOME BY

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

THE development of district nursing, especially by the Queen's nurses, has made it possible for many chronic invalids to be cared for in their own homes, but between the visits of the district nurse the relatives must undertake the nursing duties and general care that is required. Such in"\'alids are not always old people for chronic illness exists in all age groups, and the sufferers are not always bedridden, in fact, with good nursing care comparatively few need to be bedridden. Chronic diseases may be considered in six large groups (r) Diseases of the heart and art~r~es. (2) Ton~tuberculo~s diseases of the lungs. (3) Arthnus and chronlc rheumauc diseases. (4) Diseases affecting the nervous system. (5) Tuberculosis. (6) Cancer. General Care Whatever the specific disease the first questions to be considered are" where is the patient to be nursed, and by whom ?" If it is possible for him to remain at home this is the best place for him. He is likely to be happiest in the surroundings to which he is accustomed, and if he goes into a nursing home, a hospital or other institution, he will have to conform to a certain routine and be controlled by regulations that will entail some degree of loss of liberty and this may be irksome and depressing for him. In choosing the room for the patient it must be remembered that most of his time will be spent in it. It should, therefore, be as pleasant as possible, preferably on the ground floor with a view on to a garden, although many such patients enjoy looking out on to a street where they can watch the traffic, for they still retain a curiosity about the world that passes by their window. A ground floor room is usually more convenient for nursing duties and for visitors. It is often the housewife who must take the responsibility for the care of the patient, and other members of the family must be encouraged to help; but whereas the interests and comfort of a family may be sacrificed to the care of a patient with a short, severe illness, in the care of one who may be ill for months or even years, a routine must be arranged that will fit in with the household, especially with the other duties of the housewife, leaving her time for rest and recreation. This is important, for otherwise she will become tired, irritable and unhappy, and not only will she be unable to care for the patient effectively, but there may be disharmony in the family circle. A trained social worker may be able to visit and to help the family and the patient to make the necessary adjustments in their way of life. It is being more than ever realised that many of the difficulties arising in nursing the chronic invalid are due to boredom and mental stagnation, so that every effort should be made to keep the patient occupied and interested. In this connection a wireless set is a tremendous help. Suitable books should be available and some form of handicraft is desirable, and the patient should be told about all that

is happening in the house in so far as these happenings are of interest to him. Another important point to remember is that he should not be left without a means of attracting the attention of the person in charge of him. A bell, a whistle or a stick must be within his reach. Chronic Heart Disease Chronic heart disease may follow rheumatic fever, scarlet fever and other acute infections of young life, so the patient is not necessarily an elderly person, although with modern treatment of the acute infections a good deal of resultant damage to the heart can be avoided. In other cases, although the vahTes of the heart may be thickened or contracted so that they do not function correctly, the heart itself may become larger and stronger in order to compensate for the defecti"\Te valve action, and this compensation may be sustained until late in life and then begin to fail. Therefore the majority of patients with chronic valvular disease are in late middle age. Another group of chronic heart diseases are due to degeneration of the muscular walls of the heart. The main symptoms in the disease are palpitation and breathlessness on exertion and the tendency for fluid to collect in all the tissues and cavities of the body. Cough, dyspepsia and constipation are often present, and in the later stages the functions of practically all the organs and tissues of the body are impaired owing to insufficient oxygenation and removal of waste products by the blood. Rest All forms of exertion place added work upon the heart and also upon the lungs, so that rest is an essential measure in treating a failing heart. This does not mean that the patient must stay in bed all the time unless his condition absolutely necessitates this. He must then be propped up with a bedrest or pillows, two of the latter being placed obliquely so that the elbows are supporte,d, for otherwise the shoulders will sag forward and this will make breathing more difficult. Steps must be taken to prevent the patient from slipping down in the bed, but the means used must be adjusted to the individual patient. The knees may be flexed over a pillow which can be secured in position by a " knee-pillow sling." This sling is made of a piece of strong calico, about 20 by IO inches, with webbing straps stitched on to the short sides and long enough to be passed round the top bedpost and fastened either with a buckle or by tying the ends. This is neater, more efficient and less wasteful both of material and laundry than is the practice of rolling a pillow in a drawsheet, the ends of which are twisted and tucked under the sides of the mattress-a method that has, however, the sanction of a fairly wide usage. A foot rest adds to the patient's comfort and helps to maintain the sitting-up position. A suitable one for use in the bed may be made

FIRST by filling a ticking or calico bag with sand. An air ring or an air cushion under the buttocks seryes two purposesit helps the patient to maintain his position and it prevents soreness over the sacral region. If the foot of the bedstead is raised on 6-inch blocks the slight incline that is given to the bed helps to prevent the patient from slipping down. With advanced heart disease the patient may find relief from discomfort and be able to breathe more easily if the arms are raised to shoulder level and he can lean forward. A special type of bed-table is obtainable "hich has a hollowed out portion in the centre front, around which are padded rests for the arms, and it may have an adjustable forehead rest. Some patients are more comfortable sitting up in a very straight-backed armchair, across the arms of which a bed-table, such as described above, might be fixed.

AID

occurs in chronic heart disease it may be due to an error in diet, but it may indicate the onset of heart failure or be a symptom of overdosage with digitalis. In both these conditions, however, vomiting is also present, whereas indigestion due to dietary causes is accompanied by flatulence and may often be relieved by taking a soda mint tablet.

Decrease of Weight and Elimination of Fluid .Many patients with chronic heart disease are o"\'erweight, due in part to an oyer generous diet and in part to accumulations of fluid in the tissues, known as <:edema. This adds to discomfort and also to the danger of sudden heart failure on account of the extra strain that it imposes on the heart. Efforts must be made to reduce the weight and to prevent or eliminate the collection of unwanted fluid in the tissues and cavities of the body. The patient should be "eighed Drug Treatment frequently, a record being kept. The patient will often be The drug most commonly given in chronic heart most interested in this and will readilr co-operate when disease is digitalis. It may be incorporated in a mixture or once he realises how much better he feels "hen his weight given in the form of small tablets or pills. As its excretion is normal than when it is raised. As much of the overis often slower than its absorption this is a drug that may weight mar be due to fluid retention a careful check must accumulate in the body, giving rise to symptoms of oYer- be kept on the amount taken and the amount excreted. dosage, which must be watched for most carefullr They Apart from the fluid lost through the skin and in the are nausea and vomiting, decreased output of unne, and expired air the main avenues of fluid excretion are by the slow or irregular pulse, usually below 60 beats a minute, kidneys and the bowel. If <::edema is severe the doctor although occasionally it becomes yery rapid. If these may give an injection of a drug called mersab'l that symptoms occur the medicine must be withheld until stimulates the kidneys to excrete abundant urine, thus the doctor has given fresh instructions. For troublesome reducing <::edema, but barley water and home-made cough a linctus may be prescrib.ed, and this acts best ~ it lemonade will act in the same way although in a lesser is sipped slowly. For acute pam round the heart which degree. Constipation must be avoided, in fact, by keeping radiates down the left arm small tablets of a drug called the bowel actions rather loose the excretion of fluid is trinitrin may be ordered. These should be placed und~r the increased. A daily dose of Epsom salts, odium sulphate tongue and allowed to dissolve slowly. Alternativelr, or other saline aperient will help the elimination of fluid amyl nitrite may be used. This is in. small gla~s capsules by the bowel. covered with silk. gauze. A capsule 1S broken ill a handkerchief and given to the patient to inhale. Occupation In all chronic illness it is good to let the patient do any Diet little household jobs that are \\rithin his or her power, for Rich, highly seasoned foods should be avoided and so should cabbage and starchy foods that cause flatulence. in"\Talids like to feel that they can still be helpful. Hobbies Salt should be omitted if there is any tendency to <::edema, such as knitting, needlework, jigsaw puzzles, painting, or dropsy, and fluids should be restricted. Otherwi~e, chip carving, modelling and toy-making can all be most the patient may have any light, pl~ foods. Fresh frU1ts engrossing and can while. away . many an. hou~ ve17. and vegetable salads are usually de~1rable for ~ey count~r pleasurably, leaying the panent w1th the sansfacnon ot act a tendency to constipation. It 1S never WIse to restt1ct achievement; for nothing is so demoralising as complete the things that give the chronic ~valid pleasur~ unless inactivity and it is astonishing to see the progress that can there is a definite reason for dOillg so. Smoking and be made after a little tuition and guidance, (to be continued.) alcohol are allowed in moderation. \Vhen indigestion

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Queries and Answers to fJorrespondents I have been a reader of FIRST AID for J11aJ!)' years and Queries will be dealt with under the following rules : I have gained a lot of knou;fedge from )Iour anS1vers to our I.-Letters containing Queries must be m.'Zrked on the top leftque1'ies. So I thank you in anticipation of your repfy} and hand corner of the envelope "Query," and addressed to Ilvish more power to )Iour elbow. " First Aid/' 32, Finsbury Square, London} E.C.2. Your query is difficult to answer because, if you refer to 2.-AIIQueries must be written on one side of the paper on&. the diagram of the tibia in the Textbook you will realise 3.-AII Queries must be accompanied by a "Query Coupon" that it has no "uppermost tip." Assuming that the test cut from the current issue of the Journal} or} in case ofQueries refers to the upper end of the tibia near the knee joint, from abroad} from a recent issue. I would treat as for fractured leg in accordance with the 4--The Textbook to which reference mqy be made in this column instructions in the Textbook. Of course, it is understood is the 39th (1937) Edition of the S.J. A .A. Manual of First that in this case (as with the ends of any of the long bones) it is not possible to apply bandages above and below the Aid to the Injured. fracture. Consequently the bandage which you placed above the knee would have little or no effect. in immobilising Treatment of Fractured Clavicle J. G. (Grays).-At a recent Div2sional Practice we lvere the tibia.-N.C.P. Black Eye discussing the treatment of a fractured collar-bone and it lvas the general opinion that to remove the coat would cause T. M. (Dublin).-At a recent Divisional Practice tve 7vere discussing wou17ds and we were divided in opinIOn as to unnecessary pain and loss of body heat) which would in turn whether or 170t a black rye is a contused wound. So 1ve refer increase the shock. Nevertheless} the fact that the Textbook the point for your ruling) please. states that the coat should be removed and as much more of A black eye is a hcemorrhage under the skin whereas, the clothing as is expedient} suggests that there is a good reason for doing so. We lvould therefore appreciate very as the Supplement to Textbook tells you, a wound is "a break in the continuity of tissues of body which permits much your opinion on the subject. escape of blood and entrance of disease-producing germs The weight of the coat on the seat of fracture causes or other injurious agents." In these circumstances a black increased pain because of the dragging effect on the eye cannot be classified as a contused wound unless the displaced outer portion of the fractured collar-bone and skin is also broken.-N.C.F. these effects are further aggravated by pressure of the Treatment of Crush Injury braces if these are worn. On the other hand the skilful removal of coat (and braces) would not cause aggravation C. W. (Rotherham). -As a regular reader of the Query Columll from which I have learned many interesting points) I would of the fracture. Consequently, it is unlikely that removal like to ask a query ,vhich} as I think} will be of interest to of coat would cause increased shock, but should the patient other first-aiders. complain of feeling cold you know that in the treatment The Supplement to Textbook on page 7} paragraph 8} of shock the Textbook tells you to cover patient and so tells us that in the treatment of crush i,gury involving a limb keep him warm.- . Corbet Fletcher. 1ve should give a weak solution of bicarbonate of soda. Should the water be cold} warm or luke-warm? In the treatment Examination Howler of severe shock which would accompany thIs injury} I wonder O. B. (Exeter).-In a recent examination I asked one candidate if cold water administered in quantity would not increase the to tell me what is an antiseptic . Without a moment's shock. Also} would not warm or even lttke-zvarm (given in hesitation she replied-" An antiseptic is a chemical subquantity) tend to make a patient vomit? In a recent COJJJstance which restricts the growth of girls!" The roar of petition the doctor estimated that four pints should be given laughter which greeted this definition convinced the candidate to the patient. that she had badlY blundered. Good! Next, please! !-N.C.F. The Textbook lays down specific instructions for those cases in which the treatment calls for warm or hot fluids. Treatment of Fractured Tibia When these are not given, it should be clear that cold R. C. (Liverpool).-At Divisional Practice recentfy I was drinks are to be administered. Further, with reference to given a test which involved the uppermost tip of the tibia. your query the administration of cold water would not, I set. it up with narr01V loop bandages (r)just above the knee) in my opinion, aggravate any shock which may be present.(2) lust b~/ow the knee} and (3) round the thigh. I finished N.C.F. the Job with a narrow bandage as figure-of-eight round both Propane, Pyro or Calor Gas ankles and feet) with a broad bandage round both knees C. W. (Rotherham).-Also at my place of employment we UJ'e (I had assistance) and with two padded splints. Afterwards} for specific jobs a gas which is called " Propane) Pyro or I was fold that I was wrong and that I should have treated Calor Gas." This is a liquid which gives off vapour under the fracture a f per diagram in the Blackbook! Am I or my pressure and which} if brought into contact 7vith the skin} critics right ? causes a huge blister such as mqy occur with a scald. I would be ver.J1 glad of your ruling on this matter which Please tell me if there 's any further treatm311t for th,s t~ me is a very knotty problem. inju1J' other than excluding air and getting quick medical

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attention. FinallY, I wish every success to future issues ,of

have been applied do 1ve remove the clothing? Also, does the clothing adhere to the skin and does the skin blister? SurelY, in cold weather, the wet clothing would increase the shock. I take FIRST Am every month and find the Query Column most interesting. So I thank J'ou for reading my letter and I hope you will deal with my three problems in an earb issue of FIRST Am.

FIRST Am.

This injury should be treated as set out in pages 28 and 29 of the Supplement to Textbook., Incidentally, if you have not read 1t I wO,uld re,fer you, to the interesting and informative letter on this subject ~hich was published in the Query Column of the February 1ssue of FIRST Am.-N.C.F. The instructions in the Supplement to Textbook clearly Petrol for Wounds state (I) that the clothing must not be removed in treatP'. S. (Cardiff),-I w~s told recentp; that petrol is a useful ment of burns and (2) that the dressings must be applied antiseptic and that zt can be used zn the treatment of wounds. over the clothes . This treatment evidently had serious I shall be grateful for your ruling ,on th~s point. , consideration before the ruling was given, and it was Pure petrol is certainly an antlSept1c, a,nd it h~s been considered that although the dressings were not so used by surgeons for disinfecting. th~ skin prevlOus, to effective as when placed directly upon the burned skin, operations. Further, to so~e extent 1t w1ll co~trol bl~eding. there was definite benefit from avoiding exposure of the The chief drawback to 1ts use, however, 1S that it may injured surface, apart from the risk of causing complicaprove an irritant, but this, is negligible, if, as has been tions by taking off clothing which was possibly adhering to claimed, petrol can be relied upon to ward off t~tanus the skin.-N,C.F. in accidents in which the wounds have been contarrunated , by soil from the road. It is necessary, however, to rerrund you that th~ presentday commercial petrol is far from pure and that 1t should Anatomy and Physiology in First Aid not be used for disinfectant purposes.-N.C.F. Fractured Lower Jaw ( Con~inued from page II) T. M. (Liverpool).-Will you please tell me in what position we should place a patient who is suffering from compound fractures of both sides of the lower jaw and from fracture of the base of skull and who is insensible? In a re,cent c~m petition one minute was allowed by stopwatch , if p~tzent was kept on his back, face upwards and after thls period he was pronounced dead. , , Without a knowledge of all the facts of the case 1t 1S not possible to expre~s a .defini~e, C?pinion. It is very unlikely, however, that w1th lnsens1bllity present there would be any considerable hremorrhage. It, would, seem, therefore, that the competition judge visualIse? a r,1sk of the blood getting into the lungs and preClp1tatlng death from asphyxia. Should this be the case and should the hremorrhage be profuse, then it might be necessary to place patient face downwards on the stretcher and to transport him to hospital without delay.- N.C.F. Compound Fracture of Lower Limb T. M. (Liverpool).-In the same competition 16 marks w.ere given for putting up a compound fracture, of 101ver Izmb without splints and onlY 10 marks for dozng the Job ~lth spNnts. Afew weeks later I ~ook part in another c~mpetlt20n in which the same injury requzred treatment. In thzs case the competition judge gave 10 marks for treating the fracture with splints and no marks if splints were not used. In both cases the bone protruded through the back of the calf and splints were available. As competitions are ~he o~!J way in which a keen first-aider can learn the practzcal szde of the work, I am puzzled by this difference in treatment; and I would welcome your ruling. It is obvious that there were other circumstances in these two cases which called for modification of treatment. Without knowledge of these it would be unwise to comment on the decisions of the two competition judges.N.C.F.

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Secure splints by bandages : (a) A bove the fracture. (b) Below the fracture. (c) Immediately above the knee. (d) Round ankles and feet as a figure of eight bandage. (e) A broad bandage around the knees. This bandage is important as it renders the limb immobile. fPhen single handed, after extending the limb, tie ankles and feet together, dispense with the inner splint, and pass bandages round both limbs, in the same order as given above. When no spl£nt is available, tie feet, ankles, thighs and knees together.

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Fractured Bones of Foot or Toes (Crushed Foot) Usually caused by direct violence: A heavy weight dropped on to foot, or a heavy weight passed over it, especially if surface under the foot is hard and not soft c;round. SIGNS AND SYMPTOMS

Pain, swelling and loss of power. Treatment : -

Appliances required: A well-padded splint and a bandage ; a cold compress. (I) Remove boot and stocking. (2) Apply padded splint to sole of foot, reaching from the heel to the toes. (3) Apply centre of narrow bandage over the instep, crossing it after the manner of a figure of eight and Treatment of Burns tying it off on the splint. T. M. (Liverpool).-Also in the treatment of burns caused by (4) Support foot in a raised position. corrosive acids and alkalies after the clothing has been saturated with water and such antidotes as may be available (5) A cold compress to relieve pain and swelling.

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Editorial A Course in Advanced First Aid First Aid as Practised at the Close of the I9th Century The Medicine Chest

The Blood, Heart, Blood Vessels and Circulation News from all Quarters The Care of the Chronic Invalid in the Home

Queries and Answers to Correspondents

3 4

9 12

NOTICE TO READERS. FIRST AID & NURSING is published Monthly. The Annual Subscription is 5•. post free single copies 4d. Its aim !,nd object~ .being the advancement of Am~ulance. First Aid Work and ursing in all branches, the Editor invites Readers to send Articles and Reports on subjects pertammg to the Movements and also welcomes suggestions for Practical Papers. All Reports, &c:. should be addressed to the Editor ~t the address below, and should reacb him belo re the 8th 01 each mont~ and must be dccompanied (not necessarily for publicotion) by tbe narne and address of tbe Correspondent. . Subscriptions. Advertisements and other business Communications connected with FIRST AID & URS ING should be forwarded to the Publishers. DALE, REYNOLDS & CO .• LTD., 32, FINSBURY SQUARE. LONDON, E.C.2. Telegraphic Addres.s-" Twenty-lolIT, Firuquare, London." Telephones-MON arch 1541 /2.

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"First Aid and NurSing," and the change. or rather the addition, is an indication of our intention to devote more spa<;e in the future to nursing activities. We have. of course, always dealt with this most important subject. and the interest that has been shown. for example, in the articles on practical home nursing by Agnes E. Pavey. have indicated a real need for more information and instruction on similar topiCS. In fact. there never was a time when so much interest was being shown in nursing. There are several reasons for this; an important one. in our opinion. being the serious shortage of professional nursing staffs and the consequent overcrowding of hospitals. In these conditions efficient home nursing is becoming increasingly necessary, and the demand for parttime nurses and nursing auxiliaries to fill the breach has met with ready response. Then again, one can argue with sound reason that the ending of the civil nursing reserve has left its former members with a taste for this kind of service which they wish to keep up. In this connection it was interesti ng to read the figures given in the recent statement by the Minister of Health. when thanking members of the nursing reserve for their valuable services in the past. Membership of the Reserve when at its peak in 1941 numbered 50.000 whole-time members and 57,000 part-time members. a total of 107.000, including

about 78.000 nursing auxiliaries of wham nearly 60 per cent. were also members of the St . John Ambulance Brigade, or British Red Cross SOCiety. Although the Reserve has ceased to exist there is plenty for its exmembers to do, and Mr. Bevan has expressed the hope that past and present members will give all the service they pOSSibly can in the future in relieving the serious shortage of nursing staff. There is, he points out. ample scope for part-ti me service for those who cannot take a full-time job. In these circumstances we can readily understand the revival of interest in practical nursin g and , haVing as it does a close connection with first aid work. it is our aim to provide for this valuable activity in our columns. To this end we have made an addition to our title to indicate the widened scope of the journal. and are planning a number of features which will make a special appeal to those interested in nursing. There is a great demand for literature on nursing subjects. and in these days textbooks are difficult to obtain. We hope to supply the deficiency in some small measure by articles which will appear between our covers in the future. Other items will also be appearing. and we need hardly add that our correspondence columns are open to the discussion of nursing topics. while we shall do our best to provide an expert service for queries and problems. We shall. in fact, do everything we can to meet the new interest in nursing. and we are confident that in making these changes we have the approval of our readers.

FIRST AID & NURSING , JULY, 1948

A COURSE IN ADVANCED FIRST AID BY

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

Epilepsy : Apoplexy.

I N our last article we described diabetic coma and die, twitchings begin in his body as the attack passes into insulin poisoning, two causes of unconsciousness not well known to the average reader. This time it will repay us to enlarge our knowledge of some diseases which every first-aider has already studied.

Epilepsy This common complaint is characterised by sudden attacks of unconsciousness. There are two main varieties . Major Epilepsy (Grand Mal) in which the attacks are accompanied by convulsions, and Minor Epilepsy (Petit Mal) in which convulsions are absent. Fits like those of Major Epilepsy, commonly described as Epileptiform convulsions, occur in other diseases such as high blood pressure, while a special variety of the complaint called Jacksonian Epilepsy may follow head injuries. Very little is known of the causes of the complaintmost cases are said to be idiopathic (without known cause). There is no doubt, however, that heredity is an important factor. The disease usually commences in childhood or early adult life; it is estimated that three-quarters of all cases begin before the age of twenty. Major Epilepsy About 60 per cent. of patients who are about to have an epileptic fit experience a warning, called an aura, that an attack is imminent. The aura may take many forms such as a s~n~ation of giddiness, twitching of muscles, numbness or pall I I some part of the body. Some times the warning affe~ts one of ~he special sense organs, e.g., a patient may notIce a peculiar smell, an unusual odour or taste in his mouth or ~ flash of light in front of his eyes ; occasionally he may think he hears a loud noise or an actual word. I~ will be appreciated that an aura may be valuable for the patient b~cause, .altho.ugh it only precedes the fit by a very short penod. of tlr:ne, It t?ay enable him to take precautions such as gettllg himself lltO a position of safety before the fit actually begins. .Soon after noticing the aura, the patient drops unconSCIOUS to the ground, often hurting himself during his fall. Oc~asionally, but not always, he utters the well-known shnll cry. . The next stage of the fit lasts for about forty seconds and IS called the stage of rigidity because it is characterised by extreme stiffness of muscles all over the body. The teeth are firmly clenched and the mouth cannot be opened. The f?uscles of breathing are in a state of spasm hence there IS temp~)!ary partial asphyxia, shown by t he patient's colour cl'an~llg from pallo~ to lividity and also by redness and ~ongestlOn of the whites of the eyes which usually remaIn open and turned to one side. Th~ appeara-?-ce of t?e patient a.t this stage may be very alarmmg, but Just as 1t looks as If 'he might be about to

the stage of convulsions which will last for about three minutes . Convulsions are defined as irregular and involuntary muscular contractions. In epilepsy they affect all the muscles in the body causing pronounced shaking of the arms, legs, etc. The convulsive movements of the jaw cause the saliva in the mouth to be beaten up into a foam and since the tongue and cheeks are often bitten, blood-s tained froth escapes from between the lips. Incontinence of urine and freces are very common. In this stage, the breathing recommences although it is jerky and noisy; gradually as the convulsions pass off, it becomes easier. The stage of recovery is variable. Usually the patient opens his eyes and appears dazed and uncertain of his surroundings. He is pale, sweating and exhausted and may express a: desire for sleep, which should always be encouraged. Sometimes, however, he passes into a deep coma which is gradually replaced by natural sleep. FIRST Am.-The treatment of a fit must be considered according to its stages. The stage of rigidity is only of short duration and the time will be occupied by preparing a suitable gag to place between the teeth. earby sources of danger such as chairs and other articles of furniture against which the patient might strike himself must quickly be removed from the vicinity; sometimes, of course, the patient may have to be dragged away from a source of danger such as machinery. If time permits, tight clothing round the neck, ches t and waist should be undone. Directly the convulsions begin, the gag must be slipped between the teeth to prevent biting of the tongue and ~heeks. Unless there is an obvious gap in the mouth, there IS very little object in attempting to introduce the gag in the stage of rigidity since the teeth are so firmly clenched that it is almost impossible to effect an entrance. The first-aider must hold the gag in position until the convulsion~ have ceased and at the same time gently support the patient's head to prevent injury, otherwise no attempt must be made to control the convulsions. When the fit is over, a quick examination should be made to disc.over any injuries that may require treatment. Then the patIent must be removed to suitable shelter where he can rest until he has completely recovered. Observation mu~t be maintained for complications or recurrence, in which ev:ent medical aid r:nust be obtained. Occasionally one fit WIll follow another 111 quick succession-a condition which is ca~led status epilepticus. Petit Mal This is the. usua~ nam~ applied to minor epilepsy, the form of the disease ill whIch the patient is subject to sudden attacks of unconsciousness without convulsions. The attack may manifest itself in several ways. Generally there

FIRST AID & NURS1NG , JULY, 1948

is just a short loss of consciousness unnoticed by anyone except. a close observer. Thus a patient holding a conversatlOn may suddenly turn pale, develop a dreaming stare and appear dazed, or his speech may become incoherent ; after a few seconds, he will recover and continue with his conversation as if nothing had happened. It is uncommon for him to fall down or change his position. COMPLICATIONS.- Both varieties of epilepsy are sometimes followed by complications. POST EPILEPTIC AUTOMATION is a condition in which the patient automatically undertakes some action of which he is entirely ignorant at the time and cannot recall afterwards. Often his conduct is unsocial. Thus there is the story of a well-known judge who had an attack of petit mal unrecognised by anyone until he was seen to leave his place, go into the corner of the Court and begin undressing himself as if going to bed. In post epileptic mania the patient may be temporarily deranged mentally and even become homicidal. One such patient suffering from status epilepticus occupied the intervals between his attacks by throwing chairs at other articles of furniture in his sitting-room and attacking those who were trying to restrain him. Ultimately he had to be removed to a mental hospital where he soon recovered.

The ?uration of the attacks varies ; in favourable cases, the patient mar recover c~nsciousness at any time within a few hours, I I more senous cases the unconsciousness may last for several days. On return to consciousness, there is a variable amount of paralysis. Often the whole of one side of the body is paralysed (hemiplegia) and the speech is also affected. . Cerebral Thromb osis This is very simil.ar to cerebral h~morrhage but is caused by the formatlOn of a clot of blood in one of the b~o<?dve~sels of the brain. It may be very difficult to distlilgulsh between the two conditions, but the onset of a thrombosis is more gradual and the paralysis may spread slowl~, e.g., begin in the hand and extend upwards. Warnmg symptoms are more common than with cerebral hremorrhage and the patient does not alwavs lose consciousness. ' FIRST Am.-The most important point to remember is not to move the patient if this can be possibly be avoided. If, for example, the seizure occurs at home, he should be kept in the room where he has collapsed, being made comfortable on a bed improvised on the floor. Any ~ttempt to carry ~ upstairs may proye fatal since it may llcrease the bleeding. Often, of course, removal is essential, as, for example, when the case has occurred in the street. Then the guiding principle must be to transport the patient as carefully as possible-stretcher and ambulance essential-to suitable shelter. Other points in treatment include undoing tight clothing, removing false teeth, raising slightly the head and shoulders, covering the patient and applying hot water bottles to the rower part of the body, being careful to avoid burns. Iced cold compresses may be applied to the head but are of very doubtful value. Stertor can be relieved by keeping the head turned to one side and pushing the jaw forwards from its angle. Small wisps of cotton wool should be used periodically to mop up excess of saliva in the mouth. The remainder of first aid comprises masterly inactivityremembering that any treatment such as applying smelling salts, giving stimulants or drinks will do more harm than good.

Cerebral Haemorrhage This is the technical name applied to bleeding within the brain and is a common cause of unconsciousness from middle age onwards. It is generally caused by the rupture of a blood vessel which has been weakened by arteriosclerosis (hardening of the arteries) and is usually associated with high blood pressure. Patients susceptible to cerebral hremorrhage often experience warning symptoms for some time prior to the attack. These symptoms are caused by the arteriosclerosis and high blood pressure; they include attacks of giddiness, headaches, sleeplessness, nose-bleeding and numbness or twitchings in the limbs. The attack itself may occur at night, but the onset is more common during the day and may be precipitated by many factors such as mental excitement, coughing, straining or over-exertion, especially if undertaken on an overloaded stomach. The onset is sudden, the patient is seized with a severe headache, feels giddy and faint; he falls to the ground, passing rapidly into a state of coma. At first, all his muscles are relaxed, but it is usually possible to detect that one side Handbook of First Aid and Bandaging of the body is limper than the other. Limpness of the muscles of the face results in the cheeks being puffed out By ARTHUR D. BELILIOS , M.B., B.S. ; DESMOND K. :.\IULVANY, with each breath, again often more on one side than the M.S., F.R.C.S. ; and KATHARrnE F. AR:-rsTRo:-<G, S.R.N., S.C.M. other. London : Bailliere Tindall & Cox. Price 5/- lIet The breathing is deep and stertorous, the snores being This Handbook of First Aid and Bandaging, which is now in its caused by the paralysed tongue and soft palate falling third edition, has definitely established itself among first-aiders the backwards into the throat. It is a bad sign if the breathing world over. This fact must be a source of great satisfaction to i[s becomes irregular-alternating phases of deep and shallow authors who in this issue had to face the question of how much they breathing known to those who have studied home-nursing ought to omit of the first aid recommended for injuries sustained in as Cheyne Stokes respiration. The pulse is variable being warfare. They have accordingly deleted the chapter on chemical usually full and slow. Incontinence of urine and freces is warfare but have otherwise made no changes, bearing in mind that common. In severe cases the face is flushed and the the circulation of this book extends to parts of the world where temperature of the body raised. . peaceful conditions do not yet prevail. Further, they have largely Valuable confirmatory evidence may be obtained by re-written the chapter on hremorrhage and have revised the treatment examination of the eyes. The pupils may be large or small of spinal injuries in the light of modern teaching on these subjects. but are otten irregular; frequently both eyes are directed Finally, they have introduced short sections on heat exhaustion, towards one side-the affected side of the brain-a sign stoker's cramp, the vibration syndrome and the pillow and splint called conjugate deviation ot the eyes. method in treatment of fractures of the leg.

FIRST AID & NURSING , JULY, 1948

First Aid as Practised at the Close of the 19th Century by

J. A. COOK. they have come off, and more blood generally flows (Continued from June issue) then than when they are sucking. The total amount The next item to catch my eye was that dealing with of the blood drawn and subsequently lost by each "DISLOCATED THmIB" which, after describing how the leech-bite is nearly half-an-ounce. injury could be caused, proceeded as follows :"Wnen leeches are gorged they will drop off " Make a clove hitch, by passing two loops of cord themselves; never tear them off from a person, but over the thumb, placing a piece of rag under the cord just dip the tip of a finger into some salt and touch to prevent it cutting the thumb ; then pull in the same them with it. After leeches come away, encourage line as the thumb. Afterwards apply a cold lotion of the bleeding by flannels dipped in hot water and one part spirit to three of water." wrung out dry, and then apply a warm spongio-piline o indication as to how long or how strong a pull was poultice. If the bleeding is not to be encouraged, necessary to effect a cure was given, and one is Ifft to cover the bites with a rag dipped in olive oil, or suppose that a strong first-aider assisting (?) a weak patient spread with spermaceti ointment, having previously on the lines described could accidentally cause more damage sponged the parts clean. than that already occasioned. " To stop continued bleeding from leech bites apply Treatments for hremorrhage were generally good, and pressure with the fingers over the part, or dip a rag all emphasised the need of drawing the sides of large in a strong solution of alum and layover them, or wounds together to stop bleeding. use the tincture of sesquichloride of iron, or apply a In the unconscious state, however, there was much that leaf of matico to them, placing the under surface of the amazed and amused me. An example of the latter was the leaf next to the skin, or touch each bite with a finelyalmost universal direction to "tickle the patient's feet" pointed piece of lunar caustic, or lay a piece of lint to see if he responded. (It is assumed that if these efforts soaked in the extract of lead over the bites; and, if produced loud cackles of laughter from the p:3tient it was all these tried in succession fail, pass a fine needle through " stupor"!) Of the former was the inevitable direction a fold of the skin) so as to include the bite) and twist a piece to "apply leeches to the temples" with very detailed of thread round it. Be sure never to allow anyone to accounts of how to make such applications. As they are go to sleep with leech bites bleeding, without watching so rarely seen by the present-day first-aider I think part of them carefully. these directions would be of interest to the reader; they "Mter leeches have been used, place them in read as follows :water containing 16 per cent. of salt, which facilitates "LEECHES AND THEIR ApPLICATION.-The leech the removal of the blood they contain; and they used for medical purposes is called hirudo medicinaiis, should afterwards be placed one by one in warm water, to distinguish it from other varieties, such as the and the blood forced out by gentle pressure. The horse leech and Lisbon leech. It varies from two to leeches should then be placed into fresh water, which four inches in length, and is of a blackish-brown is to be renewed every 24 hours; they may then be colour, marked on the back with six yellow spots, and re-applied after an interval of eight or ten days, and edged with a yellow line on each side. Formerly be disgorged a second time. The best plan, however, leeches were supplied by Lincolnshire, Yorkshire and is to empty the leech by drawing the thumb and foreother fenny counties, but latterly most of the leeches finger of the right hand along its body from its tail are procured from France. to the mouth, the leech being firmly held at the " To apply leeches, hold them over the part with a sucking extremity by the fingers of the left hand. By piece of linen cloth, or by means of an inverted this means, with a few minutes rest between each glass, under which they must be placed. The part application, the same leech may be used four or five should first be thoroughly freed from down or hair times in succession." by shaving, and all liniments, etc., carefully and In treatments for drowning I found, after detailed effectually cleaned away by washing. If the leech is accounts of inducing respiration by means of bellows held hungry it will soon bite, but sometimes great difficulty in the patient's nose, and other barbaric measures, the is experienced in getting them to fasten . When this following list of " Cautions" : is the case, roll the leech into a little porter, or moisten " Never rub the body with salt or spirits. the surface with a little blood, milk or sugar and water. Never roll the body on casks . When applied to the gums care should be taken to Continue the remedies for twelve hours without use. a leech glass, as they are apt to creep down the ceasing." patle.;:'1t's throat; a large swan's quill will answer the Cases of" Hanging" were dealt with more expeditiously purpose of a leech glass . and, one is tempted to believe, after reading the treatment "Each leech is supposed to abstract about two recommended, that the writer must have had some interest drachms of blood, or six leeches draw about an in the undertaking business! Such measures were as ounce; but this is independent of the bleeding after follows : -

FIRST AID & NURSING , JULY, 1948

" Loosen the cord, or 'w hatever it may be by which the person has been suspended. Open tbe telllporal artery or jugular vein) or bleed from the arlll; employ electricity, if at hand, and proceed as for drowning, taking the additional precaution to app~y eight or ten leeches to the temples." ! ! ! Poisoning in those days, either intentionally or accidentally, was very common owing to the fact that there was no control on the manufacture or sale of such substances, and that they were in common household use, even in the poorest of homes. The treatments being as many, and as varied, as the poisons themselves I do not propose to deal with them in this article, except to mention that the inevitable leech entered into most of the treatment although it was now applied to the abdomen and not the temples. The "Bites of Mad Animals" were always treated rather drastically and, as a typical example, I ' commend the following : "Hydrophobia, or a fear of Fluids.-Tie a string tightly over the part, cut out the bite, and cauterise the wound with a red-hot poker, lunar caustic, or disinfecting fluid. Then apply a piece of "spongio piline," give a purgative, and plenty of warm drink. \\7henever chloroform can be procured, sprinkle a few drops upon a handkerchief, and apply to the nose and mouth of the patient before cauteri ing the wound.

\~'hen the breatrun&, appears difficult, cease the applica-

tlOn of the chloroform. A physician, \\Titin a in the , Times,' strongly urged thL course, and stated, many years ago, that there is no danger, with ordinary care in the application of :..ne chloroform, while th~ cauterisation may be mot ~ effectivel)" performed." In conclusion, I should like t(., draw the readers' attention to the many "Caution " for tl e pre\Tention of accidents that \"ere printed, at variou tin.es, in the periodical of those day. The mo t intere ting contain the follo"Ting advice " T ever point a gun or loaded pi tol at anyone in jest, whether it i loaded or unloaded. "\. loaded gun should ne,'cr be brought into the house." " Te,er meddle \\Tith gun-powder by candle light. ' " Tever sleep near charcoal; if dro\\"_ ,- at an,- work \-vhere charcoal fires are used, take the fresh ·air." " hould an infant lay hold of a knife or razor, do not try to pull it away, or to force open the hand; but, holding the child's hand that i emrt~T, offer to its other hand anything nice or pretty, and it will immediately open the hand and let the dangerous in trument faU." Of such was the treatment of first aid and the prevention of accidents at the close of the 19th centu ry-the " Gay I ineties " and the " Good Old Days" !

The Medicine Chest By FRANK BERRY, PH.,C.

Betaine Hydrochloride, see Hydrochloric Acid. Bicarbonate of Soda, see Sodiwn Bicarbonate. Biniodide, see Mercury. Bismuth This is a metallic substance which can be specially prepared in the form of a very fine grey powder which is readily diffused when shaken with water. It is a useful drug u . ed in the treatment of the many varieties of syphilis and for this purpose is administered by intramuscular injection. It should not be given intravenously or hypodermically, the former procedure being frequently followed by seyere toxic reactions and the latter being very irritant and painful. It is advisable to use an all-glass syringe for these injections as symptons of nickel poisoning have been noted when a syringe with a nickel-plated piston has been used. A typical product suitable for injections contains 20 per cent. bismuth with glucose solution, and the average weekly dose represents from I § to 6 grains precipitated bismuth metal. Provided sufficient time is allowed between doses to permit effective elimination, bismuth injection therapy can be continued for long periods with little likelihood of toxic symptoms developing. Many salts of Bismuth are used medicinally, the chief being : Bismuth Carbonate This is a white, odourless, tasteless powder which is insoluble in water. When taken internally it forms a protective layer on the walls of the stomach and intestines, thereby reducing the irritation which might be caused by food or glandular secretions. This soothing effect leads to its use in the treatment of dyspepsia, ga eric inBammation, vomiting and diarrhrea.

\long \yirh such substances as \Iagne ium Carbonate, Calcium Carbonate and Sodium Bicarbonate, Bismuth Carbonate is widely used in the treatment of ga tric and duodenal ulcers. ExtensiYe and prolonged alkali therapy of this type is u ually gi\'en in conjunction with specially modified diet scheme. Bismuth Carbonate is a frequent inarediem in many proprietary Antacid and so-called Indigestion ;,Iixrures, Powders, and Tablets. but owing to scarcity and high price it has been largely replaced during war-time by substances more readily available. Bismuth Carbonate is opaque to X-rays and may be used to assi r X-ray diag nosis of disorder of the alimentary cract, bm the cheaper and equally effectin Barium Sulphate has no,,- largel)' replaced it for this purpose . Externally, Bismuth Carbonate is frequently used in form of ointment or dt; ting powder to relic\c irritation caused b,- many skin complaints. The following formulx may bc regarded as typical : Bismuth and Soda Mixture. Each tablespoonful do e contains : Bismuth Carbonatc Sodium Bicarbonate .. . nIagnesium Carbonate .. . Glycerin .. \"Xiater to Sedative Bi muth Mixture. Each tablespoonful dose contains . Bismuth Carbonate Sodium Bicarbonate Calcium Carbonate

5 grains 5 grains 5 grains 12 minims ~ tluid ounce

grains

10 grains

5 grains

FIRST AID & NURSING , JULY, 1948

FIRST AID & NURSING, JULY, 1948

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10 minims Tincture of Chloroform and Morphine t fluid ounce Water ... to Compound Bismuth Powder. I part Bismuth Carbonate 3 parts Calcium Carbonate 3 parts Magnesium Carbonate .. . I part Sodium Bicarbonate .. . This is largely used in treatment of gastric and duodenal ulcer. Maclean's Power is a modification of this formula. Dose 15 to 60 grains. Bismuth Salicylate This is a substance typical of the products obtained by combining Bismuth with antiseptic compounds. It is an almost white, odourless, and tasteless powder which is quite insoluble in water. It is a valuable antiseptic protcctive for the intestinal tract and is useful in the treatment of summer diarrhcea in children, ulcerative colitis, typhoid and dysentery. It is given in doses of 10 to 30 grains in powder or mixture form and in oily solution may be injected intramuscularly for treatment of syphilis.· Bismuth Subnittate This is a white, odourless, tasteless, water-insoluble powder, which is given in doses of 5 to 20 grains in treatment of dysentery and gastric ulcer. It also acts as an intestinal antiseptic and has astringent properties. Along with Iodoform it forms an ingredient in Bismuth and Iodoform Paste, better known as BJ.P.P., a popular application for promoting healing of wounds. The formula for this preparation is :Bismuth Subnitrate 4 oz. Iodoform 8 oz. Liquid Paraffin ... 4 oz. Bismuth Subgallate This ~s a yellow powder insoluble in water. It has mild astringent properhes and may be given internally in doses of 10 to 30 grains for treatment of colitis and diarrhcea. It is frequently used in form of suppositories, each containing 3 grains, for relief of h:emorrhoids, and mixed with starch, boric acid or zinc oxide it forms a useful antiseptic dusting power for wounds, eczema, etc. Black Currant The fresh ripe fruits contain sugars and organic acids such as citric and malic, together with colouring matter. The juice is used as a. flavouring and colouring agent and in the preparation of many pastllles and syrups. Black Currant Puree, issued by the Government during war-time, forms a valuable source of Vitamin C. Black Draught This is a brisk purgative containing Epsom Salts together with Senna, Liquorice, Cardamoms and Aromatic Spirit of Ammonia. Duse I to 2 fluid ounces. Black Wash. see Mercury. Bladder Wrack The brown seaweed, Fucus vesiculosus, also known as Bladder Wrack or Sea Wrack, is very common around the English Coast an~ in the form of an extract has been frequently used in treatment of g01:re an~ obesit~. It contains a gelatinous carbohydrate substance, algill, together wJth small quantities of Iodine. Blaud's Pills Th~s .pill mass is. generally issued in the form of 5-grain pills, each approXlmately I grain of Carbonate of Iron (Ferrous Carbonate). The pills may be sugar- or chocolate-coated or treated ~o as to have a highly-polished black surface. They were formerly Issued gelatine coated, but these are not now generally available. Sugar-coa:ed tablets are also issued, one tablet being equivalent to one 5-graJn Blaud's Pill. Soft gelatine capsules are available, being contaillill~

described as one-pill, two-pill or three-pill according as each contains the equivalent of 5, 10 or IS grains of Blaud's Pill mass, and being therefore equal respectively to one, two or three 5-grain Blaud's Pills. Blaud's Pills are very useful in the treatment of simple an:emias and as a general tonic. Compound formul:e are frequently prepared in which the action of the iron carbonate is augmented by that of cascara, copper, manganese, strychnine or arsenic. Bleaching Powd er This is prepared by passing chlorine gas over slaked lime until absorption ceases. It occurs as a dull white powder smelling characteristically of chlorine which it evolves on exposure to air or treatment with acids. Bleaching Powder, known also as chlorinated lime, contains not kss than 30 per cent. of Chlorine, and the variety known as Tropical Bleaching Powder contains excess of unslaked lime to increase its keeping properties. It should be stored in well-closed containers. Bleaching Powder is a powerful disinfectant and deodorant used to disinfect f:eces, urine, drains and sanitary utensils in general. In the proportion of I ounce to 2,000 gallons it may be used to purify water for drinking purposes, the unpleasant taste being subse.quently removed by addition of a small quantity of sodium thiosulphate (photographic hypo). If Bleaching Powder be used for disinfecting rooms after infectious diseases, all metals and articles such as fabrics, likely to be bleached, should first be removed and disinfected by some other process. Bleach Cream and Bleach Ointment (Anti-Gas Ointment 0.]) consisting essentially of Bleaching Powder, were available during wartime for application to casualties if liquid vesicants such as IustaTd Gas or Lewisite had been used. Several antiseptic solutions prepared from Bleaching Powder have been used in hospital work and tbe following may be noted :Solution of Chlorinated Lime Two ounces of Bleaching Powder are mixed with I pint I)f distilled water, the mixture set aside and shaken frequently during three hours and then filtered. The resulting clear liquid is useful in treatment of foul ulcers, but its general application is limited by reason of Its somewhat irritant action. Solution of Chlorinated Lime lvith Boric Acid This is the well-known EUSOL, prepared similarly to the above described Solution of Chlorinated Lime, but using i ounce each of Bleaching Powder and Boric Acid to each pint of distilled water. This is used as a general antiseptic either in the form of lotion or on gauze wrung out and applied without protective covering. This solution also is somewhat irritant and is of limited application. Surgical Solution of Chlorinated Soda This. is the well-known Dakin's solution and is prepared from Bleachillg Powder, Sodium Carbonate and Boric ACId, the proportions used ~arying according to the strength of the Bleaching Powder. Assurrung the Bleaching Powder to yield 30 per cent. available chlorine when tested chemically, the quantities would be : Bleaching Powder I65t grains Sodium Carbonate 329 grains Boric Acid 35 grains Distilled Water to I pint This constitutes one of the most stable and suitable forms of chlorinated solution for general use, and is especially useful in the continuous irrigation treatment of infected wounds as by the Carrel-Dakin technique. Al~ types of chlorinated solutions should be kept in well-stoppered contamers, protected from light, and stored in a cool place. They gradually lose strength on keeping. There are several proprietary products of this type, issued as deodorisers and general antiseptics. (To be con/intled)

The Blood, Heart, Blood Vessels and Circulation by

J. WELLS, M.R.C.S., L.R. C. P. THE BLOOD consists of Liquor Sanguinis, called also the scarlet blood is ususally found in the arteries (vessels \vhich convey blood from the heart).. The dark purple blood Plasma, blood corpuscles, red and white. LIQUOR SANGUINIS consists of water in which is dissolved usually flows through the .velns (vessels which convey certain mineral salts, albumen and other nitrogenous blood to the heart). The bnght scarlet blood is therefore called arterial, and the dark purple blood, venous . It matter. should, however, be noted that the blood contained in the I THE RED CORPUSCLES have a diameter of about 3,200 pulmonary arteries. is v~nous. It enters t.he right auricle by the supenor and mfenor vena:: cavre, It then flows into inch, and a thickness of about __ I --inch. If placed flat the right ventricle through the tricuspid orifice and is I2,000 edge to edge it would require 10 millions to cover a square then forced by contraction of the right ventricle into the pulmonary artery, an~ so to the lungs to be purified by inch. THE WHITE CORPUSCLES are slightly larger than the red, the oxygen from the mspued au. After purification in the lungs, the arterial ~lood passes into the left auricle by the being about ~ inch in diameter. As they consist of a four pulmonary velilS, and from the left auricle into the 2,5 00 left ventricle, through the mitral orifice. Pure arterial soft jelly-like substance (protoplasm) they easily change bloo~ is now ~eady for distributi?n to the body, after being their shape. The white corpuscles are not nearly so numer- re-oXlgenated ill the lungs. It WIll thus be seen the imporous as the red, the proportion being one white to five tance of fresh air and good ventilation to maintain good hundred red . . If freshly-drawn blood stands at rest for a health. The normal temperature of the blood is 98.4-F. few minutes, it becomes semi-solid, and forms a blood This high temperature is maintained by chemical action, clot. The clot is due to the formation of fibrin, a sub- chiefly by the oxidation of the carbon and hydrogen of the stance not present in living blood, but is formed spontane- tissues. The blood is warmed as it passes through muscles, ously after the blood has been drawn, from materials in glands and other active organs, but is cooled slightly in solution. This change in the blood is called coagulation, the capillaries of the skin. and the liquid which separates from the clot is calJed The quantity of the blood is usually estimated at about blood serum. The serum is almost entirely free from one-tenth of the total weight of the body. corpuscles, these becoming entangled with the fibrin. If fresh blood is stirred briskly with a branch of twigs, the The Chief Uses of the Blood are :(I) It serves as a storehouse for nutrient matter fibrin is formed very rapidly, and collects on the twigs, absorbed from the foods we eat and drink, and leaving behind a red fluid called defibrinated blood, which conveys this nutriment to all parts of the body. will not coagulate. The colour of the blood is due to a (2) It conveys the materials from which the glandular nitrogenous substance in the red corpuscles called secretions are formed to the various glands which ha::maglobin. This substance contains a large proportion prepare them, e.g., the pancreas, suprarenal, thyroid of iron oxide, and has the chemica-l property of combining and digestive glands. with oxygen gas . As the blood flows through the capil(3) It carries oxygen gas to all the tissues, where the laries which surround the air cells of the lungs, the process of oxidation goes on, thus being essential ha::maglobin in the blood combines with the oxygen of for the maintenance of the high temperature of the the air which we inspire when breathing and becomes of body. a bright red colour. The blood thus re-oxygenated and (4) On its journey through the body it collects up waste changed in colour returns to the heart by the four pulmonary materials, and conveys them to the excreting organs veins, into the left auricle and then passes into the left for separation and removal. ventricle through the mitral valve of the heart. The left (5) It serves to distribute heat throughout the body. ventricle then contracts and forces the blood into the (6) It moistens the various tissues. aorta and by its main branches it then becomes distributed THE HEART is a hollow muscular organ cOnslStlilg of throughout the body. four cavities-a left auricle, left ventricle, right auricle and On passing through the tissues of the various organs, right ventricle. It is situated nearly in the middle of the and especially the muscles, the ha::maglobin gives up some front and lower part of the chest, just above the diaphragm. of its oxygen to the carbon and hydrogen of these tissues, It is conical in form, and is placed with its base uppermost, torming r.e spectively carbonic acid gas and water. The and with its apex or pointed end turned downwards and ha::maglobin then changes to dark purple in colour and towards the left. Its size in the adult is about equal to the the blood then again returns by the veins to the lungs closed fist, and weights about nine to ten ounces. The with the carbonic acid gas in solution. In the lungs this heart is covered by a membrane called the pericardium, gas is given off into the air during expiration, while the which consists of two layers of fibrous tissue, one being h a::maglobin receives a fresh supply of oxygen from the attached to the heart, and the other enveloping it loosely. inspired air. It is therefore seen that the ha::maglobin is (Please turn to page 16) the oxygen carrier of the blood. In the body the bright

FmST AID & NURSING , JULY , 1948

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News From All Quarters 'G sen-itude, but of sen-ice-yoluntary sen'ice. THE ST. JOHN AMBULANCE RE.\'DI On Tuesday, June 1St, a joint meeting was They belonged to an ancient Order founded held by members of the British Red Cross on Christian principles. BRIGADE. Society and Sr. John Ambulance Brigade in There was a tendency, he said, for yoluntar"

connection wirh the St. John and Red Cross service to be decried ill these days and people Hospital Library Sen-ice. A very interesting were heard to say that if a per on were doing demonstration of "First Aid m Books" a job, then he should be paid for it. was given by :\1iss E. Barker, County Welfare " It ,,'ould be a ,-ery e,il day for our country Officer (B.R.e. .) shmving how to clean up and our Empire when people \vere no longer No. I (prince of Wales's) District and re-bind torn and diny books for the use ready to help their fello,,- citizens in times of H.-\.CKKEY DIYISIOI\ of pari ems in hospirals. A course of lectures trouble unless they were going m be paid for The Di.-ision ran an exhibit in the form of a is shonly being arranged on the subject. it." roadside first ajd hur in a recent Road-Safety Among those attending the meeting were The Lord Lieutenant congratulated the Exhibition held by the Hackney Borougii .\fiss Hanbury Williams (B.R.e.S.) County Divisions on their fine turn out on parade, and Council. Organiser Hospital Library Service and County paid tribute to the work of the Brigade. He The hut, which was fully equipped, had one Officer Miss D. K. Gibbins (S.J..A .B.) hoped that they would see another centre side removed to enable \-isirors to ,iew the established in Bath before long. THEALE interior, and was manned by members of the The ~Iayor (Ald . Sam Day), who, ,,-ith the On Friday, June 1 th, the members of Division assisted by members of 1 o. 1 ( toke Theale .t\ursing Division and Ambulance and Mayoress (~1rs. Gillard), accompanied the l'ewingron) 1 ursing Division. Lord Lieutenant on his inspection, said that Each e,ening the members on dury gave ?\ursing Cadet Diyisions began their Annual the attitude of those on parade suggested good demonstrations of first aid work to the public. St. John Week ,,-ith a display which was held org~sation, good discipline - and good The Exhibition was opened by Mr. James on the Rectory lawn by kind permission of the serVlce. Callagan, :\1.P., Secrerary ro the Minister of Rev. W. H. Trebble and Mrs. Trebble. This O n parade were the five Bath DivisionsTransport, who expressed his appreciarion of was attended by County Cadet Officer W. G. the Men's Division, the ursing Di\-ision, the fine work done by the Brigade in dealing Thomas and Div. Supt. Mrs. Thomas "'ith the Student lurses, the Ambulance Cadets their son David and an appreciative audience \dth road accidents. of parents and friends. The programme and the Nursing Cadets-and contingents included demonstrations of .fust aid by members from orton, Radstock, Frome and Timsbury, 98th Wands worth and Southfields of the ursing Division and of the Ambulance with the band of the Brisml St. John AmbuOn Saturday, 29th ;\1ay, Dis. Off. F. E. Cadet Division and ke-ep-fit and folk dancing lance Brigade. The number present was Stratton and :\,1rs. Stratton were presem at a by the Nursing Cadets. Items were also between 250 and 300. yery successful variery sho,,' that raised over provided by the Reading Town "A" AmbuThe Lord-Lieutenant took the salute at a £7 in aid of the fund to equip the new First lance Cadet Diyision Band and the evening march-past, and the Divisions later marched Aid Station at Tibbets Corner, Putney Heath. ended with a "camp-tire" sing-song. to the Pump Room, where tea was served on the Terrace. Supt. Brown expressed gratitude of the County of Leicester Division to the artists who had giYen their Sir James presented to Divisional Supt. fELT 0 seryices so freely to raise the funds. E . \Y/. Smith, Senior Officer for Bath, an Ambulance O fficer J. Foster, Divisional address, in r ecognition of the Instructor since the Division's formation 10 illuminated 0t h anniversary of Bath City Ambulance County of Berkshire years ago, and Mr. R. Gates, Treasurer for 5Division. DrDCOT 10 years, were presented with a cigarette case Members of the County Staff present On Sunday, June 13th, Didcot, Hunger- and a pipe respectively by Divisional Surgeon ford, Kintbury and \\:'allingford Divisions Dr. G. John at the Annual1feeting of Melton included A.ssistant Commissioner Dr. Leslie Beath; COUnty Supt. Dr. G. A. Danby; held their Annual Inspection at Didcot Division. Secondary Modern Boys' School. The The Diyision had made good progress and County President Mrs. Geoffrey Lutterall; Inspecting Officer was :\1rs. H. D. Beckwith- members were taking more interest than ever County Officers Mrs. Bingham-Hall, Miss St. Smith (late Deputy Superintendent-in-Chief) before, reported Secretary Mr. P. E. Hunt, Lo Wilkinson, Mrs. Selwyn, l\fr. W. J. Tottle (Parade Marshal) and l\f1'. Bailey; County who expressed regret at the absence through adding that it was now 27 strong. illness of County Commissioner e. A. Poole, In the past year, the Division had performed Cadet Officer O . H. Thomas; Assistant and complimented all Divisions on their 20 7 public duties and treated 102 cases. Its County Cadet Officer Miss E. B. Colley and smart turn-out. She was accompanied by annual flag-day collection had been the largest County ursing O fficer Miss Leedham Fuller. Representing the British Red Cross Society Assistant County Commissioner F. A. e. of any district in the county. Jarvis, County Superintendent the Hon. Mrs. The l\felton team was placed third in the were Mrs. A. G. e. King, President, Balh Leslie Gamage and members of the County county finals of the Dewar Shield national Division; Commandant E . G. Stock and Commandant R. Tooze. Staff. The Parade was linder the command of first-aid competition at Leicester. The parade was organised by Divisional Di,-. Supt. \Xl . J. Fisher (Didcm Ambulance The Melton men-Sgt. e. Chamberlain, Diyision). Service ribbons were presemed to Ptes. F. Wright, II. King and e. Cram-were Superintendents E. W. Smith and Mrs. A. D . Div. Supt. W. J. Fisher (Didcot), Div. Supt. beaten by the Wigs ton team (who will represent Appleby. F. J. Jolley (Wallingford), Div. Supt. Mrs. Leicestershire against orthampton in the WEST SOMERSET E. E . Cusden (Didcot), Amb. Officer W. T. regional finals) and Southfields Library. Eight Some 200 Ambulance and Nursing members Bolton (Wallingford), Amb. Officer Mrs. e. teams competed. of the West Somerset Section (with their Ruddle (Did cOt) , Transport Sergt. F. J. Cadets) paraded at Bishop Fox's School, Denness (Hungerford), Sergt. W. J. Hall County of Somerset Taunton, on Sunday, July 4th, for their (Wallingford) and Sergt. Mrs . E. ~1. Ackrill BATH NURSING DIVISION Annual Inspection. (Didcot). The Inspection was followed by a The five Bath Divisions parading with The Inspection was carried out by Dr. march past and parade through the town neighbouring Divisions for their Annual headed by Reading Town "A" Ambulance Inspection were told by Admiral Sir James Hugh Powell, M.B.E., County Commissioner, Cadet Division Band, and tea was provided at Somerville, L ord-Lieutenant of Somerset, assisted by 1\11'. A . Wevell, J.P., e.e., Assistant County Commissioner, and Dr. Clark, County the Dideot Ambulance Station. that their uniform was a badge, not of Surgeon.

FIRST AID & NURSING , JULY , 1948

Cardiff 10 t London lidland Region Leicesrcr 190 The result of the International \mbulancc Preston 7 10 Compctition held in Derby on 1 Tth June was i\hnchestcr" " IS:! as fol low' :Test Indi"idua] To tal The peakers at tea included .Udem1an T eam In juri es Que' tlons Mark, H. . \ . Bennie Gray (Huddersfield) who 100 100 100 3UO I. Camden ,< _-\ . , welcomed the team ' and \~ i irors, ~[ajor F. L7 b i-! 1S7! East\yood, who pre eored the Stirk Trophy 2. :. [orherwell go 71 0 ~i-7 to the winning team, tOgether \\'ith indiyidual 3. \\ olverton \,'orks ~I prizes [or the.fu t three team ,and poke of the value of fir t aid training in Road Passenger 4· Dundee \\ 'orks 70 Transport C nderrakings. The ;\ssociation's 5. Horwich Pre idem, ~1r. H. Muscroft (General ~[anager, \\ork n 71 Huddersfield Corporation Transport) handed o. Gla go,," oyer office to :'1r. R. _-\ . Fearnley (General Eglint~n (. 7 2 70t 73 ~ 210 ~[anager Cm'enrry Corporation Transport). Judges were: Dr. J. R. utherland ~1r. P. ayage- (Hon. Treasurer, :'lid~and Gla gow (Team Test); Dr. H. \\. O. hew, Red :'[otOr Seryices), gaye a re -ume ot the Glasgow (Indiyidual.); and Dr. \\. Dunc.m, Association's ,,-ork and appealed to those Li,erpool (Que tion.) . present to endeayour ro further their work ,\11. R. Hewitt, Good - Dept., \\ o rkington which was already making progress after ~lain, and '\1r. E. \'\. G. l\ orton, D.O.~L haying been discontinued during the war Office, London (\\estem), ha\e n::ccntly been period. Any Road Passenger Tran POrt admitted to the Order of ~ t. J ohn in the Cndertaking interested in first aid work and grade of Scn ing Brother. .. . \\-i hing to become affiliated to the Kational Dr. :'1cinnes, Tyldesley, ha- recel\"t:d sllnIlar Road Passenger Transport .l\mbulance recognition in respect o f hi~ 'cn icc ' to A sociation should write to the Secretary, clas es in the Tddes!c\' arca. :'Ir. H. D. Lewis, 6 , Flora treet, Cardiff, SO~lthem' Region when a copy of the Rules will be forwarded. Raihyaynien from all parts of Kcnt were present o-n the occasion of th~ opemng of.thc BRITISH RAIL WAYS Canterbury \\" elfare Hut at Cantcrbur) \\ e ' t TAG TO AMBl..JL CE DIV1SION Women's Inter-Railway First Aid t~1tion recenth~ . The Hut, which during the The Taunton Ambulance Di,ision returned Competit[on war ,,'as the o~ffi.ce of the Raih\'ay Tratl'pon home recentl v in possession of a further two The inaugural competition for women Officer, wa recently acquired by the Rail\\-ay silyer cups. in the competition held at Barnstaple Taunton was runner-up for the Lady employed by the British Raihnys ,,:as held~ at Executiye as a welfare centre for raih'aymen Forre~ter Cup; but for scoring .t he highest Trenchard House, London, on Fnday, I th in the area, but primarily to be u ed as a number of pointS of ~y team :v.hich had not June. A team from each <;.>f the former main headquarters for the local railway ambulance previously entered thiS competltlon, Taunton line railways and one trom the London class. 1\1r. G. Poimer, Di trict ecretar~ of the Transport ~Executiye competed, the result received a silver cup. outhcm Region Ambulance Centre, presided, being as under : and the opening ceremony \\'a. pelfo nned by Birmingham County .' [ark.s 11r. P. ' unn, Diyisional upenmendcnt, who \'{'ITTO & KIKGSTAI DI 'G DIYISIOt \\'e tern Region- windon team. \yas supported by :'1r. ~ . T. ~ r;1nbrid ge On Sunday, June 6th, over si~y members Ea tern and Torth-Eastern RegIOn (tation .\faster, Cant~rbur) ) , \It. R.. E. and friends of \'fitton & Kmgstandlng -Hull diStrict team Goodman (Diyi ' ional \\ clfare Repre entat.l\e) J;)ivision travelled by coach to Maidenhead, ourhern Region - _\udit Ladie' and upt. H. G. Butcher (Kent Co unty Police). then by steamer to \'\'indsor, where lunc.heon team ADDI CO:'IBE DIVI 101 was seryed, after which a visit was patd to London :l \Iidland Region-Somers A splendid record and one of whi~h to be St. Georges Chapel and the grounds of Town team 37 6 justly proud, is the record .of the _\d~ltscombe \'rindsor Castle. London Transport Executive _ 3+f After tea, the party returned by road to The adjudicatOrs were Dr. K. S. Maunce- Diyision, .J.A.B., compnsed of rallwarmen Birmingham, the visit being voted. ~ huge Smith of Ely and Colonel E. J. Selby, ,,-ho for O\' er 35 years ha\'e ?ecn present on dutv at the Epsom Race ~fcetlng each year. success, despite adverse weather conditIOns. of London. . During thi long period they_ ha\e ~kalt Corps O fficer and :\1rs. G. Fowles accomPrizes were awarded by the St. Jobn panied the party. . \mbulance Association to each mem?er of ,,-ith hundreds of casualties ot all kInd', includina births and deaths, and ne:'er once The National Road Passenger Transport all teams and the winning team ( wmdon) in spite b of the ~a.ny difficul?es '\\'hlc~. ha\'e will hold for the year the Challenge Rose Bowl Ambulance Association which has been pre ented by if Robert arisen haye they fruled to arrl\'e at thell po t STIRK TROPHY FIt AL to carr\' on their innluablc yoluntary work. The final for the Stirk Trophy held under Burto,,'s Chairman of the former London Western Region . the auspices of the ational. ~oad Passenger Midland' & ScOttish Railway. The Annual Concert and Presentation of The sub equent proceeding were preslded Transport f\mbulance AssoclatlOn took place Awards was held at windon on Ilth J:IllC,_ at the I. e.I. Sports Ground, Huddersfield, on o\'er by Briaadier WI. B. G. Barne, e.B.E., I94- , when 1[r. F. W. H~\\'ksworth.' ChLd Sunday, July 4th. Over 300 spectators were D.S.O.: Secr~tary-General of the Order, who Mechanical Engineer, was In the ~h:ur, sup-. present including the Mayor and. Mayoress was supported by Lady. Burrows.; ~~rs. ported by ~lr. R. Burgo) nc, RegIOnal . tait of Huddersfield, officials of the af!iliated R~ad Garouard, "\ssistanr Sup nntende~t-m-ChLef? Officer; ~Irs. Burgoyne; \1r. H. R. \\ ebb, ursina Diyision of S ..J.A.B. ; Major General Passenger Transport Under~ak.l11gs~ ~r~lor Stores uperinrendenr; , \lderman G. H. F. S. Eastwood (Traffic COml11iSSlOner, North- F \ 7 13 \,\'itts e.B. C.B.E., D . . 0., 1Le., elman, Deputy11ayor; and Mr. J. . -\. Western Area), and representatives of the St. Assis~an~ Direc;or of ~\l11bulance ; Mr. W. M. l1artin, Assistant Ambulance cntr.e ccretary. John Ambulance Brigade. Prior to the Barrino-ton \'fard e.B.E., D .. 0., member of The presentation of long SerYlCe awards, competition, lunch was sen-ed at the Co- the Railway Exe~utin, and officers from each also class awards, was made by Mr. Burg~r.ne, Operative Rooms, after whlch b~~es com-eyed of the Regions. The Challenge Bmd was pre en ted to the and l1rs. Burgoyne presented thc compctltion the spectators to the competltlor: ground. trophics and prizes. . The teams taking part \V:er~ th.e wmners and winning team by Lady Burro:ng " ' ho e;,pre?Eastern ReglOn sed her admiration for the ladles teams 10 thl runners up of the Area e1llTIlnatlOg contests. The Chief of Police at l~ing'~ Cro ~ .has The judge for the team test :vas County the first competition ?f its kind and hopcd revived the Annual ,,\mbulance COmp~tLtlOn. Surgeon D. J. icol, 1 Le. (Bltm~ngham), there would, in the future, be men .yer us to stimulate the first aid amongst poltceme~~ and Dr. Ball (Barnsley) judged the Vl\'a Voce women first aid contests. J\1r. Barnn~ton throughout the Region. The" Jesper Cup WIard, in pre enting the indi.Yidual l?nzes, and Individual Practical Test. won by the P:ukesron team at a contest Marie..; said, " We want not ~~ly Bn,rlsh Rath"ays wa Results were : second to none, but BntL h Ratl\Ya~-s Ambu- beautifully staged by the Fngincer at \laryle23 1 Coventry Corporation Transport bone recently. lance second to none." 216 ottingham

Dr. Powell stre, sed the need fOI continuing the wor k of the Brigade in spite of the new . ational Health en' ice Act. The general public, said Dr. Powell, still eemed to be under the impression that this new Act would " take m-er" the British Red Cross oClety and St. John Ambulance Brigade as paid personnel. It could not be too strongly emphasized that this ,,'a~ ~Ot the ~ e. .Uthough, in order to m~l11taJ?- an effiClent 2+-hour ambulance sernce, lt would be necessary to enrol a few full-time paid men, there w~uld still be plenty of opportunity for \-oluntary members to take their turns for relief and night duty-apart from attendance at public function - of all kinds? as at present. The Somerset County Councll would now pay for the ,":se aJld maimenance of the ambulances "hlch are owned by the B.R.e.S. and .J.A.B. It mu t be understood, howeye.r, that tbis money could only be used for certaJl1 specific pUlposes connected \Yith. t~e Ambulance Service and could not be asslffillated tnto the general funds of the Brigade. "\\'e are still," said Dr. Po\,' ll, " a \- olun~a.ry bo.dy aJld must maintain that ,' oluntary spine ,,'hlch has been a feature of the Brigade in the past. \\ e bope, also, that th~ public, r~alising our true position, will contmue to ~lve us th~, good support which it has done ill the past.

FIRST AID & NURSING , JULY, 1948

THE CARE OF THE CHRONIC INVALID IN THE HOME BY

AGNES E. PAVEY, S.R.N. Diploma in Nursing (University of London) t? three minutes to allow the blood to drain out of the (Continued from June issue.) 11mbs, when they become rather blanched. Then he sits D iseases of the Arteries up with the legs hanging down until they become flushed THE old saying that" a man is as old as his arteries" and for abc:>ut one minute longer, after which the legs are contains a profound medical truth, for as long as the placed honzontal to the body for three minutes . These arteries retain their elasticity it is possible to live a normal t~ree movements should be repeated four to six times active life, but directly they become hardened and inelastic rught and mornmg and, if considered r.ecessary, at midday the person I?ust cc go slow" in all he does . The rigidity also. and narrowmg of the arteries diminishes the supply of If varicose. veins a.re present the patient must be advised ~lood to all parts and especially to the limbs, gives rise to to we~r elastic stockings and to avoid standing, for if once mcrease~ blood pressure and predisposes to rupture of a the skm breaks the wound may never heal again. vess~l w.1th consequent ha':morrhage. The hardening of the arterIes IS called arteriosclerosis and, in itself, it is not a caus.= Prevention of Gangrene of chronic invalidism, but it can lead to cerebral Gangrene i.s loc~l death of tissues, and changes will then ha':morrhage, also known as apoplexy or cc stroke", and to certa0 heart conditions, such as coronary thrombosis occur at the Junction of the dead and living tissues which or embolIsm, that may cause sudden death or necessitate WIll lead, eventually, to complete separation; the dead, careful nursing over a long period. Less alarming ~r gan~renous, toe or foot coming away from the healthy consequences may be gangrene of a toe or a foo t and other tissue m much the same way as dead leaves separate from results of an. i-?adequate blood supply. An understanding t?e bra~ches of a tree in autumn. The extent of death of of the conditlOn and a careful management of patients tissues IS showl~ by the appearance of a line of demarcation . with arteriosclerosis may do much to ward off these Gangrene may mvolve one joint of a toe only, or it may extend to the whole foot. complications. Apart from improving the blood supply to the feet, Al?art frorr: high b~ood pressure, some of the signs ot artenosclerosis are pam and cramp in the muscles of th<" much can be . don~ ~o prevent gangrene by avoidance of ~eg on exercise or when lying in bed, cold and numbness cold and of ~or ~Junes. Warm, well-fitting socks must I-? the extr~mities, a th0 :' tissue paper" skin and very be worn, aVOiding tightness and wrinkles, and long enough litt~e blee.ding when an mJury occurs . The patients are to ~llow the toes to move freely . In winter two pairs are easIly fatIgued, both physically and mentally and they deslrabl e. The shoes must not constrict the feet or cause be.c?me. breathless on exertion or experience dizziness o~ pres~ure on any part. Nails and lumps in the sole are partIcularly dangerous . The feet must be washed with ansmg m the morning. warm. water at least once a day and be carefully dried, General T reatment espeCially between the toes, afterwards using a little dusting The aim ?f the treatment is. to lower blood pressure powder and placing wisps of cotton wool between the and to avoId, as far as pOSSIble, all conditions that toes . Great care is necessary in cutting the nails or paring ~ggravat.e the condition. Adequate rest of mind and body :s es s ent~al, for worry, anxiety, excitement and any excesses a c~)tn. Ch erru cal corn cures must never be used. The m exerCIse, f~od. or drink can lead to rupture of a blood patient must be. instructed to report at once if a cEster, a vessel. ObesIty IS most undesirable in these patients an d cut or ~n abraslOn appears on the foot, for this will heal efforts. should be. made to reduce weight by regulation of slowly, If at all. He must then be kept in bed. The lesion t?e . dIet. Smo~lng should b~ ~orbidd en or be strictly s~ould be gently clea-?sed with surgical spirit and covered limited be~ause It cause~ constnctlOn of small arteries, but w ith .dry gauze or ~nt held in position with a strip of alcohol .dilates superfiCIal vessels and so is allowed in adhesIve pl~ster, whIch must never encircle a toe. If a moderatl?n, ~specially as a "nightcap" . The functions small ulc~r IS not painful it might be treated with Friar's of the ~kin, kidneys an~ in.testines should be stimulated by balsam. (tincture of benzoin) . The heel should be raised by warm baths, ~he dnnkmg of large quantities of water by placmg a small pillow under the leg and the weight of and the pre.ventlOn of constipation. Exposure to cold the bedclothes sh ould be taken by a cradle. Prompt and efficient treatment may avoid gangrene must ce aVOlded, especially in elderly people. but if th~s c:>ccurs the area must be kept clean and drv. I~ Prev~ntion of Muscle Cramps may be lIrruted to the toe or it may spread to involve the . ThIS must. depend upon improving the circulation to the whole of the foot and extend up the leg: Surgical spirit lImbs, espeCIally to .the legs . Some simple exerCIses have should be applied s~veral times a day, the foot must be kept bee~ deSIgned to this end, but they should not be carried warm, but If pOSSIble expose the area to the air as this out If ther~ are any abrasions or ulcers on the legs or feet . promotes drying. Applicat~ons of heat to the region must The~ are known as Buerger's exercises . The patient lies never be ~sed. .When the lIne of demarcation appears the on hIS back and elevate~ his.re~s , the heels bein g sup ported doctor Will decIde whether the gangrenous portion should on the foot of the bed If t~l1S IS high enough, or on the arm b~ amputated or left ~o separate of its own accord, and this of a couch or settee. ThIS p osition is maintained for one Will depend upon hIS condition and the wishes of the

FIRST AID & NURS1NC , JULY, 1948

patient and his family. \Xlhen only one toe is involved and hot-water bottles around the body and at the feet. th~ patient may. object to surgical removal. However, This may help to lessen congestion in the head. N elJer pam, waste of tlille and expense may influence him to give .rtimu/ants. Lift and drop the limbs on each &-.i de in choose an immediate operation, and if the gangrene has turn in order to estimate the degree of laxity or limpness, spread beyond the foot a neat amputation makes it possible and so discover w?1ch is the paralysed side. If vomiting to fit an artificial limb . If the area is not kept dry or if occurs turn the patIent towards the sound side with a pillow it becomes infected "wet gangrene" ensues, and this at the back to give support, and keep the head turned so demands amputation as soon as the line of demarcation that vomited material is not drawn into the lungs and the tendency for the tongue to slip back into the throat is appears. checked . The paralysed limbs must be supported on Cerebral H remorrhage With arteriosclerosis and a marked increase of blood pillows, taking care that there is no pressure upon them pressure the danger of rupture of a vessel is always present, and the joints are in normal position. This is particularly and ~s there is less room for expansion in the cranial cavity important at the shoulder, for stretching of the large nerve passing in front of the joint may make a temporary paralysis than In any other part of the body, a ha':morrhage occurring into a permanent one. No attempt should be made to there h~s seri~us consequences, for the blood presses upon the bram and lffipedes or destroys its functions .. This leads rouse the patient. When the doctor comes he may perform venesection, to unconsciousness and paralysis and loss of sensation in and if convulsions are present he may administer a sedative all parts of the body which receive their nerve stimuli drug by hypodermic injection. The patient may die within from the area of the brain that is damaged. This may be a few minutes or a few hours of the stroke, he may live fot one limb only or the whole side of the body, and with some days, or he may recover consciousness and then make paralysis of the right side there is often loss of speech. good progress towards ultimate recovery, although this The bursting of a blood vessel in the brain is called is seldom complete and a second stroke may occur at a apoplexy or " stroke". This may be preceded, for several later date. weeks or months, by slight htemorrhages causing dizziness, (to be continued.) nausea, vomiting, tingling in the fingers or toes with temporary loss of movement, and some degree of mental N ew Safety Posters confusion. Eventually a larger ·vessel ruptures . The The Royal Society for the Prevention of Accidents haye two new exciting cause of alJoplexy may be a sudden physical strain, posters in production in connection with" Home Safety," we learn strong emotion, worry, excitement or a fit of bad temper. This must be kept constantly in mind and slight irritations from the current issue of" Safety News " ; they are" First Aidjor Scalds and Bums" suitable for use as a wall chart to be displayed in or vexations should, if possible, be prevented, for it is Clinics, Welfare . Centres o r Hospital Casualty departments, and a often a seemingly trivial thing that brings on a loss of temper and results in a terminal cerebral htemorrhage. Fire Guard Posler-relating to Section I I of the Children and Young Persons' Act 1933. This is a simple letterpress poster calling The attack may occur with no warning, but it may be attention to the fact that it is essential to have fire-g uards fixed preceded by a few moments of dizziness, ringing in the wherever there are children under seven years of age. ears, specks before the eyes and a sudden blinding neuralgic pain in the head. The patient then becomes deeply unconscious, the skin is warm and moist and the face may be flushed, bluish or ashen gray. The pupils may be The Local and Home Health Services dilated, but they are often unequal. The respirations are This series of services is the responsibility of the I 46 major slow, deep and noisy, like a loud snoring, the cheeks being blown out during expiration, with spluttering at the lips. local authorities in England and Wales-the County Councils and The pulse is full and slow, with a high tension. Con- County Borough Councils - acting as Local Health A uthorities. vulsions may occur and urine and fteces may be passed They work through Health Committees. In many Counties there are Local Area Sub-Committees of the County H ealth Committee involuntarily. Treatment P ut the patient to bed, lying flat but with the head elevated. Apply cold compresses to the head and forehead

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Edited by NORMAN HAMMER, M.R.C.S., Major,late R.A.M.C.,T.A.

Queries will be dealt with under the following rules : of the bo4Y and ,vork it d07vn to the required pr;sition; a pull on the thumb knolJ' opel1s the other knot so that the end I.-Letters containing Queries must be marked on the top lefthand corner of the envelope "Ouery," and addressed to of a bandage (or if required looped, both ends) can be inserted, ,1/hen tension on the .rtring firmlY grips the bandage, which " First Aid & Nursing/' 32, Finsbury Square, London) E.C.2. can then be drawn beneath the patient until visible the other side and released. Continuing working the string d07vn to the 2.-AllQueries must be written on one side of the paper onlY. next po.fition, another bandage is linked up and so on to the 3·-All Queries must be accompanied by a "Query Coupon" end: An additional advantage is that string is usualb, more cut from the current issue of the Journal) or, in case ofQueries available than a suitable piece of wood. Another purpose from abroad) from a recent issue. for zvhich it mqy be used is to secure the tongue forward when 4·-The Textbook to which reference mqy be made in this column StIch action is indicated. is the 39th (I937) Edition of the S.J.A.A. Manual oj First Best thanks for your letter and its ingenious suggest.ion. Aid to the Injured. Personally, I have never found much difficulty in passing a bandage under the body of a patient when it is doubled over a splint. Some of our readers, however, may perhaps Dry Lime on Hands decide to adopt your method.-N.C.F. F. C. (Brixton Hill).-At a recent S.J.A.B. Final Competition a builder was supposed to have fallen from a ladder) and to have received certain injuries. He ,vas found lYing on the Brigade Efficiency ground, ,vith hzs right hand inside an overturned. pail of dry lime. The four teams treated the injuries, and to my surprise, E . J. (Neath).-Please would you be kind enough to let me have treated the hand for BURNS! the exact positiol1 regarding efficiency in the Brigade. It is well kn01vn amongst builders, gardeners, and others, U7i11 the efficiency of a member of a Division who was that slaked lime as is used on buildings will not burn at all. serving in the R.A.F. as a Civilian Armourer for a while I have put my hand in a pail of lime mairy times without and was then transferred to the Mines as a Bevin Boy, be any discomfort. Mqy I suggest that even if it had been classed the same as a member who was in the forces . quicklime there would still not have been a burn ? Meanwhile) Your valued help in thzs matter would be very much I thank you for your valued opinion on this subject. appreciated. Best thanks for your letter and for your interesting As your query is one which is governed by Brigade criticism with which I am in full agreement. As, however, Regulations you should ask your Divisional Superintendent I have not seen the marking sheet and do not know what to submit it to the Commissioner. Personally, however, the surgeon examiner had in mind I can offer no further I am of the opinion that time spent as Civilian Armourer comment.-N. Corbet Fletcher. and in the Mines does not count as time spent in one of H.M. Services.- .c.F. Examination Howler A. H. (Thornton).-At a recent examination a Cadet SuperinTreatment of Fractured Ankle tendent gave a Cadet the job of treating a supposed patient for simple fracture of ribs. H7hen the Cadet had treated N. B. (Chepstow) .-In· a recent examination I 1vas s14rprised to hear an examiner ask one candidate to treat a patient for this il1jU1Y properlY, he asked the boy what he would haz)e Jracture of ankle. As no specific instructio!1S for the treatdone if the patient had been found to be suffering from ment of this iryury are given in the Textbook, I shall be complicated fracture oj ribs, the boy's replY was-" I would grateful to have your ruling and advice. have treated as before,. and also I would have given the The term "fractured ankle" is usually applied to patient an Aspro tablet! fractures of the lower end of tibia and/or fibula at the Good! ext please! !-N.C.P. ankle joint. Consequently, treatment should be as for frac ture of leg.- .c.F. Passing Bandages Under Body R. T. (Moulton).-When inserting bandages under a patient in Short Breathing with Fractured Ribs a recumbent position we are instructed to double the bandage over the end of a splint and to pass it under the bo4Y. I find, M. O. (Cardi£f).-Please tell me ,vhat is the meaning of the zIJord in practice) that the splint gets caught up in the clothing or " short" in connection ,vith the breathing of a patient irregularity in the surface of the ground. suffering from fractured ribs (Textbook, page 7 8 ). To overcome this difficulty I use two pieces of string, each Th.e word " short" means" not long in time or space." a yard tong, joined ]vith what is known as the Englishman's ApplIed to the breathing, it signifies that each breath will or Fisherman's knot, ,vith a thumb knot at the ends to grip be. carried out in less than the usual time. Consequent on to open the former. At the ends of the hauling parts loops th1s . change the breathing must be shallow and also are made to insert a finger. To use it commence at the top hurned.-N. c.F.

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THE HUMAN BODY by The Body as a Whole; Skeleton ; Muscles; Respi~atio.n ; Circulation of the Blood ; Symphatic System; Digestive System; Various Abdominal Organs ; Urinary. Syste":,; Nervous System; Brain; Gen ital Organs; Embryo ; Skin; S~eclal Senses, Touch, Light, Hearing , Smell, Taste ; Internal Secretions ; Death; Bibliography; Glossary; ~opiously Illustrated

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FIRST AID & NURSING, JULY, 1848

The Blood, Heart, Blood Vessels Circulation (continued)

.FIRST AID & NURSING, JULY, 1948

and

Between the two layers of pericardium is the pericardial fluid which acts as a lubricant to the heart during its cont;action and dilatation, and it also lessens friction.

FATIGUE article on the above subject appears in a recent issue A N ofinteresting the official organ of The Industrial First Aid Attendants' Association of British Columbia. It states that fatigue is a state of partial tiredness more or less. In industry it probably has a greater underlying tendency to accidents than most folks realise. Not all fatigue at work is due to the working environment. We should be thinking of two varieties then of fatigue.

AORTA

On-duty fatigue can be caused by boredom due to the monotony of the task, awkward work position, lack of rest periods, poor lighting, heat, racket, fumes, poor atcitude to the job, prolonged speed-up, long hours or personal worries.

SPECIAL eUNDLE Of MUSCLE FIBRE5.')0It!ING

IIIC.HT AND LEFT

VENTRICLES

THE HEART.

THE HEART MUSCLE.-There are two kinds of muscle in the body: (r) voluntary muscle, ~hich is. striated or striped, and is under the control or the will; (2) Involuntary muscle which is non-striated and not under the control of the will. The heart muscle is of a special type, in that, although striated, is not under the control of the will. (To be continued.)

ANATOMY

HUMAN SKELETONS

Both above types can be numerous among either the executive or physical labour workers. The best basic cure is-do not drive yourself so hard, work reasonable hours, relax your mind with some interests other than your job and the people who do the job with you. Yes, get yourself some other active interests, memberships or hobbies.

HALF SKELETONS, Etc. Etc.

Fatigue spells inefficiency all along the chain of command and the top executives can pretty well eliminate it by schemes that have worked elsewhere.

ADAM, ROUILL Y & CO.

Have a training plan which not only works but shows the worker where his job fits into the main production set-up.

Articulated & Disarticulated

Human Osteology, Anatomy, etc.,

that cuts friction and

Have rest periods that are just that. Rotate the tough, dirty, monotonous jobs. Arrange full time to eat in comfort and not waste time finding either food or comfort. Never relax a day on health and safety education. Welfare policies which have been morale and loyalty mainstays elsewhere include pensions, sickness insurance, counseling.

Trade Advts .

DENISTHORPE CHALLENGE CUPS open Ambulance Competitions for Senior and Cadets. Denisthorpe Church Hall, Burton-on-Trent, August 28th, 1948. Entry forms: Sgt.]. Finch, Daybell, Moira, Burton-on-Trent.

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If First Aid is a subject in which you are interested, then you will readily understand the value of SWEDISH MASSAGE and how it can assist in healing the sufferer.

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Give the new worker jobs that the tests have shown he can do with his present training.

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WATERPROOF ELASTOPLAST. • • these B U L K PAC KS are handy, economical Waterproof Elastoplast First Aid Dressings have a base of a new plastic skin. They are waterproof, greaseproot~ oilproof. They adhere to the flesh all round a wound and give complete protection. For the special needs of factories and first-aid posts, there are First Aid Outfits, containing 120 dressings, 40 of each of three useful sizes Cli" X I", 2t" X I", 3" X I"). Refills of each size are available. There are also Bulk Packs of 100 dressings in three additional sizes: Ii" X Ii", 2/1 X 3/1, Patchettes i" diameter. Order these useful packs now. PLASTIC

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Editorial

A Course in Advanced First Aid

The Medicine Chest

The Blood, Heart, Blood Vessels and Circulation

News from all Quarters The Care of the Chronic Invalid in the Home Nursing Problems Queries and Answers to Correspondents Topical Notes for First Aiders and Nurses -

9 II

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Editorial Fi rst Aid on the Beach

the majority of cases should not happen, and would not if

almost daily of bathing fatalities along our coasts, and it does seem in many of these tragedies that lives are lost needlessly. It is usually the poor swimmer venturing too far who gets into trouble, or children swept away before they can be reached. Human nature being what it is, it is not enough to warn of the dangers, and whatever may be thought of the careless person who ignores a warning, the fact remains that lives are being lost, and in many cases very little is being done to prevent these tragiC happenings. Recently, correspondence in the .. Times" has emphasised the need for safety precautions on busy beaches during holiday seasons, including the provision of life-saving eqUipment, the recruitment of lifeguards, and first aid. Of course, in some seaside towns these things are organised as a matter of course, and no doubt are responsible for saving scores of lives every year, but it is the exception rather than the rule. When a ship is in danger off our shores an efficient organisation is SWiftly brought into operation for the rescue of human life. How horrified we would be if that ship was left to its fate, yet how often do we read of bathers being drowned in the sight of friends and passers-by because there were no means available of helping them; and how often do we hear of spectators of these unhappy events risking their own lives, and sometimes losing them in fruitless attempts at rescue. This sort of thing is a terrible tragedy, and in

surely time that some such organisation was formed on a national basis, and not left to the whim of the local authorities. How this could be achieved is a matter for serious consideration, but the difficulties are not insurmountable. The provision of eqUipment and premises would seem to be a matter for the local authorities, but as regards the manning no doubt a voluntary effort would work out best. In this connection we wonder if the first aid organisations can playa part in any scheme of this nature. Of course, first aid stations on beach and promenade are not unknown by any means, and indeed d.o useful work, as we know, in many directions. The need IS rather for lifeguards, properly trained and qualified, and eqUipped with every facility for saving life, although undoubtedly co-operation with first-aiders would be essential. Is it too much to ask that some such body of local volunteers should be trained and equipped from public funds, ready to stand gu~rd over .our holiday beaches? We think not; there IS a pressing need for their services, and we think it intolerable that our bathing beaches should continue to be so dangerous to the young and inexpert through the lack of safety precautions. It would be interesting to have the views of our readers on this matter, especially the point we have raised above as to the part the first-aider can play in keeping death away from our beaches.

N OW that the holiday season is in full swing we read the means of life-saving were promptly available. It is

FIRST AID Be NURSING , AUGUST , 1948

A COURSE IN ADV ANCED FIRST AID BY

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

Concussion and Compres sion of the Brain eYents which immediately preceded the accident. As an

injuries ar~ of great importance since t~ey are H EAD c:lifficult to d1agnose and may .be follo~ ed b} example, a motorist had an accident at some cross roads unpleasant complications if an error IS made ill then diagnosis or treatment. . . Concussion of the brain is common and IS .liable .to follow a blow on the head. A popular explanatIon of 1tS symptoms is that they a~e caused .by a momentary arrest. of the circulation of blood ill the bra1n due to the organ beillg squeezed as the result of the blow. . Concussion may occur in several dc-grees of ~ever1ty. In the mildest cases the patient may not Jose conscIOusr:ess at all but he feels giddy, dazed and s1ck for some tIme after the accident; sometimes he falls to the ground. Often he will lose consciousness for a few seconds or minutes. In the more serious cases, the patient becomes completely unconscious, in a sta~e of stupor or coma, and so remains for any length of time up to half an hour: An important point to reme~ber is that half an hou! IS t~e outside limit for unconSCIOusness due to concussIOn; If the insensibility lasts for longer than this l?er.iod of tim~, it is almost certain that the injury to the braill IS one that IS more serious than concussion. The symptoms and signs of unconsciousness due t.o concussion are very similar to those of shock. The ~ace :s pale and the skin is cold and clammy; the breathing IS slow and shallow and the pulse quick and feeble. Inco-?-tinence occasiqnally occurs. Examination of the eyes w1ll disclose the characteristics of either stupor or coma but the pupils are always equal in size. ;. inequality in their size suggests a more .senous head .ill) ury such as a fractured skull or compressIon of the braill. A characteristic feature is the nausea and vomiting which often accompanies the gradual return to consciou.s~ess . For this reason, any patient w~o vomits after a h~ad illJury must be suspected to have suflered from c?nCUSSIOn, Two further interesting phenomena hable to follow concussion are mental confusion and amnesia. If mentally confused, the patient may not appreciate his surrou~dings ; he may talk irrationally or commit acts automatIcally of which he has no memory afterwards . Thus a goalkeeper suffered from slight concussion which none \ of his fellow players recognised until it was noticed that he was running up and down the field aimlessly playing apparently an imaginary game on his own. Amnesia is the medical term for loss of memory; the patient, even if it was only stuporous, generally has complete amnesia for the period of his unconsciousness and perhaps for some time afterwards . Often this amnesia is also " retrograde" which means that it extends backwards from the time of injury. Hence the patient may not remember the blow that knocked him out or even the

and was taken to hospital. All that he could remember on his recovery was approaching the cross roa.ds; ~e could not recall as witnesses confirmed, sounding his horn, applying his brakes and swerving to avoid the accident. Such a " black-out" is often permanent. FIRST AlD.-\,\"lhile he is unconscious the patient should be kept lying flat, preferably on his side. _ In severe cases when there are signs of collapse, the c, head low, feet raised" position may have to be adopted. \,(Tarmth should be supplied by extra wraps and hot. water bottles, car~ beillg taken to avoid burns. Otherw1se the treatment 1S very similar to that for shock but fluids must, of course, be withheld until vomiting has ceased. !he usual general principles such as undoing tight clothing, etc., must be applied. . , On return to consciousness the patient s head and shoulders must be raised in order to diminish the blood supply to the brain. Rest must be encouraged whenever possible in a darkened ~oom.. ._ Of great jmportance IS observauon o~ .the patle~t. ThIS is necessary because in his daze.d conditlon he ffilght &"et up, wander about and cause himself further harm .qulte apart from the attention that he needs when VOffiltIng. Moreover, every first-aider must remember that the symptoms and signs of concu~si.on. may also occur at ~he onset of the more serious head InJUrIeS such as compress~on of the brain and it is often only by careful observatlOn that these more serious cases will be recognised in their early stages. For this reason, th~ temperature and pulse should be taken at half-hourly mtervals and the results recorded. The remainder of the treatment is, of course, a matter for the doctor and generally the patient will be advised. to remain in bed for quite a long time, estimated by allo~lllg two days in bed for every minute that he w~s uncon~clOus with a minimum of from ten days to a fortrught. Th1s rest is essential to prevent unpleasant complications such as severe headaches and mental impairment. Many patients, convalescent from. concussion, try to rebel against their doctor's orders. Sm~e they feel aI.:nost normal within a few days of the aCCIdent they fall to appreciate the necessity for the stay in bed which ~as been advised; in fact they will be only too pleased to dls~egard it if given any encouragement. Thi~ t~ndcI?-cy to dlsob.ey medical advice introduces a new prInCIple mto the ethICS of first aid, namely, loyalty to the doctor. . In theory, of course, the dutjes of the first-alder ce.ase directly the doctor has taken charge o~ ~ case . I.n practICe, however, it is well known (although It IS undesuable) .that the advice of the first-aider is often sought for subjects outside his scope and very often, unfortunately, it is given.

FIRST AID & NURSING , AUGUST , 1948

Loyalty means supporting the doctor in whatever advice he gives and under no circumstances making a remark which might undermine the patient's faith in his medical attendant. Occasionally first-aiders-and nurses too-are disloyal. Generally they are of an inferior type who feel consciously or unconsciously that they require a little " boosting up." They think they can appear more important if they criticise to the patient or to his relatives the doctor's advice; sometimes they even suggest a different treatment. In this manner they may retard a patient's recovery by undermining his faith . Loyalty to the doctor is of the greatest importance when talking to a patient convalescent from concussion for often he will be only too pleased to provide himself with an excuse to disobey the doctor's advi:e in regard to the length of stay in bed. Compression of the Brain

the skull to relieve the pressure on the brain and dealing with the cause of the condition. It is ob\'ious, therefore, that first aid must consist of obtaining medical advice as quickly as possible since the operation has to be performed as an emergency procedure. In the intenTal and during transport to hospital, the treatment to be adopted con ists of general principles and applying the measures recommended for cerebral h::emorrhage. Infantile Convulsions Since this is the last article on unconsciousness, this important ailment must be mentioned. Fits in infancy and early childhood are very common and cause much alarm to parents who generally assume thal they are caused by some serious disease such as epilepsy or meningitis. These are, of course, possible causes but there are many others which are more usual, such as teething, indigestion, worms or earache. .i\loreover, it is not at all unusual for a This condition results when the pressure within the child who is sickening for an infectiou disease such as skull rises to such a degree that it is sufficient to disturb measles to have a fit just as an adult would have a rigor the functions of the brain. Its causes include bleeding from (severe attack of shivering accompanied by a rise of the vessels surrounding the brain and pressure on the organ temperature). produced by a depressed fracture of the skull; sometimes The fit comes on suddenly but an observant mother will in addition there may be injury to the brain itself. often notice in her child warning symptoms such as nenTous The immediate symptoms and signs which follow the irritability, restlessness and jerky movements. The first head in jury are the same as those of concussion. Sometimes sign of the fit is that the child thro\",s it" head back, becomes the patient recovers consciousness for an interval before stiff and has obviously lost consciousness. Its breathing compression develops. This temporary. recovery ~f becomes irregular and may e\Ten stop for a second or so, consciousness before a subsequent relapse IS called a lUCId For this reason the colour alters, 'Varying from slight pallor intend and this is one of the points \"hich should be watched to actual cyanosis. Muscular twitching, squinting and for by the first-aider while he is maintaining observation frothing at the mouth may be noticed. on a case of suspected concussion. So far as first aid is concerned, there are 1',\' 0 accepted The symptoms and signs OC compression are very similar methods of treatment. The first comprises stripping the to those of apoplexy. The face is flushed and the tem- child, supporting it up to the level of its neck in a hot perature of the body raised." The breathing ,!s de~p ~d bath (IOOO to r05°) and applying cold compresses to the stertorous; in seyere cases Cheyne-Stokes respuatlOn top of its head. \Yhen the fit i- over or the doctor arri\res, may develop. The eye signs are similar to those found in the child is dried, wrapped in a \\~arm blanket and put to coma and the pupils are often unequal. Other symptoms bed, the head, however, still being kept cool. The second and signs may include tw.itching of muscles or even metho~ consists of putting the child immediately to bed, convulsions like those of epIlepsy. supplyillg warmth by means of hot water bo~tles and also A . characteristic feature is a progressive fall in the rate applying cold compresses to the. he3.d. In eIther case .all of the pulse which drops sometimes to 40 or 50 beats .a . the general p:indples of unconSClOusness must be applled minute, although it tends to become stronger. This as far as pOSSIble. . .. important sign supplies the reason for t~e instruction to !he latter is p~o~ably the .be~er m~thod SInce ~t IS rr:ore first-a:ders to maintain a careful observatlOn of the pulse sUltable for an Want that IS sickerung for .an Infectlous_ in all cases of head in juries. disease or sufferi~g .fr~m one. of the n:ore senous. causes ot FIRST AlD.-Most cases of compression following a head convulsions and It IS ImpOSSIble to dl"'':0ver dUrIng the fit injury are treated by an operation which entails opening which cause is present.

The Medicine Chest By FRANK BERRY, PH.,C. in tablets, lozenges and pastilles intended for medication of the throat. Ma.ny varieties of alkaline antiseptic solutions are used for application to the naso-pharyngeal tract and these usually contain bora., and bicarbonate of soda together with sodium chloride (salt) and small Borax This occurs as a white powder or colourless crystals and has a quantities of the antiseptics menthol, thymoL phenol and wintergreen. A whole range of specially made solution tablets is available to somewhat sweet saline taste. Large amounts are prepared by purifica. tion of the crude material obtained from dried-up inland lakes in India facilitate preparation of small quantities of these solutions. A typical solution tablet of this type is made to the followwg and Tibet and from the lakes of North America. It has a mild antiseptic and sedative action and is a frequent ingredient formula ; -

Blu e Ointment, see Mercury. Blue Pill, see Mercury Boracic Acid, see Boric Acid.

FIRST AID & NURSING , AUGUST, 1948

Some representative bromide preparations are described below : Naso-Pharyngeal Solution Tablets each containing Sodium Chloride 5 grains TABLETS OF POTASSIID! BROllfIDE Borax 3 grains Each contains 5 grains Potassium Bromide. Sodium Benzoate t grain Dose.-One to six: tablets, which should always be dissolved in Menthol r/roo grain water before swallowing. Thymol r/roo grain THREE BRmIIDEs TABLETS Benzamine Hydrochloride t grain Each contains : Boric Acid ... grain 6 grains Potassium Bromide Oil of Wintergreen 1/20 minim 6 grains Sodium Bromide ... For use, dissolve one solution tablet in two ounces of "arm water. Ammonium Bromide 3 grains Borax is readily soluble in glycerin and the resulting solution known Dose.-One or two tablets as required. as Glycerin of Bora.-.: is frequemly used, especially in children, for These tablets are also issued prepared with an effervescent base. application to the throat and mouth in cases of thrush and allied BRmuDE J\IrxTURE irritations. Each tablespoonful dose contains : Borax and Honey is a similar preparation. Bora.-.: 5 grains A solution of Borax in Water forms a useful lotion for relief of Potassium Bromide 5 grains itching and inB.ammatory skin conditions. Sodium Bromide ... 5 grains Ammonium Bromide 5 grains Boric Acid (known also as Boracic Acid) I minim Arsenical Solution This occurs as colourless crystals or fine "hite powder and has Liquid Extract of Liquorice 5 minims mild antiseptic properties. It is a frequent ingredient along with zinc Chloroform '\{'ater to i fluid ounce oxide and starch in antiseptic dusting powders. Solutions in water are largely used as ere lotions, skin lotions, and douches. Boric Acid Buchu Powder is rather difficult to dissoh"e in water and the crystal form is Buchu preparations are made from the dried lea,es of the Buchu much more con,enient for this purpose. About hali an ounce of the plant which COntains ,olatile oil and mucilage. crystals dissolved in one pint of "ater yields a lotion suitable for general Buchu is a useful diuretic and urinary antiseptic and is useful for use. relief of cystitis and allied inflammatory conditions. It is generally Boric Acid is frequently used in ointment form, the present official given as infusion or tincture and combined with Other diuretics such product containing I per cent. Boric Acid. Special types of ointment as Hexamine or Potassium Citrate. The following is a typical are prepared for application to the eyes. formula : Lint, gauze and cotton "001 are often impregnated with Boric Acid, BUCHU Axn HYOSCYA1IIliS :.\IIXTuRE tinted pink to distinguish them from the unmedicated varieties, and Each tablespoonful dose contains : used as antiseptic wound dressings. Liquid Extract of Hyoscyamus ... 2t minims Brilliant Green Potassium Bicarbonate ... 15 grains This is an antiseptic dyestuff which as a I in 2,000 solution in water Concentrated Infusion of Buchu 15 minims or saline forms a valuable, non-irritating application for wounds, Chloroform \'('ater to i fluid ounce ulcers and some skin complaints. It promotes rapid healing. Stains on Caffeine the skin can be removed by means of spirit. This is a substance present to the extent of 1 per cent. to 5 per cent. Bromethol in the leaves of the tea plant and from 0.5 per cent. to r.5 per cent. in This is a preparation used by rectal injection for inducing general coffee seeds. 11ate rea, "-idel)' used in the _tUgentine, contains about anresthesia. The dosage varies according to the body weight and I per cent. Caffeine !Day be extracted from these and other plants or condition of the patient. Bromethol is inflammable and volatile and manufactured by chemical processes. It is a, ailable for medicinal use should be stored in well-stOppered bottles protected from light. as white or colourless, silky, needle-shaped crystals which have a Solutions for injection should be freshly prepared. The advantages of markedly bitter taSte. this type of anresthetic include reduced mental distress, lack of Caffeine affects the central nervous system, the muscles, and the respiratory irritation and reduced post .. operati,e vomiting. It is very kidneys, and in view of this triple action it has many uses in medicine. valuable in cases of operation on the thyroid gland and in midwifery. It increases mental activity and decreases fatigue. In moderate dosage it tones up the heart muscles and is also a useful diuretic. It is used Bromides in treatment of heart failure, chronic nephritis, general dropsy, nervous Bromides are used medicinally as sedatives, the pnncipal ones being dyspepsia, migraine, nervous headache and asthma. Ammonium Bromide, Potassium Bromide and Sodium Bromide. The stimulant effect of strong coffee is largely due to the caffeine These have a direct action on nerve cells and by lo"ering the activity which it contains. of such cells are of great value in treatment of cerebral excitement and Caffeine is usually administered in powder or tablet form and is often in controlling epilepsy. They render the brain less sensitive to disturbance and are ,ery useful for inducing sleep where the sleeplessness combined with such useful dmgs as aspirin, phenacetin or quinine in the form of compound tablets. is due to ovel""Work or worry, but are of little value if it is due to severe The usual dose is from 2 to 5 grains. pain. Bromides are often useful for relief of dysmenorrhoea, nervous More complicated caffeine compounds are available as cardiac and headache, neuralgia and hysteria. The three bromides mentioned may ~e administered separately or mixed and may have their effects respiratory stimulants when hypodermic administration is desirable. augmented ~y combination with one or other of the barbiturates such Caffeine Citrate as phenobarbitone or hypnotics such as chloral. Prolonged adminiThis is a white, water-soluble powder given in doses of 2 to 10 stration of bromides may lead to the development of various types of grains for the same purposes as caffeine. It may be administered in skin eruption and to minimise this possibility many bromide mixtures tablet or powder form or as effervescent granules. contain a small quantity of arsenic. (to be continued)

FIRST AID & NURSING, AUGUST, 1948

The Blood, Heart, Blood Vessels and Ci rculation by

J. WELLS, M.R.C.S., L.R.C.P. COlltillued from JulY Issue.

L ast month it was mentioned that the heart muscle is of a special type. It is striated, but is not under the control of the will. The voluntary muscles are those \vhich give us the power of voluntary motion and locomotion. The involuntary muscles are found distributed in the substance of various internal organs and in the walls of the bloodvessels, and produce those movements over which the will has no control, such as the beating of the heart and the peristaltic movements of the stomach and intestines. Both the voluntary and involuntary muscles are composed of fibres, but there is a difference in the form of the fibres. Most of the voluntary muscles are connected

l1usc le Fib76 - sptd Into F1brzls

Immediately after death the muscles are soft and pliant, as in life, but after a short time they become so stiff and hard that it is impossible to bend the limbs without injuring the bones or joints. This stiffening or rigor mortis, is due to the coagulation of a fluid substance in the muscle called myosin. In the human body this condition usually set in at from four to six hours after death, and continues for one, two or three days. The Structure of Muscles On examination it is seen that the voluntan- muscle is striated or striped, is under the control of the will, is composed of bundles of fibres, and that these bundles are composed of smaller bundles called fasciculi which are visible to the naked eye and are surrounded by- sheaths of a thin transparent and tough membrane called sarcolemma. The fasciculi are. composed of fibres, each of which is surrounded by- a sheath of sarcolenuna. The average diameter of the muscle fibres is about I J sooth of an inch. The fibres are made up of minute fibrils. The fibrils, or fibrillre, are composed of disc-like bodies and are consequently striated transversely. ItIZ)olmlfary muscle is non- triated or unstriped muscle. It is not under the control of the will, and is found chiefly

<f- s lde v~e(jJ of

fLbres

A few Muscular Fibres, being part of a smaller Fa ciculu , more highly magnified.

with bones at one or both ends and every fibre compo ing the muscle has the power, under the influence of the will, of shortening in length. One end of the muscle is generally fastened by means of a tendon to a fixed bone and the other end to the bone which is to be moved, so that when the muscle fibres contract the whole muscle shortens in the middle or body of the muscle, causing one of the bones to be moved. This can be seen by placing the forearm on the table and raising the forearm when keeping the elbow fixed on the table. The biceps muscle is attached b)~ its tendon to the fix~d scapula, which is its point of origIn and als? .fixed b)~ l~S tendon to the radius just below the elbow JOInt. This IS called its point of insertion. .On lifting the fore~rm, the centre or body of the muscle IS shortened .and thickened. The muscles which are used to bend the limbs are called flexors, and those which straighten the limbs, extensors.

1m olunta!\' ~ruscular Fibre-cells from Human Blood Yessels. . Highly 11agn.iEed.

in the mu cular walls of the internal organs and bloodvessels. The muscle fibres are compo ed of elongated cells with pointed ends and a.re not striat~d transvecely. The heart IJJfIJ'cle i involuntary and IS not under the control of the "\vill, yet is striped or striated. It is striated both longitudinally and transversely, and the muscl~ fibres are composed of oblong and branched cells. By Its COQstruction and formation, the heart muscle can ~e regarded as one sheet of muscle fibres. The heart muscle IS therefore strenathened and fordfied to carryon its constant work, thro~':Jahout the whole of life. The heart's action is regulated b . tlle vagus nerve, o~e by two sets of nerves. The one beIng of the twelve cranial nerves, which come from the braID, it

FIRST AID & NURSING , AUGUST, 1948

It is interesting to note the amount of work carried out by the heart. In an average man at rest, about two ounces of blood at each beat of the heart are forced into the aorta. As the heart beats seventy times per minute, this means that about seven pints of blood are forced into the aorta for distribution around the body every minute, whether awake or asleep. The rate of the heart beat varies according to age, activity and various other circumstances. The average rates for persons of different ages are as follows : During the first year... I20 per minute second year IrO third year 95 seventh year 87 fourteenth year 85 to 80 In the adult 80 to 70 In old age 70 to 60

(To be continued.)

Muscular Fibres from the Heart showing Stirations and the Functions of Cells. Highly Magnified.

A New First Aid Dressing runs down the neck and through the chest, giving off branches to the heart and lungs, and ends by supplying large areas of the stomach and intestines in the abdomen. The vagus nerve, owing to its long and tortuous course, is called the wandering nerve. This nerve slows and rests the heart. The other set of nerves supplying the heart are branches of the. sympathetic nerve. These nerves when active

Hagnifi ed itve d/ameters

\\i nalural e

J'l 3

A small portion of Muscle consisting of larger and smaller Fasciculi.

increase the rate and strength of the heart beat. In this way the heart beat is regulated, and we speak of its rate as seventy beats per minute, this rate being constant, if the heart IS normal and free from disease.

Ruptu.red muscLe ftbre

A Muscular Fibre ruptured so as to show Sarcolemma.

A NEW type of elastic adhesive plaster has recently been intro-

duced by T. J. Smith & ephew Ltd., principally for the first aid treatment of minor injuries in industry, although it has a wide general application, and is of especial value to members of the medical profession for their own use. As its name implies, the chief characteristic of this material is its imperviousness to water and solutions such as antiseptics, acids (weak), alkalies, oils and greases, which renders it most suitable for wear by all professional, industrial and domestic workers whose hands arc constantly immersed in water or in contact with liquids of any kind. Waterproof Elastoplast has a flesh-coloured plastic base that is ,Tery much thinner than fabric, smooth in texture, pliable and extensible, yet possesses good tensile strength and sufficient toughness to withstand hard wear. Dressings made from it may be " moulded» comfortably over a finger tip and round a knuckle joint or similar irregular surface without affecting normal movement, whilst its skin-tight fit ensures that it will not catch in anything nor wrinkle, but remain intact under all ordir.ary conditions and unaffected by constant washing or moistening. Doctors and nurses in industry will find it invaluable for the first aid treatment of employees' wounds which need protection against water, oil, grease, etc., during working hours, and equally useful for covering similar injuries on workers' SpOrts days, particularly when the events include field or water sports. It is emphasised that the chief function of this plaster is to promote healing by keeping the wound dry during immersion in water or contact with liquids. As moisture cannot penetrate this plastic skin from without, neither can it escape from within, and for this reason it should be changed for an ordinary fabric Elastoplast dressing after working hours. As a first aid measure however, this new plaster proves ideal for its purpose, and it is alread; used extensively by those responsible for industrial medical treatment as well as by doctors for protection of personal injuries. From the professional user's point of view this means that there is no need to. remove a dressing every time it is necessary to " scrub up," because this plaster will not become waterlogged nor retain dirt germs. It may be washed and dried in exactly the same way as the human skin and will remain clean on the surface. (Moreover its extreme thinnes~ renders this plastic skin unobtrusive and enables the wearer to continue his work unimpeded by it, even though this work may be of a very delicate nature.)

FIRST AID & NURSING, AUGUST, 1948

News From All Quarters Finchampstead, Earley, Shinfield Regional Competitions), one for junior men THE ST. JOHN AMBULANCE Twyford, and the 1St Berks Air Unit. In the absence an.d one set for N17r~ing Divisions (here again: through illness of Mrs. H. D. Beckwith-Smith wu:ners were eltglble for Regional ComBRIGADE. O.B.E. (late Deputy Superintendent-in-Chief/, petitlOns).

No. I (prince of Wales's) District 86 HORSEFERRY DIVISIO 86 (Horseferry) Diyision's display at Hyde Park on Saturday, July 3n.l, which won for Central Area the Silyer-Gilt Rose-Bo"'l presented by Field Marshal The Lord Chetwode, G.CB., 0.1\[., G.c.S.I., K.c.:"LG., D.S.O., demonstrated an unusual aspect of first aid work. Two men working in a deep hole were affected by coal gas, and one, after a vain attempt to drag his mate clear, staggered out and summoned aid. The team swung into smooth but swift action and the public saw tvm men 'wearing Salvus apparatus take a eil-Robertson stretcher to the hole and in an amazingly short time hoist thei; patient clear of the gas. The patient was then carried to the rest of the team who at once began resuscitation by artificial respiration together with the mTox apparatus. While artificial respiration was performed, a fracture of the ,patient's right leg was dressed and splinted. On showing signs of recovery the patient was removed by ambulance to hospital. The" scenery," which was most realistic, was constructed by Amb.jOfficer T. Cranham and Pte. J. Searle in their spare time. It is emphasised that this demonstration was not merely a "stage-piece" as the situation depicted is quite likely to arise at any time during the daily work of employees of a gas undertaking. EASTERN AREA A. A D N. CADETS SPORTS The Second Annual Sports Meeting of Ambulance and ursing Cadets of the Eastern Area was held recently at Old Dagenham Park, Dagenham, when the Henry Bloore Trophy for Ambulance Cadets was won by C78 (Fairbairn House) Diyision \"ith Cr2 (Dagen ham) Division, runners-up. The trophy for ursing Cadets was won by C .8 (Grays) Division with C .71 (Upminster and Hornchurch) Didsion exceedingly close runners-up. The Mayor of Dagenham presented the awards. Besides the Mayor, the Area was honoured by the presence of the Mayoress, the Chief Officer Ambulance Cadets, the Commissioner, the Assistant Commissioner and District Officer E . IIoward. The Dagenham Branch British Legion Memorial Band provided music during the evening and spectators and competitors found entertainment also in the sideshows arranged and staffed by officers and cadets. CI2 (Dagenham) were winners of the Tug-o-war and also of one pull against a scratch team of officers. County of Berkshire READING The Annual Inspection of the Central Area was held on Sunday, July lIth, at thc Track, Palmer Park, when some 500 members were on parade from Divisions in Reading, Thcale,

th~ ~specting Officer was the County CommlSSlOner (Mr. C A. Poole). He was accompanie.d bJ S=ounty Vice-President Lady Lorame, Asslstant County Commissioner F. A. C Jarvis, County Superintendent the Hon. j\Irs. Leslie Gamage, and other members of the County Staff and Mrs. Taylor, a visiror from ew Zealand. The County Commissioner said how important it was for all members of St. John to pull together and be ready to step into the breach. He went on to say that during the first week of the National Health Act the County Office had been busier than at any time since the war. He then congratulated the members on the smartness of their turn-out and finally ,,-ished them God speed and good luck. Then followed the March Past, the salute being taken by the Inspecting Officer.

Teams for the senior men \vere entered by ParkstOne, Poole, Portland and Weymouth· for the junior men, Dorchester, Poole and Weymouth; and for the 'ursing Tests, bv Weymouth, Dorchester, Branksome and Pooh';. County Surgeon Dr. Gordon \Yallace announced the results as follows: Senior jlm-\'('eymouth, 3401; Portland, 302 ; P?ole, 286; Parksrone, 2H. J/lnior :\IenWeymouth, 30G! ; Dorchester 256}· Poole 24 6 }. Sl(rsing Teams-\\"ermo~th, 3;~ ; Dor: chester, 2711; Poole, 26:d Branksome 239~. - ,

INSPECTIO, OF \X'ESTERN DORSET .This Inspection was held at :"Iaumbury Rmgs, Dorchester, th~ .number present being about 350 and compnsmg members from the Divisions at Dorchester, \'{'eymouth, Ponland, Shaftesbury, \\'hiteheads, Bridport, Preston and Wyke Regis. The County Commissioner was the Inspecting Officer and was accompanied by His \\"orship the :"Iayor of .q?rchester, Mr. H. G. Longman, County \ lce-Pre~idents The Lady Ellenborough and Mrs. Felix Warre, and the Counrv Super int~ndent :\1rs. M. C Cooper. After [he InspecClan the Mayor and the County Commissioner took the sal~te and the membe~s then marched to the 1Iethodist Church (to the music provided by the \\yke Regis Sr. John Band), where a service was conducted by the Rey. R. Smith, assisted by Canon Bml,:ers. After the service the parade marched to the Territorial Drill Hall for tea where speeches were made by the Mayor and the County Commissioner.

On Wednesda~ evening, July: 14th, at the Town Hall, Reading, a Presentanon Ceremony was held at which the fifry years' Service Award was presented ro Reading Town "A" Am~ulance Division by Col. A. 11. O. AnwylPassmgham, CB .E., KSt.]., President of Ascot Divisions and a member of the ChapterGeneral, Order of St. John. Col. Passingham was introduced by the County ~ommissioner, and before making the presentation he read a message of congratulation from the Chief Commissioner and himself congrarulated the Division on their excellent seryice. He then handed the award to Div. Supt. \\'. J. Field who received it on behalf of his Diyision. The following presentations were also made : Badge of Office to Diy. President E. J. Carter, Long Service Medal to Div. Supr. G. Russell (attached Reading Town "B" Ambulance Diyision), Annual Awards to members of the Division, the Dr. Hartnett Cup to Cpl. A.. Clarke and Runner-up Prize to S. Sergt. E. Chart who had won them in a Competition REGIO '"\L CO':-'IPETTTIONS The Competitions for Region 6 were held and Certificates to members of a recent First at the South Dorset Technical College, W'eyAid Class. mouth, on Saturday, loth July, and teams READING AMBULA;"CE DIVISION \\'as formed in the. year r894 under Div. Surgeon Heyes competed from Berkshire, Buckinghamshire, and DlY. Supt. Rogers. There were eighteen Dorset, Hampshire, Oxfordshire and the Isle members and they met for drills and lectures of Wight. The arrangements for the Competitions were in a basement room under Dr. Heyes' Surgery. In 19·P over 100 members were on the Register made by Dr. Gordon Wallace, County Surgeon and so it was decided to split the Division into (Dorset), and the Officer in charge of Stewards two. Reading Town "A" under the late was 111ss F. B. Long, County Officer (Dorset). After keen competition in "'Thich much Supt. W. J. Meredith and Reading Town " B" under Supt. E. F. C Harvey, who is interest was taken by a large number of spectators from each of the Counties represtill in charge. In 1932 an Ambulance Cadet sented, County Surgeon Dr. Gordon \\'allace Division was formed under Cadet Supt. A . announced the results as follows: Ambulance Newport and later this Division had the TeamS-1st, \\'eymouth (Dorset), 344!; 2nd, honour of being the first Ambulance Cadet \Yoh-erton (Bucks), 30ti; 3rd, Eastleigh Division in Berkshire to have a Grand Prior (Hants), 295 ; 4th, Pressed Steel (Oxon), 294 ; Badge presented to one of its members. 5th, Great Western, Reading (Berks), 279±- ; 6th, Ryde (I.o.W.), 277~. j\Tllrs;lIg TeamS-1st, Oxford (Oxon), 309t; 2nd, Slough (Bucks), County of Dorset 309; 3rd, Weymouth (Dorset), 306t; 4th, Merrick (Hants), 280t; 5th, Maidenhead COU TY COJ\IPETITIO S The above competitions were held in (Berks), 250. Weymouth Ambulance team and Oxford Weymouth on 13th June at the South Dorset Technical College. Three sets of tests were Nursing team will as a result of this Competistaged; one for senior men of Ambulance tion represent the Region at the Brigade Divisions (the winners being eligible to enter Final on roth September.

FIRST AID & NURSING, AUGUST ,1948

TREDEGAR County of Oxford The Hon. Mrs. Herbert Lane, Dame of The competition for the Llandinam Shield Grace of the Order, presented the trophies and WITNEY DIVISION Mr. J. C. Chesterman, Superintendent of was held at the City Hall, Cardiff, on Saturday, prizes to the winners as follows: Ambttfol1ce Teams-The" Oxo" Cup, Weymouth Ambu- the Witney Division, who has completed 45 July loth. The winners were Tredegar lance team; The" Oxford" Trophy, \'V'ey- years' service, was thanked at the Annual Ambulance Division who will now represent Wales in the Dewar Shield Competition to mouth Captain (Amb. Officer E. Glover), Inspection held recently. Dr. F. A. Bevan, Assistant County Com- be held in London, September loth. Team : (Best Individual). Nursing Teams-The " Buckinghamshire" Cup, Oxford Nursing missioner, handed him a letter expressing the Cpl. D. G. Jones (Capt.), Ptes. E. Phillips, . team; The" Burn" Shield, Meyrick Captain thanks of the County Commissioner (D!·. C. J. Sea bourne and J. Price. By winning the " Arthur Griffiths Gardiner-Hill) and the County staff. Dr. (Div. Supt. E. Jones), (Best Individual). Memorial" Cup on the same day at Cardiff, With Mrs. Lane on the platform were the Bevan recalled that Mr. Chesterman joined at Regional Commissioner Dr. R. V. S. Cooper Oxford in 1903, serving in the R.A.M.C. Tredegar Nursing Division will represent (Chairman); The Mayor and Mayoress of during the 1914-18 war and won the Meritori- Wales in the Brigade Finals to be held in Weymouth; Capt. Docrwa Rogers, Chairman ous Service Medal. He was made.,a Serving London on September loth, 1948. Team: of St. John Council for Dorset; Regional Brother of the Order of St. John and when he Nursing Sisters B. Munkley (Capt.), B. Supt. The Hon. Mrs. Cubitt; County Supt. moved to Witney he started the Witney Skinner, M. Smart and M. Hooper. BRITISH RAILWAYS Mrs. M. C. Cooper; the Judges and a number Division in 1929, becoming its first SuperinWestern Region of guests, including the County Surgeon of tendent. Recently retired from the Headquarters Oxford, Dr. Weddell, and the County Officer Adding his own congratulations on Mr. of Bucks, 1tfrs. \"Weaver Adams. The last two Chesterman's length of service, Dr. Bevan staff at Paddington, at the end of over half a thanked Dorset on behalf of the Region for said that although the Wimey Division had century of service, is Mr. William Teagle, arranging the Competitions. never been a large one, members had always aged 65, who has passed the St. John Ambulance efficiency test annually for no less than been keen and their standard of work high. He presented vouchers to Messrs. A. H. forty-nine successive years, and holds the COl.mty of Kent Baston, J. Bunce, G. J. Etwell, J. Daniels and G.W.R. Gold Medal for twenty-five years' FOLKESTONE efficiency with four five-year Gold Bars. In R. G.Hill. The Annual Parade and Church Service in 1940 he was admitted to the Order of St. County of Surrey connection with St. John's Day, of the FolkeJohn of Jerusalem as a Serving Brother. ADDIS COMBE DIVISION stone Corps was held on Sunday, 27th Mr. Teagle has rendered valuable service to The Annual Inspection of the Addiscombe both officers and staff by giving them the July, at St. John's Church, Folkestone, and was Division was held recently at Woodside attended by members of the Ambulance and benefit of his skill in many serious cases of Nursing Divisions, including Cadets, from School, and was taken by the County Com- accident and illness and by instructing them missioner, W. Geo. Pape, O.B.E., accompanied Folkes tone, Cheriton and Hythe. The Parade in first aid at Evacuation Headquarters during being in charge of A./Corps Superintendent by the Assistant County Commissioner, J. the war. Flavin. W. Smith, S.B.St.]', and Corps Officer L. B. Mr. Teagle joined the G.W.R. Engineer's There was a good attendance of members, Department in 1897, served with the R.A.M.C. Easton, S.B.St.]' The service was conducted by the Vicar of who gave demonstrations of stretcher drill, abroad throughout the 1914-18 war, attaining St. John's (Rev. L. Hickin), and the address first aid, etc., at the conclusion of which the the rank of sergeant, and on his return was was given by the Vicar of Sandgate (Rev. Commissioner congratulated them on their transferred to G.W.R. Solicitor's staff, from J. C. Gethin-Jones, M.C.), Corps Officer effidency, and upon the excellent records of which he has now retired. the Division. He felt that it was more necesL. B. Easton read the Lessons. At Didcot Mr. C. W. Powell, Divisional The Mayor of Folkestone (Ald. E. P. Bridg- sary than ever to en.~'.lre keenness among Superintendent, recently presided at the land), together with members of the Council, members, for under the new Health Act there presentation of awards, which included a attended, and others present included Lady would be ample opportunities for them to number of long service medals and bars. He County Officer Mrs. A. Jay; Corps Officer utilise their skill and knowledge and of was supported by Mr. P. Cambridge, Assistant R. Moat, A.B.St.]'; A./Corps Officer Miss continuing their voluntary work. Divisional Superintendent; Mr. Major, At the conclusion, the Commissioner took Station Master; Mr. E.]. Hamblin, Divisional M. Davis; Ambulance Officer Mrs. E. Williams; Ambulance Officer L. Ashman the salute of the Division, led by Ambulance Secretary; and Mr. B. Barlow, Class Secretary. ([ Iythe Ambulance Division) ; A./Ambulance Officer W. J. Rose. The opportunity was taken of presenting the Officer Miss C. Breed. former Class Secretary, Mr. W. Lythgoe, with W. Riding of Yorks Miss M. A. Crowther, M.B.E., Matron of BRADFORD a silver cigarette case on behalf of the members the Royal Victoria Hospital, and a number of On Wednesday evening, July 14th, the of the class. the hospital nursing staff, also attended. Eastern Region Bradford Corps held the Annual Inspection The Folkestone Ambulance Division was on the Bradford Cricket Club ground,- which No. 13 (KING'S CROSS) L.N.E.R. in charge of A./Dvnl. Supt. G. Huntley, was kindly loaned for the occasion. About DIVISION S.B.St.J.; Folkestone Nursing Division, On Saturday, July 24th, some thirty members 00 officers, members of the Ambulance A./Dvnl. Supt. Mrs. P. Hadaway; Cheriton 3 Nursing and Cadets, attended under th~ of No. 13 Division, visited the Royal Free Nursing Division, Dvnl. Supt. Miss D. Hospital, Gray's Inn Road, to attend a Simpson; Hythe Ambulance Division, Dvnl. command of Corps Supt. H. Bray, Lady lecture given by Mr. C. Steele, Assistant to Corps Supt. F. Bruce and Sgt.-Maj. J. Hill. Supt. W. Jarvis; Cheriton and Hythe Cadet The Inspecting Officers were County the Pathologist. Nursing Divisions, Cadet Supt. Mrs. E. Smith; Commissioner H. L. Thornton, assisted by The talk was a very comprehensive one and I [ythe Cadet Ambulance Division, A./Cadet for about two and a half hours the visitors Lady County Supt. M. Birkbeck. Also Supt. E. Griffith. present were Dr. W. N. West Watson, Assistant had explained to them, with the aiJ of many Commissioner; County Officer S. Firth; illustrations and actual specimens, the effects County of Lancashire Corps Surgeon Dr. R. Chester; Dis. Officer of disease and accident on various parts of the PRESTON CORPS Irs. Gildard; and Area Cadet Officer Mrs. human body. Add poisoning, silicosis and other diseases were discussed at length and The Annual Church Parade of the Preston Dickinson. The parade was also graced with the presence counter measures were gone into in considerCorps was held on 27th June when about 200 able detail. Reference was made to the treatmembers marched through the town led by of the Lord and Lady Mayoress of Bradford ment of shock and the part played by bleeding and Dr. J. Douglas, Medical Officer of Health~ the Leyland Parish Band. in the healing of fractured bones. UnconThe service was conducted at the Parish PRIORY FOR WALES sciousness and the effect of various forms of Church by the Vicar, Revd. L. C. Peto. MILFORD HAVEN artificial respiration were fully explained. Asst. Commissioner W. H. Gastall comThe Milford Haven Division is keen to At the end of a fascinating afternoon a vote plimented the Corps on a smart tu'rn-out. meet any other Division in friendly team of thanks was proposed by Divisional SuperinCapt. Millin§/on commanding the Preston competition, the sole object being to gain tendent]. S. Bates, and in replying, high tribute Corp~ was accompanied !{y Miss D. Toulmin, expe.ri.ence in competitive. team work. Any Nutsmg Corps Supt. ; Dr. C. M. Willmott· DIVISion or works team Willing to co-operate was paid by Mr. C. Steele to the standard of first aid that the hospital staff had learned to Cor~s Surgeon, Mr. H. Calvert; Corp; please communicate with Division Secretary PresIdent; Corps Officers, Divisional Supts. A1r. G. ,W. Hunt, "Lessimore," Starbuck expect from the Division, most of whose hospitalised cases are dealt with at the Royal and Officers. Road, Milford Haven. Free Hospital.

FmST AID & NURSING, AUGUST, 1948

THE CARE OF THE CHRONIC INVALID IN THE HOME BY

AGNES E. PAVEY, S.R.N. Diploma 1t1 Nursing (University of London) Continued from JulY issue

Nursing Care Foll.owing a " Stroke"

A T first the p~tient may be unconscious and incontinent

of both url11C and faxes, so that a long mackintosh must be inserted under the bottom sheet to protect the mattress. Rest is the most important aspect of treatment, but the position of the patient must be changed from the side to the back every two or three hours, although he must never lie on the paralysed side. All bony prominences must be carefully washed with soap and water and the area around them massaged at least three times a day, whilst each time the patient is moved the pressure areas should be rubbed with surgical spirit and lightly dusted with talcum powder. This does much to prevent the formation of bedsores, which are so apt to occur in paralysed patients. If the patient passes urine and freces involuntarily he must be made clean and dry without delay. Sometimes there is retention of urine and the full bladder may be felt above the pubes. It may then be necessary to pass a catheter. The doctor will do this for a male patient, or a visiting nurse may catheterize a woman patient and also give an enema if the bowels have not been opened, the home nurse assisting with both procedures. The mouth must be cleansed frequently, using small pieces of gauze, lint or cotton wool dipped in glycerin and borax and held by forceps or twistcd on to a toothpick. No food or drink need be given during the period of unconsciousness unless this is prolonged for more than a day or two, and then it would need to be given by nasal tube, or the doctor may order rectal salines. Even if the patient appears unconscious it is always possible that he is aware of what is going on around him although he is unable to give any sign of this. Especially may his hearing be unimpaired. So the nurse should talk to him while she carries out her ministrations and be very careful that nothing is said in the sickroom that it would be inadvisable for him to hear. On recovery of consciousness volumary movements must be discouraged. The room should be quiet and have subdued lighting. Fluids may be given as desired although in moderation, since their absorption may increase blood pressure. A purgative may be advisable, for the bowels must be kept open with no straining on the part of the patient. He seldom has any remembrance of events immediately preceding the seizure. 1lis temperature may be raised for several days but if it is high it usually denotes a serious complication.

inv~lids for years, finding relief only in death, whilst others achieve a surprising d~gree of recovery, and much may

be done to promote this recovery by good nursing. At first there may be mental confusion, delirium and loss of speech in addition to the paralysis. The patient is often restl~ss, especi~lly at night, and careful supervision is reqUlred at all Urnes. Because of the paralysis he is unablc to turn from one side to the other without help. In the turning great care must be taken that he does not fall out of bed, because of his lack of balance. Feeding I"-t first the .patient may hav~ difficulty in swallowing, so thickened Bwds and soft solids should be given slowly and carefully to avoid choking. Good nourishment is essential and especially should the vitamin content be adequate, for with restricted diets some important constituent may be lacking. The visiting nurse will advise about this. Many of these patients must be fed, but if it is at all possible they should try to feed themselves, for the use of the hands and arms aids recovery of movement and power. The mouth and teeth must be cleansed after every feeding and, if necessary, before the feed as well. Excretion \Vhen a bedpan is required the patient carulOt help to raise himself and he is usually a dead weight to lift. Two people will be required and even then it is almost impossible for them to lift him and place the bedpan in position without hurting. both the patient and themselves. A better plan is to turn the patient on to his side and place the bedpan, tipped at an angle, close to the buttocks and then to roll him back on to the pan and adjust it in the correct position under him. A pad of cotton wool may be placed over the rim to protect the skin in the sacral region. The bedpan is removed in the same manner and the patient is cleansed whilst lying on his side, the area then being washed with soap and water, dried carefully and the routine treatment given to the pressure points. For a male patient the use of a urinal is a comparatively simple matter. A special type of female urinal is obtainable which obviates the movement necessary when a bedpan must be used.

Care of Paralysed Limbs In whatever position the patient is lying it must be seell that he has good support, there is no dragging on a paralysed limb and no pressure of one skin surface on another. A draw-sheet is a necessity when nursing such a patient. When he is on his side a pillow is placed at his back under the drawsheet, which holds it in position, the top of it being just under the pillow at his head. The paralysed arm Later Care The bleeding into the brain will have stopped and the rests on a soft pillow. The position of the legs needs blood will have formed a clot, which is eventually broken careful arrangement, being so flexed that they do not press up and its products absorbed, but in the meantime perma- upon each other, whilst a small pillow is placed between nent damage may have been done to groups of brain cells them just below the knees. Pain in paralysed limbs mar be or their emerging nerves. Some patients remain helpless due to lack of movement at the joints, the shoulder joints

FmST AID & NURSING, AUGUST, 1948

being especially liable to such pain. After the first week or two simple massage and passive exercises should be commenced. This may relieve pain, help to restore normal function and prevent the type of contractures that may occur, and the effects of such treatment are most encouraging to the patient, who usually co-operates very well. Later, a trained physiotherapist may give massage and both passive and active exercises which bring about a re-education of the paralysed muscles or teach the scientific use of other muscles to compensate for those that cannot be used. As soon as possible tbe patient sits up and when he is able to maintain this position he is lifted out of bed into a chair as often as possible. ext, he is urged to try to stand up, holding on to somebody or to a firm piece of furniture. He may learn to manipulate a wheel chair, and if the muscles of one limb are permanently paralysed he may be fitted with some form of apparatus that will enable him to use that limb. Restoration of Speech \X'hen speech is disordered or lost every effort should be made to re-educate the patient. At first it is a good plan to arrange a series of cards, each with a sentence written on it which the patient may need to use in making his wants known. It may be necessary to teach him to talk as one teaches a small child, helping him to articulate and giving him objects to name. Too much must not be attempted at once or he will become discouraged. He needs cheering approbation of his efforts, even if his speech, at first, is

slurring and almost unintelligible. Reading, looking at pictures and writing may be encouraged. An amazing improvement will often occur as a result of careful reeducation by the nurse in a patient who might otherwise never regain his power of speech. Occupation As with all other forms of chronic illness, some type of occupation is necessary as a relief of boredom and to give the patient a· sense of achievement. In tills, each patient is a law unto himself and his personality and capabilities must be studied so that he is encouraged to do the things that give him most pleasure and do not make demands upon him that he is incapable of fulfilling. Mental Changes Some people who were formerly kind, considerate and cheerful develop quite an opposite disposition after a cerebral h~morrhage. Others become emotionally unstable and, although not irritable or difficult to look after, are easily upset and often cry for no reason at all. Some cry whenever the usual nursing procedures are carried out. This may be due to a subconscious feeling of frustration and dependency upon others. These patients usually think that the changes are in other people and not in themselves. An understanding of their difficulties and their psychological reaction to them, together with much tact and patience, are necessary in dealing with them. If they are helped to overcome their physical infirmities these mental conditions often show great improvement.

Nursing Correspondence Reade~s are invited to smd their Nursing Problems jor solution.

Correspondence should be brief and to the pomt aJ7d addressed to the Editor {( First Aid & Nursing," 32 Finsbu,,:y Square, London, E.C.2.

GARGLES T. M. (Birmingham) writes : " During the epidemic periods at school I have been in the habit of giving my children gargles. no']J.! I have been told that I should exercise caution in doing this as matry substances advertised as suitable for gargling mCf.Y do more harm than good as thry are liable to destrqy the 'good germs' as well as the bad. Will you please give me your opinion on this matter." Much depends upen the substance used ror gargling. As a preventive measure salt and water, a teaspoonful to the pint, is an effective and harmless gargle_ Some of the substances advertised are rather irritating to the lining me~~rane of the mouth and throat if constantly used, and an IrrItated membrane may be more susceptible to infection than a membrane in normal condition. Personally, I should place. m.ore reliance upon fresh air, healthy exercise, good ?-oun~hing food and ad~qua~e sleep as safeguards against wfectlOn than upon antIseptiC gargles; but when a child is actually suffering from an infected threat, antiseptic gargles may be a necessary form of treatment. ADMINISTRATION OF ASPIRIN H. C. (London, N.\X7.) writes : " I have heard that it is better to dissolve tablets such as aspirin in 1vater than to give in tablet form. Personalb') I cannot see that this makes atry difference." Aspi.rin tablets are not easily dissolved and they may lodge lD the folds of the stomach wall, or pass into the

intestines, without being dissolved. If they at-:: crushed before being given this cannot happen, the aspirin is absorbed and produces the desired effect; whereas if the tablets remain undissolved no benefit results from taking them.

NURSING A SCARLET FEVER PATIENT R. T. (London, .) writes :" I have a child to nurse 1vho has scarlet fever and shall be pleased if J!ou can gi7Je me a general idea of procedure) aho steps to be taken to ensure complete sterilisation and isolation. I believe that a sheet treated 1vith antiseptic should be hung over the door. If this is so) how often should it be treated to maintain its eJliciency ? " Scarlet fever is an infectious fever that must be notified to the Medical Officer of Health for the district in which it occurs. This is compulsory, by law, and arrangements will almost certainly be made for the transference of the child to a hospital for infectious diseases. If, however, this is not possible and the child must be nursed at home he had better rem~_in in his own room, unless trJs is obviously unsuitable, for it is unnecessary to infect another room. Good ventilation is essential but draughts must be avoided. The infection is from discharges from the nose and throat and, if middle ear disease occurs as a complication, from aural discharge. Any swabs or pieces of old linen used for

F'lRS'I' AID & NURSING, AUGUST,

rMS

wiping away such discharges must be burnt. W'hen the child is coughing or crying, droplets of moisture are ejected with the expired air and may be a source of infection if inhaled by another person. Therefore, a gauze mask should be worn by the nurse in attendance, and a cotton overall should hang on a peg inside the room, to be donned as she enters and taken off as she leaves the room. There is no necessity for a sheet wrung out of a disinfectant to be hung over the door. Its only use, in the past, was as a deterrent to would-be visitors. Feeding utensils should be washed separately from others, in hot water containing a little soda, and all personal and bed linen should be soaked for one hour in L ysol or Dettol, adding two tablespoonsful to a gallon of wt'.ter, before b~ing washed. \,-hen the child is pronounced free from infection he should be gh'en an ordinary cleansing bath and his hair must be washed. He is then dressed in garments that have not been in the sickroom, and is taken to another room. The room in which he was nursed should be fumigated before being thoroughly cleaned. Everything that was used in the room must remain there until after the fumigation, which will be done by the sanitary authorities.

HOME NURSING A MATERNITY CASE Mrs. A. L. (London, .E.) writes : " J..1j daugbter ,vho is at present liz'ing ,vith me is going to have her second child in about two months' tiJJJe. H"hen she had her first ba0') 1ve managed to get her into the maternity lvard of a hospital) but on this occasion 1ve cannot get her ill. I aJJJ 1110/Jdering tJJhat preparations I ought to lllake in ol.(r slllall house) so that she can have every comfort 1vhen the tillle arrives. Can )Iou please giz'e me some advice ill this tJJatAr; also aJ!y hints on the IIursing after birth l1Ji/1 be 1ve/come as I shall have to look after her 111)lSelf I enclose a stamped em'elope for a replY for 1vhich I shall be lJery grateftll." The expectant mother may engage a midwife to attend her privately, or she may visit an ante-natal clinic and be put into touch with a "domiciliary midwife." In either case the nurse will visit the h01..1se and ,vill make suggestions as to the preparations) taking into account the available facilities and the wishes of the family. For example, the mother may wish her baby to be born in her own room, whicn has a good carpet on the floor. It is not necessary to remove this, but large sheets of thick brown paper should be provided to cover it in the region of the bed. After the confinement these can easily be gathered up and burnt. The mother "\-vill be gi\rcn a list of the things she should provide, and the nurse will give advice with regard to the position of the bed and other furniture if sbe feels that some re-arrangement is necessary. She should be asked about the possibility of obtaining gas and air analgesia, for this is freely available in many districts. After the birth of the bab\T the nurse will visit each morDina and will attend to the toilet of both the mother and the bbaby, and she will probably call ag::tin in the evening until she is certain that all is progressing well. She will be o-rateful for assistance from a capable and intelligent grand~other; but she will give full instructions with regard to the nursino- during her absence. It is important to remember that having a baby is a normal event in a woman's life and, although specialised care and atte?tio? an~ very good hygiene are necessary during the lymg-lD penod, as much as possible should be left to nature when once the baby \1as been delivered_

13 TUBERCULOSIS

NURSING

A. ]. (Salisbury) writes : " I .rha~l be called. upon shortb' to nurse a lJIall suffering from tl(bercu~oslS and he mil be ~l/{rsed at home. Call )'01( help 0' gh'illg an outime of the best practice and at the same time clarif) the order for plenfJ' of fresh air. Is there a'0' danger from cat~hillg a cold due to ONr vaJ)'zng climate ? Also, I should li lee to JWOUJ if there is a risk of infectioll either from sleeping in the same rooll/ or wing the sallie IItensils OJ the patient."

Your problen~ is one that is facing many people at the present tlITle, oWlllg to the great shortage of accommodation in sanatoria. A welfare officer or tuberculosis nurse should visit the home in order to see that conditions are suitable and to give ad\Tice regarding the infectious nature of the illness. It is important that the patient should have his own roo~ and the windows should be open day and night, and III all weathers, although he should not be in a draught. The bedclothes should be warm and light, and in \'Cry cold weather gloves may be worn; although tuberculous patients seem impervious to cold so long as ther arc kept dry. The risk of infection to others is a very real danger, but it can be guarded again t. The infection i. in droplets of moisture in the expired air and in sputum (expectoration). The patient must not fondle children, and he should be warned against kissing either children or adults. He must be provided with a bag into which he may put used handkerchiefs, and, unless these are paper and can be burnt, they must be disinfected by soaking them in Lysol, a tablespoonful to a pint of \\Tater, for at least an hour before being washed and boiled. Pillow cases should be treated in the same way. Sunlight and the oxygen of the air kills the tubercle bacillus, so that sheets and other articles should be hung out in the sun hine and fresh air whenever possible, care being taken to keep them separate from articles used by other people. Feeding uten ils are certainly a means of spreading the infection. The~' should be of a different pattern from those used by other members of the family and should be washed up separately, in hot water and dried in a rack; otherwise a separate teacloth must be used. The collection and disposal of sp utum is One of the most important cf the nursing duties. Cardboard containers that can be burnt after use are ad\Tisable, but if these cannot be obtained a bedside sputum mug, haying a lid that can be opened by depressing a small leyer above the handJe, is the best type to choose; for th.is can be used easily with one hand. It must be impressed upon the patient that he must net'er spit into anything else. A little carbolic lotion, I in 20, should be placed in the mug before it is giyen to the patient. This is a more effective disinfectant in tuberculosis than Lysd or Dettol andithas aless distincti\Te odour. \\'hen emptying a sputlli11 mug great care must be taken to avoid splashing. It should be empti~d int? a la\ atorl' p~n, which is thoroucrhly flushed afterward" or It can be emptied into a containe~ of sawdust, which is then burnt in the kitchen stove. It is only when the sputum is dry that the tubercle bacillus e capes into the ail', to b<:> inhaled by others and thus spread the infection. This is the b~s~c reaso.n why penalties are in1posed upon people \vho SpIt 111 public vehicles and other places.

FIRST AID & NURSING, AUGUST, 1948

Queries and Answers to Correspondents Queries will be dealt with under the following rules :I have beeJ1 a reader of PIRST AID for many J'ears a!ld hazle gained a great deal oj help /rom the Query Column . I.-Letters containing Queries must be marked on the top leftSo I a1vait your replY to my quely lvith much interest. hand corner of the envelope "Query," and addressed to " First Aid & Nursing," 3z, Finsbury Square, L ondon) If you refer to the last paragraph on page 8 of the E.C.z. Supplement to Textbook you will find that your examiner was quite righ t in allocating marks for securing the limb z.-AIIQueries must be written on one side of the paper onlY. to the body without the use of splints . 3.-AII Queries must be accompanied by a "Query Coupon" Prom your description of the treatment given by you, cut from the current issue of tke Journal) or) in case ofQuerjes it is evident that you gave priority to the fractured collarfrom abroad) from a recent issue. bone whereas of these two injuries the fractured humeru3 4.-The Textbook to which reference may be made in this column is by far the more serious injury.-N.C.P. is the 39th (I937) Edition of the S .J.A.A . Manual of First Humour in First Aid Aid to the Injured. WI. A . (Slough).-A young girl who ~vas attending her first course of lectures, electrified the lecturer 0 asking him if it was a fact that an aviator mounting to a considerable height Fracture of A rm would have to inhale 0 XYDOL ! A. B. (\Voodford Green).-We would appreciate more informaGoo d ! Next please! !-N.C.P. tion about a fracture of the arm consequent on muscular action Treatment of Dual Injuries (see page 6I of Textbook). ff7hich muscles are involved and ,vhere lISualIY is-the seat of it!Jury ? M . L. (Birmingham).- At Div2sionai Practice recentlY 2ve worked 014t combinatiolls of various injuries, and it was Although fracture of arm by muscular violence is mentioned in the Textbook, I have to admit that personally most interesting to note the ideas and suggested treatment I have never seen or heard of such injury, of these dual injuries. Our members, however, felt that A common error with first-aiders is to assume that the expert advice should be sought. It therefore, you ,vili kind!;' arm must be broken in the middle of the shaft. \Xlhat is give us your opil1ion as to how you would expect members of possible is that any sudden and violent movement of the the Brigade to deal with them, we should be most grateful. arm may r~5ult in the detachment of some portion of either To this end I SUppIJI the complete list as follows : end of the humerus to which large muscles (such as the (r) Complicated fracture left ribs aJ1d simple fracture left supr?-spinatus or sub-scapularis) are attached. As this is clavicle. a ~reaking of part of the arm it is rightly classified as a (2) Dislocation left shoulder and simple fracture left fracture by muscular violence.-N. CORBET PLETCHER. clavicle. (3) D2slocation left elbow aJ1d simple fracture left Examination Howler htll1Jerus . \Y./. A. (Slough) .-In a recent examination the doctor asked one (4) Simple fractures right humerus and 1'ight radius alld candidate how lnany vertebrae there were. He was palpab!J ull1a. taken by surprise when she replied-" There are thirty-/Jvo (5) Crushed hand and severe arterial bleeding from pallll. vertebrae) and of these eight are attached to the sternum ! " (6) Fracture of pelvis and horizontal1vound of abdominal Good! ext please! !-N.C.P. wall. Fractu res of Humerus and Clavicle (7) Fracture of left patella and verticallvoul1d of abdominal D . Y. (Seaham).-In a recent competition for my individual test wall. I was told to treat a person for a fracture of humerus (middle (8) Fractures of right patella and of left fibula . of shaft) and also for a fracture of clavicle on the same side. (9) Fractures of right patella and of right tibia and fibula . Both 1vere simple fractures; and splints and bandages were Your list includes a series of instances in which the available. treatment of one injury conflicts with the treatment laid I removed the coat in the proper manner, seating the patient down for the other in the Textbook. T here have been first; undid the brace on the it!Jured side ; and then supported many similar combinations with which we have dealt in the it!jured limb in a St. John sling in preference to a small previous issues of FIRST AID. In these circums tances the arm sling which ~vould have made pressure on the fractured members of your D ivision mus t realise that treatment rests clavicle. I applied the three splints to the humerus with on the first two Chapters of the T extbook. bandages above and below the fracture. I did not use a In each of the combinations included in your list you fulcrttm but fixed the limb to the trunk by a broad bandage first decide which is the more serious of the two injuries round (;~bow and body (for which I 2vas given marks from and then apply the appropriate treatment of this injury. a posszble of 25)· The examiner said that I should have Mterwards you treat the second injury according to the used no splints at all but should have passed narrow bandages instructions in the Textbook except that you modify any round arm and trunk above and belmv fracture ) and thm a part of that treatment which would aggravate the more broad bandage round elbow forearm and body. serious injury.

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THE HUMAN BODY by The Body as a Whol e; Skeleton ; Mus cl es ; Resp iration ; Circulat ion of the Blood ; Symp hat ic System ; Digestive Var ious Abdom inal Orga ns ; U r inary Sys t em ; Syste m; Nervous Syste m ; Brain ; Gen ital O rgan s ; Emb ry o ; Skin ; Special Senses. Touch , Light. Hear ing. Smell . Taste; Inter nal Secretions ; Death ; Bibliography ; Glossary ; Copiously Illust rated

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FIRST AID & t-JtJR8ING, AUGUST, 1MB FIRST AID & NURSING, JULY , 1948

In an actual case you would have little difficulty in marked irregularity of the spinal column might justify him deciding upon the modification but in the practice-ro~:)!~ y?U in deciding to treat for this injury.-N.CP. require a good theoretical knowledge of such. mJur~es Treatment of Fractured Clavicle derived from the Textbook in order that the dIfficultIes N. M . (Felixstowe).-The Textbook on page 8r under i11structions may be realised. As examples of this, .(r~ w.hen th~ shoulder for treatment of fractured clavicle tells us in Rule 6 to is dislocated that joint is fixed and Jt IS ImpOSSIble for a " Tighten the Sling." Please tell me if this should be done first-aider to place this joint against the body. Also, (2) in all cases or onlY in cases in which the pulse is absent as when the elbow is dislocated this joint cannot be flexed and suggested in Rule 5. therefore the arm sling cannot be applied.- .CF. The arm sling is to be tightened in all cases to ensure Diagnosis of Fractured Spine . effective support of the upper limb which must be supported. T. (Edinburgh) .-Please tell us hOlv a.Jrac.tured ;sp~ne can For this reason the patient who has fractured his collarbe diagnosed by a first-aider 2vhe~ the patlent zs un~onsczous . bone" usually supports it (upper limb) at the elbow with The diagnosis of fractured spme by a first-alder w?en his hand," as the Textbook states on page 80. The absence the patient is unconsci?us is a ~ost di!ficult propOSItIOn, of the pulse is an indication that the body bandage is too since no definite and easIly recogmsable signs and symptoms tight and that it is obstructing the circulation.-N.CF. are present. The history of the accident or the presence of

Topical Notes for First Aiders & Nurses Fluorescent Blood Circulation Tests During the recent Olympic games, much physiological research was carried out with regard to the effects of strenuous exercise up.on the various tissues and processes of the body; and it is predicted that the knowledge thus gained will be of great value in the fight against various diseases. One of the most interesting experiments is the injection into a vein of a fluorescent liqu~d which, being carried in the blood stream, wrll render the lips luminous in a variable time, according to the degree of physical exertion that is taking place. The experiment. was first. carried out by Professor Herxhelmer, of Berlin, with the athlete sitting upon a ?xed bicycle frame in a darkened room. Weights which control and measure the power and exertion expended in turning the fly-wheel were adjusted and then the injection was made into a vein of the arm, and a powerful beam of light was thrown on to the athlet~'s .face. The time taken for the fluorescent 11qUld to reach the lips was taken hy a stop watch. When at rest, the average time was found to be about 20 seconds, but the speed of the circulation was so quickened by exertion that during a maximum effort the time was shortened to 7 or 8 seconds. Adaptations of this test enable the speed of the circulation to be accurately estimated under differing conditions, both normal and abnormal. Causation and Treatment of Rheumatic Diseases For eighteen years the British Red Cross Society Clinic for Rheumatism, in Peto Place, Marylebone, has carried out pioneer and experimental work in connection with the treatment of one of the most crippling diseases of all time . It has now presented a report upon the work of the last year of its independent existence, the total number of patients' attendances during that year being 65,735. It is now affiliated with the M.iddlesex Hospital, and this association with one of the great teaching hospitals of London will, undoubtedly, 0lJen many avenues of expansion, in which the observations already made and the experience accumulated should prove of inestimable help in the fight against the rheumatic diseases. There is nothing dramatic in the course or the treatment of these

diseases-just a relentless advance of disabling processes in the muscles and joints of the body--and the study of them has never attracted the limelight; but it is good to know that a comprehensive attack upon this scourge is already being organised, not only at the Clinic and at the Middlesex Hospital but also at the West London Hospital, where an enthusiastic team of research workers are pursuing their investigations. Sterilisation of Ice Cream The ice cream heat regulations demand that, after mixing, the ice cre'lm should be subjected to heat treatment, and shall then be reduced to a temperature of not more than 45 degrees Fahrenheit within 90 minutes and shall be kept at this temperature until the freezing process begins. Regulations now issued jointly by the l\1inister of Health and the Minister of Food extend until May 1st, 1949, the period during which a special defence can be put up in a court of law by ice cream manufacturers accused of marketing insufficiently sterilised ice cream. The accused may be acquitted if he can show that he has ordered suitable apparatus for the cooling process, but that this apparatus has not yet been delivered to him. The regulations are published by H.M. Stationery Office, price Id., under the title "Ice Cream (Heat Treatment) Amended Regulations, 1948." The Minister of Health Answers Questions on : DaJI Nurseries.-In reply to questions in the House of Commons about the numbers of Day Nurseries in use at the present time in England and Wales, .Mr. Aneurin Bevan gave the following figures :Day Nurseries in use ... A verage number of children per nursery 48 Total number of children under two . .. 13,888 The number of trained and untrained staff for a nursery accommodating thirty children was six, including domestic staff. The gross weekly cost per place was 27S. in London and 23S. elsewhere. Local authorities fixed their own charge to the parents, subject to a minimum of Is. a day. The average amount recovered from parents was 5S. 6d. a week for each child.

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Edit9rial Those Foreign Nurses OUR Special Correspondent refers in her notes this month to a matter wh ich is causing concern to many in nursing circles-the training of foreign women as nurses in this country. The Ministry of Labour are bringing over 100 Austrian and 50 German women and arranging for their training here, after which they will take the qualifying examination for State Registration. That in itself gives no cause for concern. Nurses are badly needed, and we see no reason why these foreign women, if carefully chosen, should not come over here to work in our hospitals. But the astonishing thing is that once they have qualified they are free to return to their own country. In other words, the expense of bringing these people over here, and their training (not an inconsiderable item), is borne by us, through our contributions to the National Health Service, but there is no obligation to give their services, once qualified, to our hospital service. There is presu mably nothing to prevent them coming here and obtaining a first-class training free, and then returning to the Continent where qualified nurses are worth their weight in gold. It does seem an extraordinary position, and one wonders who is responsible for such a short-Sighted policy. Our Correspondent's conclusion is that the Ministry are content to acqUiesce in the exploiting of nursing students, and relies upon them as employees. If this is the case, and it is

difficult to come to any other conclusion, it is a deplorable practice, and it is time it was stopped. The official policy for recruiting nurses has been bombarded with criticism lately, espeCially from members of the professio n, and this latest example of maladministration does not insp ire any confidence in Whitehall's ability to hand le what is undoubtedly a serious problem. There are many in the country to-day who strongly assert that t here are pienty of young people anxious to take up nursing as a profession but are unable to do so because of the wage. Without getting involved in a matter which is. to say the least, manY-Sided, the fact is that a great number of our nurses, and especially trainee-nurses , are suffering from a grievance. It is up to the authorities, if they want an efficient and smooth ly-run health service to remove that grievance. Meanwhile it does not help matte rs to mollycoddle foreign workers in the hospitals. If they are to receive their training here then it is only reasonable to expect that they should give their services, at least for a period, to our hospitals. The question of foreign labour for domestiC work, too, is far from satisfactory. They are under contract to ente r such employment as may be specified by the Ministry of Labour and National Service. Is this the best means of ensuring their presence where most needed? We doubt it. Surely it is not too much to ask that the whole question of labour and trainees from other countries should be carefully reconsidered?

FIRST AID & NURSING , SEPTEMBER, 1948

A COURSE IN ADVAN~ED FIRST AID BY

A. D . B ELILI OS, M.B. , B.S. (Lon d.) D.P.H. (Eng.) Poisons students. of Erst a~d s?udder at t~c thought. of M ANY studying pOIsons. It ill fact, a ~lffic~lt subject IS,

but it is of oreat importance. Cases of pOIsonrng are far more comm~n than is usually supposed; indeed many doctors declare that they treat in their practices more cases of poisoning than fractures. . . Poisons may enter the human body by (r) lDgestlon, (2) inhalation, (3) inocu.lation. . The ingestion of a pOlson through the mouth IS probably the rnost common route. Inhalation, e.g., ot poisonous fumes such as coal gas or trichlorethylene commonly used in industry, is of importance to Erst-aiders who work ill factories. The entrance of a poison by the skin (inoculation) is uncommon except for over-doseage with insulin as has been described in a previous article. Poisoning may be (r) accidental, (2) attempted suicide, (3) homicidal. . (r) Accidenfal.- umerous examples ot. accldentd poisoning can be quoted. Thus, a child may: ga!n access to sleeping tablets intend~d fo~ an adult. Dnnkillg from.a bottle containing a pOlson IS not uncommon. A tragIc instance of this kind occurred in a man suffering from a cough and pains. in his chest.. .His doctor p~escri~ed ~or him a bottle of linctus and a liniment to rub Into his skID. \'\"aking up in the middle of the night with a severe att-'l -k of coughing, the patient poured himself out, as he thougl1t, a dose of linctus and did not bother to turn on the ligln. Unfortunately the liniment which he drank by accident oontained a powerful poison and he died before medical assistance could be obtained. An interesting case of accidental poisoning occurred in a school recently. An older boy bought a box of menthol snuff from a chemist which he took to school and made one of the younger boys inhale. It is not generally appreciated that menthol is a poison, a fact, however, which was soon realised when the youngster was seen to be swaying about like one intoxicated, vomiting and suffering from shock. Cases of accidental poisoning are very common in industry and may then be acute or chronic. Acute ("~ses occur when the worker contaminates his food or cLink with a chemical "t;hich he is using; hence the rule in many factories that meals must not be taken in the workshop. Chronic cases occur when the workers repeatedly inhale or ingest small quantities of a poisonous substance ; thus thermometer workers are liable to a form of mercurial poisoning which results in them becoming mentally depressed and developing a trembling ~ovement such as a tremor Gf their hands. (2) Suicidal Poiso1Jing.-Unfortunately is not at all uncommon. It must always be suspected if an apparently healthy patient is found obviously ill but has made no attempt to send for help. Recently, for example, a young

man was found in bed by his landlady at about ro o'clock in the morning. He was not unconscious but obviously ill. Questioning revealed that he had taken a large number of aspirin tablets . . . \X1hen dealing with a case of attempted sUlclde the Erstaider has to be almost like a detective since there may be many clues as to the nature of the case, e.g., an empty glass may be found close at hand and perhaps the bottle or box of tablets which has been obviously used. There may be a history of depression or of a severe worry; sometimes a farewell letter will be obviously visible. Occasionally it may be very difficult to distinguish a case ot suicidal poisoning from an actual illness. For this reason the Erst-aider must always bear the possibility of poisoning in mind in dealing with a case such as supposed apoplexy. An elderly woman was recently.found unc,::>nscious in bed. She was known to be sufferillg from high blood pressure hence a stroke was anticipated at any time. The fact that she had attempted suicide, however, was cleverly spotted by a relative who noticed that she was clasping a rosary in her hand and was ~earing a chain with a religious cross round her neck which was not her normal custom when going to bed. An empty box of sleeping tablets by the bedside provided the final clue. (3) Homicidal POlsonil1g.-Fortunately is uncommon in this country. The poison may be given as a single large dme or in repeated small doses over a period of time. If gi ven as a single dose, the victim may notice an unusual taste in his food or drink and the symptoms generally come on quickly. If the poison is given in repeated small doses, he may develop symptoms and signs which may be difficult to distinguish from those of a chronic illness. Many homicidal cases could be quoted that have occurred both in fact and in fiction. Thus, Thomas Griffith \X1ainewright persuaded his sister-in-law to insure her life for £r2,000 and then to make a will in his favour. Later he gave her, in her meals, repeated small doses of tartar emetic (antimony)-an irritant poison. There resulted an illness which resembled gastroenteritis of which the cruef symptoms were nausea, vomiting, diarrha:a and abdominal pain. Wainewright called in a doctor to attend her but the treatment was not successful-not unnaturally since the poison was still being administered! Finally, having reduced his victin1 to an extremely low state of health by means of the antimony, Wainewright administered Strychnine which caused convulsions from which she died. Since an illness of this kind sometimes ends with convulsions the doctors assumed that the death was natural until the life insurance companies became suspicious. Fortunately, nowadays, with improved medical methods, cases of poisoning of this kind are quickly detected. PRINCIPLES OF TREA TtlfENT

The treatment of a case of poisoning can be divided into (r) administrative and (2) treatment of the p atient himself.

FIRST AID & NURSING, SEPTEMBER, 1948

The l.atter. depends on the poison that has been given. H ence It WIll be thoroughly described in later articles. From the point of view of administrative treatment, the most important principle is to obtain the services of a ?octor .as quickly as possible and it is generally wiser to send Immediately for ~n ambul~nce and to have the patient remo~ed .to hospltal. Me~lcal methods of treating cases of pOlsorung are far supenor to those that can be carried out by the first-aider . Some of those will be mentioned later. If there is delay in obtaining an ambulance the Erstaider must, of course, begin treatment himself and the first step is to identify the poison. If a bottle or a box of tablets is near at hand the label may supply a valuable clue for it may contain the name of the chemist from whom the poison was obtained. In this event a telephone call to the chemist is well worth while for by reference to his books he may be able to tell the first-aider not only the name of the poison but also the correct Erst aid treatment to adopt.

An irr:porta-?-t point in administration is to preserve any

clu.e whleh nught provide evidence of the ll'1.ture of the

pOlson that has been taken. Clues may include an empty gla~s from ~hi~h the patient has drunk, the bottle from whlch the liqUld was obtained, the vomit or excreta or eve~ soiled clothing, stained, for example by the juice or bernes. CLASSIFICATION OF POISONS

The numerous chemicals which can cause poisoning are . usually classified as rollows : (a) Corrosives. (b) Irritants. (c) arcotics. (d) Deliriants. (e) Convulsants. ~here are, in addition, however, numerous poisons wIuch cannot be properly classifie~ in one of these groups. Some or these wtll be referred to m subsequent articles.

The Medicine Chest By FRANK BERRY, PR.,e. Cal amin e This is a variety of zinc carbonate associated with varying amounts of zinc oxide and having a pink colour owing to the presence of traces of iron oxide. It is available as an extremely nne powder and is a frequent ingredient in dusting powders, lotions and ointments u ed to relieve irrirabiliry of the skin and many eczematous conditions. Calamine Lotion is a valuable mildly astringent lotion used in treatment of many skin complaims and especially to relieve rhe intense irritation which usually follows excessiye exposure co sunlight. There are several popular formul~ for this lotion, usually containing calamine, zinc oxide, and glycerin, and sometimes lime-water or rose-water Calciferol See Vitamin D.

Calcium This metallic element is widely distributed in narure, occurring universally as chalk, marble, and limestone, and is one of the principal factors responsible for the hardness of cerrain waters. It is essential to the animal organism, and the body of an adult man ·weighing I I stones contains approximately 21 lb. of the element calcium, the major proportion of which occurs in the bones and teeth. Blood plasma must contain O.OI per cent. calcium in suitable form if the activity of important body muscles is to be maintained and the constancy of thi proportion is regulated by the parathyroid gland. Calcium is well distributed in natural foodstulfs and while milk and cheese form the most valuable sources, nuts and many rypes of nsh and vegerables contain useful amounts. For successful assimilation, the calcium must be present in an available form and adequate Vitamin D must also be present. It has been estimated that the human body requires a daily intake of approximately 700 milligranU11es of Calcium per day bur during periods of active growth, pregnancy, or lactalion, the quantity required exceeds 1,000 milligrammes (r Gramme). One pint of milk contains about 680 milligrammes and therefore provides the daily requirements of a normal adult. During war-time the nation's bread was forrjned by the addirion of appropriate saJt~ of calcium,

Denciency of calcium results in faulty bone formation and if associated with Vitamin D shortage, rickets and allied complaints ensue. Many calcium salts are used medicinally, the following being the most imponant : C\LClillr ACETYLSAUCYLATE

This is more familiar under the name Soluble Aspirin and has been described under" Aspirin." C-\Lclillr CARBO:-<A TE

There are two principal forms of rhis substance in use, Precipitared Chalk which is manufactured by chemical processes and has a minutely crystalline structure, and Prepared Chalk which is prepared by purification of naturally occurring chalk and is non-crystalline. Calcium Carbonate is given internally in treatment of diarrmea and for this purpose is often combined ,. . . ith Opium. Ie is also given as an antacid in treatment of gastric and duodenal ulcer and in this case is usually associated with Sodium Bicarbonare and rhe carbonates of bismuth and magnesia. It often forms a basic ingredient in many tooth powders and pastes and is applied externally as a dusting powder. Some familiar preparations are : -

Calliphora ted Chalk This is Calcium Carbonate containing IO per cent. Camphor and is used as a dentrince. Ie should be stored in \n'll-closed containers. Chalk Mixtllre Each tablespoonful dose contains about 6} grains of chalk together wirh sugar, tragacanrh and cinnamon. Chalk ",fix lure Jl'ith OpiuIJI

Each tablespoonful dose contains: Prepared Chalk ... Compound Powder of Tragacanlh Tincrure of Opium Chloroform \X 'ater to ...

{o grains 5 grains 5 minims k fluid ounce

Aroll/alle PO}}'der of Chalk

Each tablespoonful dose contains 15 grains of Prepared Chalk rogether \\-ith sugar, c!m·es, cinnamon, nutmeg and cardamoms.

FIRST AID & NURSING, SEPTEMBER, 1948

6 Atltacid Luzenge Each contains: Calcium Carbonate Magnesium Carbonate . .. in a suitable lozenge base.

property of increasing the coagulability of blood has led to its frequent use to check bleeding associated with dental extractions. 3~ g.ains

CALCIUM SODIUM L".CT ATE

2~ grains

This is a white, water soluble powder which is more readily absorbed and assimilated than the simple lactate and is widely used in treatment of all types of ailments thought to be due to shortage of calcium in the body. It is given in doses ranging from 5 to 30 grains and is available in tablet form each containing 5 or 7t grains, often with the add ition of small amounts of Parathyroid gland substance or Vitamin D . Many proprietary remedies for chilblains consist essentially of calcium sodium lactate. A frequently prescribed calcium compound tablet has the following formula : Tablets of Calcium and Vitamin D each contains:

CALCIUM CHLORIDE

This occurs in form of white granules or fused lumps which rapidly absorb moisture and liquify on exposure to air .. It is essential to store this substance in small well-closed contaIners. Calcium Chloride is stated to increase the coagulability of the blood and has been administered in many h::emorrhagic conditions. It is also used to relieve certain types of asthma, urticaria and other allergic states. It may be given in form of a flavoured mixture or syrup and by inttamuscular or intravenous injection. CALClilll GLUCONATE

Tlus occurs as a white crystalline powder ,,,hich is readily soluble in water. It is useful in treatment of many respiratory diseases and urticarial and allergic conditions generally. Conditions of malnutrition or debility are often improved by a course of Calcium Gluconate Therapy. It may be given orally in doses of up to 60 grains, generally in form of chocolate base tablets, or by intravenous injection of from 2 to 5 fluid drachms of a sterile, freshly prepared, 10 per cent. solution in distilled water. Injections of Calcium Gluconate are much less painful and irritating than corresponding injections of Calcium Chloride. CALCIIDI HYDROXIDE

•

FmST AID & NURSING, SEPTEMBER, 1948

This is produced when quicklime (calcium oxide) is slaked by the addition of water and is available as a soft, white, powder which has a somewhat bitter taste and is slightly soluble in water. It is used medicinally in the form of a saturated solution in water which is known as Lime Water. Lime Water This is prepared b)T shaking slaked lime with distilled water lmtil no more of the lime will dissolve, then allowing undissolved matter to settle and drawing off the clear liquid as required . LIme \'<'ater contains 0 . 15 per cent. Calcium Hydroxide and must be stored in well-filled, well-closed containers. If exposed to air, the carbon dioxide in the atmosphere combines with the calcium in the lime water and results in the formation of a surface film of almost insoluble calcium carbonate. This reduces correspondingly the amount of calcium in the Lime Water. Lime water is a useful antacid in the treatment of infantile diarrhoell and vomitrng and is often added to infant's milk in order to prevent formation of clots of curd in the stomach. It is given in doses of I to 4 flUld ounces. A similar preparatlOn known as Saccharated Solution of Lime is prepared by shaking slaked lime (Calcium Hydroxide) with water containing 10 per cent. sugar. Lime is far more soluble in sugat solution than in pure water and the resulting product contains 2.4 per cent. Calcium Hydroxide and is given in doses of IS to 60 minims. Lime water, being alkaline in reaction., is the correct antidote to administer in cases of poisoning by acids and is particularly valuable in Oxalic Acid poisoning in view of the relatiV'e insolubility of the oxalate of lime which is inunediately formed. CALCIUM LACTATE

This is a white powder with a slight but not unpleasant odour and is slowly soluble in water. It is a very suitable form in which to admin~~ter calcium and is available in tablet form, each containing 5 grains. It is given in cases of calcium deficiency and especially at those times when calcium is required for growth or body nourishment. It has been proved useful in prevention of chilblains and its

Calcium Sodium Lactate Calcium Phosphate ... Calciferol (Vitamin D 2 )

7} grains

2t grains r /4800 grain

CALCIlThl PHOSPHATE

This is an essential constituent of animal bones and is prepared from bone ash. It occurs as a fine white odourless and almost tasteless powder which may be given in doses of 10 to 30 grains in all cases where extra calcium is desirable. In conjunction with iron it is often given in cases of general debility. Parrish's Chemical Food contains 1.4 per ccnt. CALCIUM SULPHATE

Dried Calcium Sulphate is prepared by carefully heating the naturally occurring gypsum and is available as a pure white, odourless and tasteless powder which readily absorbs atmospheric moisture and should therefore be stored in well-closed containers. This carefully dried calcium sulphate was first prepared at the gypsum quarries of Montmartre near Paris and has retained the popular name Plaster of Paris. When made into a paste with a little water, Plaster of Paris quickly sets to a firm mass which gradually hardens and is widely used in preparation of special bandages used to give protection and support to broken bones. The bandage materials, impregnated with the dried calcium sulphate is moistened with water before application and the resulting setting process results in the formation of a solid plaster case accurately moulded to the area requiring protection. If the calcium sulphate was overheated in the original drying process or has been allowed to absorb moisture subsequent to drying, the setting process is interfered with and the set mass will be friable and weakened. CALClillI SULPHIDE

This is a fine greyish-white powder smell ing strongly of hydrogen sulphide (resembles bad eggs) and should be stored in well-closed containers. It is used in treatment of acne, boils, abscesses, carbuncles and allied disorders and is available in pill or tablet form each containing t to r grain of the substance. (To be continued)

FAMILY FIR ST AID T AUGHT AT WORK WITH the idea of teaching housewife employees how to apply first aid at home, the St. John Ambulance (I53) Division, attached to Lyons of Cadby Hall, has started weekly lectures on the treatment of minor injuries. Lectures and demonstrations will be given by St. John Ambulance members employed at Cadby Hall. The first aid section of the Lyons Club, through weekly meetings, aims to have a fully-trained member in every department.

The Blood, Heart, Blood Vessels and Circulation by

J. WELLS, M.R.C.S., L.R.C.P. Continued from August Issue.

The Arteries of the Body The aorta is the largest arterv in the body. It arises from the left ventricle of the heart: then forms the arch of the aorta, and travels down the left side of the spinal column to the lower border of the second lumbar vertebra where it divides into the right and left common iliac ~rteries. These are short arteries which soon divide into internal and external iliac arteries . The internal iliac arteries supply the organs in the lower part of the abdomen. The external iliac arteries after a short distance, leave the abdomen and after passing. th~ough the femoral ring appear as the fe~oral art~nes. In. the fr~nt of the thigh in the femoral tnang~e which. IS sItuated III the front and upper third of the thigh. It IS at the femoral ring where femoral hernia occurs. The femoral artery then proceeds down the inner side of the thigh and runs deeply through a canal of muscles called Hunter's Canal to the centre of the popliteal space at the ~ack of the knee. While in this space it is called the pophtea~ ~rtery:, at the lowe~ end of the popliteal space, the artery diVIdes lIlto the antenor and posterior tibial arteries. The anterior tibial artery runs down the muscles in the front of the leg to a point midway between the ankle bones, called the internal and external malleoli. The posterior tibial artery runs down the muscles at the back of the leg to a point midway between the internal malleolus and the tip of the heel. At this point pulsation of the artery can be felt. The dorsal artery of the foot is the prolongation of the anterior tibial artery, which runs along the dorsum of the foot to the inter-space between the first and second metatarsal bones. It then dips sharply down to the plantar surface of the foot between the first and second metatarsal bones, and joins the plantar artery, which is the prolongation of the posterior tibial artery in the sole of the foot, to form the plantar arch from which is given off branches to the great toe and each of the other toes. These are called the digital arteries of the foot. Branches of the Aorta From the arch of the aorta are given off the common carotids right and left which at the level of the upper border of the thyroid cartilage divide into the internal and external carotid arteries. The internal carotid ascends and passes through the carotid foramen of the skull to supply the brain and meninges. The external carotids proceed upwards and give off branches to the tongue, the lingual arteries, the buccal arteries to the cheeks, the facial arteries to the fa ce, the anterior and posterior temporal arteries, and the occipital arteries. The vertebral artery runs up the side of the spinal column, entering the skull and assists in supplying the brain and meninges with blood, together with the internal carotid.

r=--~~_ [pithelUl,l

llnzng

~-- Muscular ml.ddfe coat outer coal of

areoLe7 (tSSl.l.e

£/Jdhellal hnzng ----outer coat of

areolar tzssu.e

~-'mLddLe muscular and eCasLlc [oat

Transverse Section through a Small Artery and Vein. (Highly Magnified)

On the right side the innominate artery gives off the right subclavian artery which lies on the first rib under the clavicle and then proceeds to the axilla or armpit, where it is called the axillary artery . The left subclayian artery is a branch of the arch of the aorta. The heart has its own special blood supply and is supplied by the coronary arteries. These arise just above the level of the aortic valves and thus obtain some of the first arterial blood pumped out by the left ventricle. The coronary veins then collect the blood and return it direct to the superior vena cava. Branches of the Descending Aorta The coeliac artery supplies the stomach, liver and spleen) the suprarenal arteries supply the right and left suprarenal glands. These glands are situated at the top of each kidney and supply the blood with suprarenal fluid. The superior mesenteric artery which supplies all the small intestine and part of the colon or large bowel, the renal arteries which supply the kidneys, the testicular arteries which supply the testicles, the inferior mesenteric arteries which arise from the aorta about an inch above the point where the aorta divides into the common iliac arteries, which is at the lower border ot the second lumbar yertebra. These arteries with their branches, supply the large intestines, the ovarian and uterine arteries which supply the ovaries and uterus in the female, with blood.

FIRST AID & NURSING , SEPTEMBER, 1948

8 The Arteries of the Upper Limbs The axillary artery when leaving the axilla, runs along the inner border of the biceps muscle to the centre of the elbow joint on its anterior surface, as the brachial artery, where it divides into the radial and ulnar arteries. The radial artery runs down the radial side of the forearm, to the wrist and here can be felt pulsating. The ulnar artery runs down the ulna side of the forearm, also to the wrist. These arteries, the radial and ulnar, then enter the palm of the hand and join together to form the palmar arch, the lower border of the palmar arch being at the level of the outstretched thumb. From the palmar arch are given off branches, to the thumb and each of the fingers. These are called the digital arteries. From the aorta, as it runs down in the chest, are given off the intercostal arteries which run round the chest, in the intercostal spaces between the ribs.

The Capilliary Circulation (A. Artet)1.

V. Vein).

The Capillaries (Latin Capillus-a hair) are very minute bloodvessels, the average diameter being about r/3000th of an inch. It is important to remember that these vessels may be arterial capillaries and venous capillaries and it is in these yessels that the exchange of blood takes place and .also no,":rishment is given to the tissues; this being possIble owmg to the blood corpuscles being able to penetrate their weak and delicate walls. It is in these vessels that the interchange of gases and fluids takes place. The blood stream is first forced by the left ventricle into the aorta and larger arteries, then into the smaller arteries and arterioles, finally reaching the arterial capillaries. These arterial capillaries intermingle with the venous capillaries and the blood is transferred to them as venous blood w1:ich thefo1- enters the venules and finally passes into th~ vems. This. venous .blood from the systemic circulation, enters. the nght aurIcle of the heart by the inferior and supenor venre cavre and then passes into the right ventricle through the tricuspid orifice. The blood is then forced by the contr~ctio? of the right ventricle through the pulm.onary .onf]ce mto the pulmonary arteries and pulmonary cl!c~:danon as venou.s blood, to be changed in the lungs to artenal blood (after ItS contact with, and absorption of, the oxygen from the air we inspire) by the ha:maglobin of the red blood corpuscles.

E xamination of the Pulse When the pulse is examined the patient should be lying on his back or sitting. The pulse is most readily felt when the forearm is in the prone position and the wrist slightly flexed . To feel the pulse, place three fingers of the right hand on the patient's radial artery at the wrist. The typical normal pulse of a healthy adult can then be described as : rate 70 per minute, the beats being regular in rhythm. The radial artery being of medium size, its walls not tortuous or thickened. The passage of the pulsewave can be stopped by moderately firm pressure and the beat is felt best when a moderate degree of pressure is applied to the artery. The first aid student should take ample opportunities to examine the normal pulse, as he will then be the more likely to detect the abnormal pulse. Some of these may be noted, such as : The rapid pulse due to various cardiac conditions or to infective disease and high temperature. The infrequent or slow pulse which is sometimes natural in some people. If the rate falls to 30 to 40 per minute, it is probably due to heart block, that is, thrombosis of the coronary arteries, which is often a fatal condi60n. The wiry pulse when the vessels are contracted and the pulse is rapid and moderately strong. This may occur in peritonitis. The running pulse occurs when the vessels are relaxed and the heart's action is weak and rapid. The intermittent and irregular pulse in some forms of heart dis ease. In cases of shock which it is very often necessary to treat in rendering first aid, the pulse is very rapid and weak and often imperceptible at the wrist. We may ask, what causes the pulse. If the blood flowed evenly and regularly from the heart to the limbs, and organs, no pulse would be felt, but as the left ,-entricie contracts, it throws out a large quantity of blood into the aorta, which is an elastic tube. The aorta then stretches and rebounds again owing to the elastic fibres in the vessel wall. Although it rebounds, it cannot send the column of blood back into the heart, as the heart's outlet valves have closed. The blood is therefore propelled along the arteries. This wave caused by the rebound in the aorta travels rapidly along the arteries and can be felt as a pulsatin.g vessel in certain definite positions of the body, e.g., at the wrist, at the facial artery, the carotid arteries, the anterjor temporal arteries and posterior tibal arteries, which lie on the oscalcis midway between the internal malleolus and the tip of the heel. The pulse-wave travels at about seven metres, which is ahout23 ft. per second, so that the pulse felt at the wrist occurs about one-fifth of a second later than the heart beat. It is thus seen that the pulse wave is due to the elasticity of the aorta and not to the contraction of the left ventricle. This explains why the pulse cannot be felt at th ~ wrist, although the heart beat can be heard with the stethoscope, because with t~e heart muscle failing it is not able to pump enough blood mto the aorta to cause the elastic rebound, which makes the pulse.

.. FIRST AID & NURSING"

QUERIES and ANSWE RS COUPO N To be cut out and encfosed with all Queries . Septe mb e r, 1948.

FIRST AID & NURSING , SEPTEMBER, 1948

News From All Qu arters C ounty of B erkshire THE ST. JOHN AMBULANCE On Saturday, porter supposed to have been severely injured August 14th, Efty members when coupling two carriages. of the St. J ohn Ambulance Brigade Cadets .Th.e Challenge Shield was presented to the BRIGADE. from .Readin g G.W., Maidenhead, and Theale wlOlling team by Mr. E. :\1. Rutter the Su rgeons' Ann ual Dinner and Conference The Annual Conference and Dinner of the Surgeons of the Brigade will be held at the Royal Hotel, Woburn Place, L ondon, W.C.I, on Saturday and Sunday, October 30th and 3 1S t. Whilst the full programme cannot vet be announced it can be stated that amongst the speakers at the Conference will be the Chief Commissioner of the Brigade, Dr. Frank C. Eve, who will discuss artiEcial respiration and give a demonstration with the "Rocking Stretcher," and Mr. Dickson Wright, M.S., F.R.C.S., who will open a discussion on the use of Elms in training. Lord Webb-Johnson will be the principal guest at the Dinner. Further details will be available shortly but in the meantime, Surgeons who expect to attend are asked to advise the District Countv Surgeons at once. ,County of Birmingham YARDLEY On Thursday, July 15th, an interesting contest took place between two teams from each of the Yardley Ambulance and ursing Divisions, for a cup presented to the Joint Diyision by Div. Supt. L. A. Black. The contest included a Team test, Indiyidual Practical Test, and a Yiva Voce Test. The Team Test, which consisted of diagnosing and treating a patient who had supposedly fallen from the rear of a lorry which had not stopped, was judged by Corps Officer WI. R. Lloyd . The Individual Practical Test consisted of four individual tests and two dual tests for each team, and was judged by Amb. Div. Supt. J. Leggett of Shelton Di,Tision, and the Viva Voce Contest, which " Tas of a very varied nature, was judged by Nursing Div. Officer .M rs. E. Holmes. Timekeepers were Cpl. C. Beddall, Amb. Officer It. Eke, and Nursing Cadet Supt. :M rs. Grant. The result of the Competition was: Yardley Amb. Div. o. I Team, 274-Leader, Sgt. Durant; Yardley Amb. Div. NO.4 Team, 263-Leader, Pte. Baker; Yardley Nursing Div. o . 3 Team, 253-Leader, Amb. Sister Mrs. Gosling; Yardley ursing Diy. o. 2 Team, 23S-Leader, Amb. Sister Mrs. \\'hitehouse. After short speeches on the tests by the yarious judges, the cup ,vas presented to Sgt. Durant for the winning team by Nursing Corps Officer 1\1rs. Freeman, in the absence of her husband, Amb. Corps Supt. B. L. Freeman. Among those present were Corps Officers E. Beech and A. E. Green, Nursing Corps Supt. Mrs. Dedicoat, Nursing Corps Officers W. Finley and Mrs. Hamrnond. Div. Supt. L. A. Black, the donor of the cup was also present with his wife, having travelled specially from Coventry for the occasion. All the arrangements were successfully carried out by Amb. Officer A. H. Giles, ably assisted by Amb. Officer B. Chandler.

DlvlslOns left Reading for two weeks training under canvas at Freshwater, 1. of \VI. Church Parade was attended by all on the Erst Sunday, at St. Andrews Church the lessons being read by Cadet Corporal Englefield and Cadet Jefferis. During the two weeks several hiking tours were arranged which included one to Alum Bay where all the boys filled glass containers with the coloured sands. ::\Ir. Jarvis (Asst. County Commissioner, Berkshire) paid a visit to the camp and was impressed by the way the boys enjoyed themselves. The Camp Commandant in charge was Cadet Superinten dent E. J. Hamblin (G.W. Division) assisted by Cadet Officer H. Jervis (Reading) and Cadet Superintendent A . Austin (vlaidenhead) .

County of Lancashire PRESTON About 200 members, including Boy and Girl Cadets, attended the \nnual Church Parade at Leyland on 27th June. A SerYice was conducted at the Parish Church b y the Vicar, Revd. L. C. PetO, and Fr. Allen officiated at the St. Mary's Church Service. Assistant Comm. Gastall complimented the Corps on a smart turn-out. Capt. Millington, commanding the PrestOn Corps, was accompanied by illiss D. Toulmin, 'ursing Corps Supt. ; Dr. C. :;\1. W'illmott, Corps Surgeon; 11r. H. Calvert, Corps President; and Corps Officers, Divisional Supts, and Officers . The annual competition of the Preston Corps for the Galloway Cup was held at the Drill Hall, Chapel Walks, on Saturday, August 21St. The Corps Surgeon, Dr. Willmott, presided, supported by Corps Supt. E. F. Millington and Tursing Corps Supt. :\Iiss D. Toulmin. Dr. Rose conducted the competition and complimented the teams o n their performance. The winning team 'was Frenchwood Di,-. with Headquarters Div. second, and Leyland Div. third. The Hodgkinson Cup for individual competition was won by CpL Crossley, Frenchwood Div., who was also leader of the winning team. BRITISH RAIL WAYS England v. Scotland Ambulance Competition The sL';:teenth competition for the Challenge Shield was held in the Gymnasium, York, on Friday, the 13th August, before a large and interested audience, the result of which is given below : Team IlJdillidllai Total Place TealJJ 200 200 +00 Max. iHarks ISS,} 1. King's Cross Loco 170 358~ 2 2~ 2. Langwith Loco... II3 169~ 3. Edinburgh (Waverley) ... 121 157 27 8 4. Kipps District ... 94160 254York Station was realist.ically represented by the Carriage & Wagon \\' orks, York, with a

Superinten~ent, York, who congratulated not only the wInners but the other teams on their splendid performance. The judge for the team work was Dr. A. C. White Knox of London and for the individual work Dr. J. Rodger Sutherland of Glasgow. In their remarks at the close of the competition the judges said that the standard of work performed was exceptionally high and congratulated King's Cross Loco on their outstanding success. Eastern Region Two recent occasions when meritorious ErSt aid has been rendered by railwaymen are reported : The 6.31 p.m. passenger train from ~Iarvle bone was just leaving the termini on 2'Sth June, when a passenger tried to join the train in motion. The passenger's foot was caught between the step-board of the train and the platform edge, and he was drawn along the platform, falling on his left side. The train was brought to a stand, and :\Ir. Fielding, of the Parcels Department at :Marylebone, who was a passenger on the train, alighted and took charp:e. He found the casualty in a very awkward position, with the right foot trapped, and nearly severed from the leg except for tendons, and with profuse ha::morrhage. :\Ir. Fielding could not get to the femoral artery, so gently holding leg and foot, and bringing both back together, managed to control the bleeding by impro\ised pressure on the popliteal artery. He subsequently bound foot and leg together, and the casualty, still lying on his left side, was lifted on to a stretcher, and in this position was treated for shock and com'eyed to hospital---illl within a few minutes. \\'e ha\e since learned that the prompt and efficient Erst aid rendered by ::\1 r . .fielding has ayoided complete amputation of the foot in hospital. Mr. Fielding is an ambulance man of many years' standing and a member of 1'0. 134Division (Greenford) of the Brigade, and the Director of Ambulance has awarded the .\ssociation's Meritorious First Aid Certificate for the splendid deed. It proyes the value of good training, and is an inspiration to us all in the art of dexterity, impwyisation and resourcefulness. The second occasion happened when ~Ir. \\,' . Moore (a ci,ilian "ho has no connection \vith British Railways) fell into the canal at King's Cross Goods on 8th June. Goods Guard Dale, King's Cross stafl~ hearing a shout at 12.30 a.m. went to the canal with an unknown ciyilian, and succeeded in rescuing Mr. Moore. :\Ir. Dale attempted artificial respiration whilst the w1known ci,ilian fetched Mr. Dunford and ::\lr. Yenning, 'i\-here they found :;\1r. Moore in an apparently lifeless condition. \",,' orking in relays Messrs. Dunford and Yenning applied artificial respiration and after about twenty minutes got the ErSt gasp, and they persevered in their efforts for another

FIRST AID & NURSING, SEPTEMBER, 1948

fifteen minutes. In the meanwhile, the Police Region, said that he was certain in his own Ambulance which had been sent for, arrived, mind that the transfer of the S. and D. Firstand the man was conveyed to hospital, and aiders to the Southern Region would be subsequently it was learned he had completely beneficial, particularly as the Southern organisation was a very virile ooe. 1It. Trott, in recovered. reply, thanked :Mr. Hill for his kind remarks, Southern Region for attending and for handing over such a HORSHAM keen band of First-aiders who would A company of about eighty, compnSll1g undoubtedly do\'"etail into the Southern Family members of the Horsham Class and their and assist in joint efforts-of furthering the wives, and railway officials, recently assembled training of staff in first aid work. at the Railway Canteen. Western Region Following an excellent repast, Mr. H. C. On Sunday, August 22nd, 66 members and Lang, Deputy Chief Officer for Labour and Establishment, in presenting the team with friends of the o. 37 Division, G.W.R. and certificates to mark their success on securing Paddington Boro. spent a very pleasant dar the Inter-Railway Shield for the second year at Southend. The party included Div. Officer in succession, said "Ambulance work calls Dunford and his wife, Supt. S. H. Smith, for service, the most unselfish hobby one can Supt. Finch, Amb. Officers Barnett, Heatherhave--a study commended to those who wish ington, and Mayor. The party travelled by to serve others with whom they live and Eagle Steamer from Tower Bridge and arrived at South end at 12.30 p.m. An excellent lunch work." Others present were: ~rrs. H. C. Lang, was served at the Beehive Cafe, after which Dr. and :Mrs. K. Mawson, Dr. and 1frs. G. everyone sought their own amusement until Scott, Dr. B. A. R. Pitt, Mr. and Mrs. F. A. 5.30 p.m. when the party re-assembled on the Trott, Mr. H. Lloyd, Station Master and pier, and boarded the steamer for home. 1fr. and :\f.rs. A. Goddard (District Secretary). Tea was served as soon as the steamer left the pier, the ship's captain joining the party for SOlnerset and Dorset Joint Line this meal. The day's arrangements were At a meeting held at Bath recently, :i'vfr. excellently carried out by Supt. Finch and the G. S. Hill, Centre Secretary, London Midland Divisional Entertainment Committee.

Topical Notes for First Aiders & Nurses Training of Women as Domestic Helps In 1936, the Ministry of Health inaugurated a Home Helps Service which gave local authorities perrnis ion to employ home helps in maternity and child welfare cases, but not until 1944 did a special order gi\'"e power to local authorities to provide such help during sickness in the home. Less than two-thirds of local authorities used these powers, and although in some boroughs the organisation was well planned and worked efficiently, in others it remained more or less a scheme on paper. The Minister of Health has now stated that the National Medical Service could never be fully efficient without a good domestic help service. A lational Institute of Houseworkers has been formed for the purpose of examining the problem of help in the home during sickness and other emergencies, and also in homes where there are old people. It is working in close co-operation with the Ministry of Health and is available to advise local authorities to develop home help schemes and to set up courses of training. Five such centres are already operating and five or six more are planned. Good conditions and generous allowances are offered to students, who may be resident or non-resident. The course covers six months for women and nine months for girls under seventeen. The ~yllabus is comprehensive and practical. It Include~ all branches of housewifery and do~estlC craft, and also courses in citizenship, hyglen~, general education and physical recreatlOn. After training, the students are offered three main avenues of employment. They could undertake domestic work in a household where there was an essential need and be resJdent 111 that household, they could take part 111 a Domestic Help Scheme with a local authority or they could join the Daily Houseworkers' Service arranged by the National Institute of Houseworkers. The

Institute has arranged a standard of conditions and wages for workers who hold its diploma, £3 lIS. 6d. being paid to a nonresident home help for a forty-hour week. The address of the ational Institute of Houseworkers is 53, ~lount Street, London,

W.I.

has been considering special designs for both chas~is and body that will give low loading faCIlities, perfect stretcher fitment, springing that wiil ensure good riding over rough roads with a minimum roll on corners, and dimensions of the body that will permit resuscitation and rescue equipment to be carried. Suitable interior finishing to facilitate cleaning and disinfection, adequate heating and ventilation, a communicating hatch with a sLiding panel between the interior of the ambulance and the driver's cab, and an emergency exit at the forward end through which a loaded stretcher can be passed are among the many suggested specifications for the ambulance of the future. Student Nurses and Domestic Workers from Abroad It was announced some weeks ago that, in view of the increasing demand for nurses, the ::"linistry of Labour was bringing o\'"er 50 German and roo Austrian women to train as nurses in this country. The German women have already arri,ed and ha,e undergone a week's induction course at the Ministry's reception centre at Colwyn Bay before being assigned to the hospitals in which they will receive their training. The Austrian contingent is expected to arrive this month. At the end of their training they will take the qualifying examination for State Registration, after which thl!)' u'il/ be free to return to their own counllJ'· To the ordinary lay person this seems to be an astounding arrangement. \Y/e are also short of teachers, but how would that problem be helped if we undertook to train numbers of students from abroad without requiring them to serve for a time as teachers in this country ? One can only conclude that the Ministry acquiesces in the exploiting of nursing students and relies upon them as employees. Surely the students from abroad should be asked to give a limited period of service to our hospitals after qualifying! The expense of a student nurse's training is quite considerable and will now be met by the general public through the contributions to the ational Health Service. It is high time that the authorities realised that putting a girl into hospital and dressing her in a uniform does not make her a nurse. A number of German women are also being r~cruited for domestic work in hospitals and similar institutions, workers' hostels and farmers' households where there is urgent need for domestic help, but these voll111teers are under contract to enter such employment as may be specified by the Ministry of Labour and National Service and not to leave that employment without the consent of the Ministry.

Public Health Congress at Olympia An Exhibition anei Congress will open at Olympia on November IS, under the patronage of. ~.M. the King, and presided over by the Mlnlster of Health. Over 200 firms will show equipment, plant and materials used in the various branches of Public Health and in municip~ engineering. At the Congress, papers Will be read on a very wide range of subjects connected with the health of the people. They include administration of the .ational Health Service, refuse storage and dIsposal, se'Yag~, rural water supply gathering grounds, dlS.ttlct heat1I1g, housing of old ~eople, pla.J111.!l1g of a new. town, park organisatIon, quarry~g .and highway engineering. Local authOrItIes 111 every part of the country have received the p~ovisional programme ; and all those who are 1I1terested in the schemes A New Statute for Children The passing of the Nurseries and Child t'? .be developed in. the future should try to VISit Oly,mpla dunng the six days of the Minders Regulations Bill through Parliament forthcorrung Congress and Exhibition. places a duty upon every local authority to kee~ ~ register of all nurseries and all persons Design and Equipment of Ambulances recelv111g reward for looking after young It has been stated that the average life of an chtldren for the day or any substantial part of ambulance should not exceed ten years or the day, to enforce regulations and conditions 100,000 miles. Therefore, one-tenth of the and to impose penalties. Such a Statute has total number of ambulances operating through- bee,: long overdue, and doubtless the public o~t the country need replacing every year. feellOg aroused by such cases as that of little Hitherto, the construction of ambulances has Denis O'Neill has speeded up the legislation. inv,?lved ad~ptation~ of commercial or private A great deal of work will be involved in vehicles deSigned pnmarily f<;>r other purposes, putting the provisions of the Statute into and there has b~en no special thought given operation with as little delay as possible and to the constructlOn of the most suitable and it is hoped that many voluntary workers, who comfortable form of chassis. An Ambulance have the welfare of young children particularly Group of the Medical Supply Working Party at heart, will give a helping hand.

FIRST AID & NURSING, SEPTEMBER, 1948

THE CARE OF THE CHRONIC INVALID IN THE HOME BY

AGNES E. PAVEY, S.R.N. Diploma tn Nursing (University of London) The joints will not, howeyer, be free from pain unless the, a.re imn:obilised, and this_ is. be t ~chieyed by the applic~ tIon of lIght but perfectly htUng splints. A trained masseuse Nursing of Chronic Arthritis (physiotherapi t) should, if possible, ,-isit the patient each ARTHRITIS is one of the most de\Tastating of the day to remoye the splints, gently massage the mu des and chronic crippling diseases and it affects persons of moye the affected joints before re-applying the plints, the almost any age. A t~Tpe known as tm's disease may affect home nurse giying what assi_tance is necessan". ~ omechildren between three and ten years of age, and in this times radiant heat or infra-red rays can be gi,"en from a condition the joint affection resembles the chronic arthritis portable apparatu plugged into the ordinary lighting ' of older people, but feyer and glandular enlargements are circuit. also present and the disease runs a yery prolonged course. Two chief forms of arthritis affect adults-rhetlmatoid Physical Treatment Later, the splints can be left off for some hour each da,-, arthn/7s) which occurs in women more often than men and is essentially a disease of young people, the age of onset preferably at meal time, or may be wo rn only at night. being behveen 25 and 35 ; and osteo-arthritis, which rarely A few weeks of spa treatment is of great use at this, tage. occurs before the age of forty, but which also affect's L'nder-water rna sage is excellent and electrical treatment women more than men. Both type lead, e,' entually to such may do much to improye the condition of the muscle in degree of crippling disablement that the patient may become the region of the affected joint_. If spa treatment is impo_ ible, \yarm medicated baths bedridden. Even then, with strict nursing care and intelligent handling many patients can regain some ability may be giyen in the patient s own home. A brine bath to care for themselves, and they may even reco\'er sufficiently ""1th a saline content equal to that of sea water may be to become employable. It has been authoritati\Tely stated prepared by adding three to four pounds of common salt that if all cases of rheumatic arthritis were treated correctly to the bath, which _hould immer e the patient to the in the acute and sub-acute stages yery few of them would shoulders. One to two pound of commercial Ep om result in deformities . VnfortunatehT, the case is different salts may be used instead of salt, or a tablespoonful of with osteo-arthritis, for this is chro;Uc from the beginning mustard may be mixed to a thin cream with cold ,,,ater and b~ added to'the bath. The patient remains in the ,vater tor and is, in fact, part of the aging process ot the body. Some of the difficulties in both type arise because the 10 to 15 minutes, after which he is dried, wrapped in hot patient tries to treat himself, or he is not in a position to to,vels and rests in bed for at least half an hour. Graduated have the best treatment. A man may not be able to leave exercises help towards the restoration of tunction. \\'alking his work, or a woman her household duties. Lack of training, step climbing, postural training and finger and money has often put treatment out of the reach of the toe exercises might be initiated by the physiotherapi t, the sufferer, and even under the new Health Service there is, home nurse as i ting the patient to carry them out as as yet, no comprehensive plan for the care of patients with directed. these diseases. The two fundamental principles underlying The Chronic State all treatment and nursing care are the prevention or limitaFor the correction of deformities that ha,-e already tion of deformity and the maintenance of the maximum occurred the patient may need skilled and specialised caH~, degree of function that is possible. with weight extensions, sp cial plasters and, sometimes, manipulations of the joints under an ame thetic. Heat and Nursing Treatment of Rheumatoid Arthritis mO\Tement to the joints and rna sage and exercise for the As the intelligent co-operation of the pa6ent is essential muscles help in restoring function. In seyere cases the the condition and the objects of treatment must be explained patient may need crutches to help him regain the power to to him. An optimistic outlook with regard to results walk, for the joints must not be required to bear much should be incalculated, for it is a mistake to allow the weiaht at first. He must be encouraged to exercise even patient to think that permanent crippling is inevitable. tho~O"h this is painful, for only b)~ graduated exercise In the early stages the affected joints are swollen and \\Till he be able to keep the joints mo\rable. tender. Movements cause severe pain and spa m in the muscles may be present. Physical and mental rest are Osteo-Arthritis The symptoms of this condition appear slowly at first important, so that the patient must remain in bed. He may find that lying with the joints flexed is the more com- and may be just a slight stiffness which become more' fortable position, but if he is allowed to remain like this noticeable when the joint i exerci ed. Later, there is deformities may occur. Of course, pain must be relieved, constant pain in the affected joints. ~est ~n be~ i~ a great and the doctor will prescribe some analgesic for this. help at this stage. It takes the stram off the JOlnts, but

Continued fron; August Issue.

FIRST AID & NURSING, SEPTEMBER, 1948

they should be put through the full range of mO'Tement~ of oyer-ride each other, hand splints and plastic boots may which they are capable at least once a day.. If t?e patient 1::e required. \'·hen a bedpan is needed it may be best is oyerweight he should ce put on a reducwg diet, and as to turn the patient on his side, place the pan close to the he loses ,veight he \vill Bnd more comfort in moying and buttock and hold it securelv while he is rolled on to his especially in walking. The physical treatment, with baths, back. Small pillows may then be adjusted to gi\-e the heat, massage and re-education of muscles should be gi\Ten maximum degree of comfort. as for rheumato~d arthritis. Occupational Therapy The Bedridden Patient Although it is nece sary to maintain and de\-elop the \,-ith both forms of arthritis the patient may become widest range of movement possible the type of occupation completely bedridde~, .at least for a time . . Some of these must be car.d ully chosen. For example, knitting or patients may have Jowts that are so stIffened that no crochcting is often bad for arthritis because it keeps the movement is possible, \vhilst other joints are so painful hands too cramped and allows for such a mall range of that they must be mo\ ed with great care, a\-oiding any ffiOyement that deformity of the hands and fingers is quick or jerky rno' ement. In blanket bathing such a patient increased. Chip carving, toy making, painting or pastel two helpers are required to handle him to best advantage, drawing may be marc suitable. \Yeaving on a table loom and all pressure points of the body need careful attention, requires mo,-ement of the whole arm as well as the hand, for bedsores could \-ery easily form. The patient should and although this is painful at first the patient soon realises lie alternately on his back and on his side, \\ ith onh- one that there is imprm ement in the hands and arms and that pillow unde~ his head. An air ring may be r:tcess~ry to pain tecomes less. 1Iusic can be an absorbing pastime, and take' pressure off the sacral region, and when lying on his if it is possible for the patient to practise on an instrument side small pillows may be placed between the knees . Tow this should be encouraged. Jig-saw puzzles and card games and wool ring pads may be bandaged on to elbows and may provide an interest that relieyes the tedium of many knees. A cradle is generally required to take off the weight an hour, and if the patient can help 'with small domestic of the bedclothes. The toe and finger nails need special tasks, such as shelling peas, preparing fruit and other foods attention in arthritic patients. They may become long, for cooking or cleaning table silver, he should be allowed tough and grow into the ends of the Bngers or toes. If to do so, for it makes him feel less of a burden to the there is distortion of the fingers or toes that cause them to household and is excellent for his morale.

NUl-sing Correspondence Readers are invited to send their i\Tursil7g Problems jor solution. CorrespoJ7deJ7ce should be brief and to the poiJ7t and addressed to the Editor (( First Aid & J\Tursi17g," 3 2 Fi17Sbut:y Square, LOJ7doJl, E .C.2. Taking the Temperature Painful Sunbathing L. S. (Tottenham) writes : F S (Leeds) writes :_ " I am a reader of FIRST AID A~D l\URSI~G and find the . . articfes very useful and instructi'b'e. l\-01v I wonder 1vhether J'ou " IF'lill )'OU please advi.se me as to what I can use to prn'ent the can help me with a problem. Sometimes a patient's temperature peeling off of the skin after sunbathing? I have been ~'etJ' careful is taken by placing the thermometer under the tongue and in other about exposing tlryself to the sun this )'ear and have also applied cases under the arm. IrT0' is this) and should the thermometer calamine lotion regular!),) but ha~'e still had to endure the painfttl reading be the same ?" process ~f " peeling." The reason for taking a patient's temperature in the mouth is that this region is easily accessible, without The skin will not peel unless it has been injured, so that disturbing the patient or his clothing, but the method is the care taken was obviously inadequate to prevent burning unsuitable for babies and small children, for unconscious of the epidermis. The best method of acquiring a tan or delirious patients and for patients with difficult breathing, without burning is to expose the skin to the sunlignt for persistent cough or convulsions. In these cases the tem- not more tnan ten minutes on the first day and increase the perature may be taken under the arm. For babies, the bulb time by ten minutes each day until the skin is tanncd, after of the thermometer is lubricated with vaseline and is which no burning will occur. Alternatively, the skin could pass~d just inside the rectum, holding the baby's legs be exposed tor one hour from 5 p _m . on the first day, from vertIcal to the body, as when putting on a napkin. For 4.3 0 on the second day and from 4 p.m. on the third day. toddlers the temperature may be taken in the groin, and For skins that are unduly sensitive to the sun's rays a 2 or f<::>r slightly bigger children under the arm. When using 3 per cent. solution of tannic acid in equal parts of surgical either of these methods the skin. surface must be dried if spirit and water may afford protection. Calamine protects the patient is perspiring, otherwise the thermometer will the skin from sunlight because it forms an opaque film, not register correctly. \X'hichever method is selected, it but then tanning does not occur. The treatment of sunburn must be fullowed throughout the illness, because the and of painful peeling depends upon the severity of the reading when the temperature is taken in the mouth is condition. In mild cases a powder consisting of equal half a degree higher than when taken in the' groin or axilla parts of zinc oxide, boric acid and talcum may be all that is and half a degree lower than when take1:l in the rectum. needed. J n more severe cases calamine lotion gives relief.

FIRST AID & NURSING, SEPTEMBER, 1948

Disinfection of Room after Infectious Illness A . T. (Deal) writes : " I have not done arry JIursing for /J1C1lij' J'ears and was aJked hOJv to disinfect a room after an infectious illness. I presume that the old method of sealing and burning sulphur bas been superseded) so should be interested to leam the latest method." "hen a notifiable disease has been nursed at home the sanitary authorities usually carry out disinfection, if fumigation is considered necessary. :2\owadays, much more stress and reliance is placed upon the free use of soap and water, combined with fresh air and sunshine, and this will suffice to disinfect rooms that haye been used for nursing many of the ordinary infectious fe\-ers, providing that they are suitably furnished . If carpets, rugs, heavy curtains and upholstered furniture is in the room fumigation may be necessary, but formalin is used much more than sulphur, for thc latter is not effective in a dry atmosphere and, seeing that the gas liberated is a heavy one, the apparatus needs to be placed high, for example, on a chair standing on a table. Moreo,-er, it tarnishes metal and bleaches some dyed fabrics . Formalin gas has none of these disadyantages. It is produced by heating paraformaldeh:-de tablets. An " Alformant" lamp may be borrowed from a nursing association, or the tablets mar be placed in a saucer which is heated o\~er a spirit lamp or a bunsen burner, the number of tablets depending upon the size of the room. The apparatus can stand on a tray on the floor. Formalin gas penetrates better than sulphur gas and it is a better general disinfectant, especially for the tubercle bacillus; in fact, gaseous disinfection is probably more necessary after nursing a case of tuberculosis than after an)" Other of the common diseases. If gaseous disinfection of a sick room is to be carried out the bed should be stripped and the mattress rolled and placed on end, all furniture should be drawn away from the wall and all drawers and cupboards should be opened. The window must be closed and sealed with strips of paper pasted around the frame. A large ~eet of paper must be pasted oyer the fireplace and any gratwgs or other apertures must be similarly sealed up. The liberation of the gas is then commenced and the operator immediately lea\'es the room, closing and sealing the door by pasting strips of paper a~ound the fr~me _ The keyhole should be sealed from outs1de. After S1X hours the room may be opened and thoroughly ventilated. The \valls-if papered-should be stripped and the \\-hole room cleaned and redecorated . Chronic Arthritis . ... _ . " In nursing a patient 1vlth cbromc artbrltls IS It adt'lsabie to mcot/rage as much exercise as possible in order t~ ~eep the joiJlts free) or should exercise be cut to a mini/mllll 1v/Jen It 1J" apparent0' tl painful procedure ?" This depends, to a great extent, upo~ whether. the patient is undergoing an acute ph.ase, wl:i~h somctlmCS occurs in the course of the chrome conditlOn, and also upon the type of arthritis. The whole que~tion is ~is~ussed in an article on " The Care of the Chromc Im-alid 111 the Home," which appears on page I I of this issue.

J. H. (Liverpool) writes.;-

LC.A.P. Examinations 1948 The secretary informs us that Preliminary and Final E:xarninations will take place in L ondon on the 16th and 30th O ctober respectively,

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afie ~/t(t'ilJ ~t tfie fRed &~,6/ (The International Red Cross Conference u/as recmt(y held in Stockholm. In the foll02ving article) lvhich is a condensed version of otle appearing in the "Mancheste1' Guard!an '.' last montb) the lvriter traces the h?stoJ)' of the Red Cross since ltS formatton.)

FIRST AID & NURSING, SEPTEMBER, 1948

QUESTIONS

new convention replaced the rudimentary convention of

1864. In tlus, the principle underlying the Red Cross was given first place. Still, ho,,-ever, the Red Cross lacked a firm basis in international law. A great advance was made in defining the scope of the Red Cross and in establishing its international principles when in 1928 the Statutes of the International Red Cross were adopted at the International Red Cross Conference at the Hague. These Statutes govern an organisation comprising the national societies, the International Committee, and the League of adonal Societies. Its legislative authority is the International 'Conference, to which are called delegates of the national societies, the International Committee, and the Statues Signatory to the Geneva Convention s. In the following year, 1929, two instruments were signed at Geneva on July 27 . The first was the" International Convention for the Relief of Armies in the Field" superseding the 1906 Convention. The second was the" International Convention Relating to the Treatment of Prisoners of \X/ar." Red Cross organisations, and in particular the International Committee, figure for the first time in the Conventions. Article 77 provides for official information bureaux; article 78 gives authorisation to recognised relief societies; and article 79 gives sanction to the establishment of the Central Prisoners of War Agency. Such is the extent of international agreement on the powers and scope of the Red Cross . The Conference In Stockholm reviewed the work accomplished during the last ten years by the national societies of the Red Cross, the Red Crescent, and the Red Lion and Sun, as well as that of the International Committee.

1859 Iapoleon II~ joined Victor ?.r::unanue~ as an ally against Austna. Battle was. J?llled ~lth the Austrians at Magenta on June 4 and agaIn In the neIghbourhood of Solferino on June 24. The second battle lasted for fifteen hours. The heat of the day was intense and at four in the afternoon a thunderstorm broke. The Allies lost 17,000 men and the Austrians 22,000. Present at Solferino was Henry Dunant, a young Genevese who was pursuing his private schemes of business. He was drawn on to the field and went from one wounded man to another giving what aid he could, and recording the messages of those mortally wounded. His next step was to organise help for the suffering and the dying. He inspired the women of the neighbourhood, commercial travellers, English tourists, and even the chi~dren, to come and help him, not only to succour the soldJers who had fought on their behalf but also men of the enemy forces. His efforts were in a sense the start of the International Red Cross. Dunant returned to Geneva. Three years later his book " Un Souvenir de Solferino "appeared. It ended with the suggestion that in time of peace societies should be formed in each country to provide care for the wounded in time of war. He also proposed that the international congress should be called to draw up certain principles in the form of a convention upon which the national societies should he Reader} s Letter based. These societies were to form detachments of voluntary helpers. The Editor is I/ot respolIJible for opinions expressed The ideas and proposals of Henry Dunant were first NATIONAL LIFE GUARD SERVICE examined by the Societe Genevoise d'Utilite Publique. That Society appointed a committee to further his proposals, DEAR EDITOR, and on October 29, 1863, this Geneva Committee for Aid I read with interest your Editorial in the .August issue. I have just to Wounded Soldiers assembled an international conference returned from a holiday on the Isle of Wight where, during my stay, I with representatives from sixteen nations. It was agreed witnessed a tragic bathing accident in which a doctor and two other that in each of the countries represented national com- visitors lost their lives attempting to save a drowning boy. This has mittees for aid to the wounded should be formed. In the prompted me to write to you on the subject. following year the Swiss Federal Council called another Whilst on holiday at Heme Bay some 15 years ago I witnessed a conference, this time of diplomatists. The result of this demonstration by the Daily Sketch Life Guards. This led me to making was the signing on August 22 of the Geneva Convention application to the Royal Life Saving Society for membership. Although tor the Relief of the Wounded and Sick of the Armies in 47 years of age I became a member, obtaining the Bronze Medallion the Field. For the first time a multilateral treaty was framed and two years later the Award of Merit. I have since done duty at and signed to mitigate the evils of war. The terms provided various places whilst on holiday and nearer home at Greenwich. for the protection of field dressing-stations and military Recently I attended the inaugural meeting of " Shanklin Local Life hospitals marked by the single recognised emblem-the Guards." red cross on a white field. The Geneva Committee also Properly trained and equipped Life Guards are, as you state, a acquired the title of the International Committee. National Necessity. Poor swimmers and " venturesome souls" are a The Committee saw war service for the first time in 1864, grave problem to sea-side committees and councils. The Government in the conflict between Prussia and Denmark. In the war should "step in" and provide a National Life Guard Corps on a between France and Prussia in 1870 an Information Bureau voluntary basis, since local authorities in the main have neither money for prisoners of war was formed, but the emblem of the nor interest-at least that has been my experience. Red Cross was not granted to it. Yours, etc., The work of the International Committee continued. B. TAFFS . At the Hague Conference of 1899 the principles of the convention were adapted to maritime warfare. In 1906 a London, S.E.

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Special Notice. In future, First Aid and Nursing will be published on 22nd of each month, instead of 20th. Thzs change is made to enable us to include late matter and to facilitate distribution. Will Secretaries please note that the Editor welcomes reports of local activities, press cuttin.gs, etc., and every effort will be made to include such ztems, All reports should be posted on or before 7th of the month. Reports from overseas readers are particularly welcome.

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FIRST AID & NURSING, SEPTEMBER. 1848

Queries and Answers to Correspondents Queries will be dealt with under the following rules : I.~Letters containing Queries must be marked on the top lefthand corner of the envelope "Query," and addressed to " First Aid & Nursing," 3z, Finsbury Square, London,

E.c.z. z.-All Queries must be written on one side of the paper onlY. 3.-All Queries must be accompanied by a "Query Coupon" cut from the current isstle of the Journal, or) in case ofQueries from abroad) from a recent issue. 4.-The Textbook to which reference mcry be made in this column is the 39th (r937) Edition of the S.J.A.A. Manual oj First Aid to the Injured.

Hremorrhage From Ear G. H. (Great Yarfl.1outh).-Since taking FIRST AID I have read with interest the marry queries and their a11S1vers. N02V I am anxious to kn01V what 1vas the cause of haemorrhage from the ear channel in a patient who was said to have previouslY suffered from fits. fVhen I lVaS called to him he was fullY conscious and so I treated him for fractured base of skull. LPhen, however, he arrived at hospital, he started to have fits 1vhich occurred at intervals. Subsequent x-rcry examination proved that there 1vas no fractured base of skull. Meanwhile, I thank you in anticipation of your answer ; and I wish good luck to FIRST Am. On the information supplied by you it is not possible to make a definite diagnosis. The patient may have been suffering from inflammation of the ear or ear channel which in some circumstances might produce the symptoms reported in your letter. Your treatment, however, was strictly correct because you avoided interference with the ear and transported patient to hospital. - N. CORBET FLETCHER. Examination Howler L. R. (Charlton Park).-In a recent examinalion the doctor asked a candidate what 1vas the variety of wound which mcry be caused by a blow from a blunt instrument. There was much amusement among all within hearing when he replied : " The wound would be confused" and it was renewed when the doctor queried" Are you ?" Good! Next please! !-N.C.F.

Laying-Out Dressing

J. N. (Newcastle).-I have been a member of the Brigade for marry years; and in a recent examination I was asked by the doctor to tell him what is a Lcrying-Out Dressing. I replied that I did not know, which answer satisfied the doctor because he evidentlY did not know either! Can you please enlighten me on this point? Y ou~ letter leads me to assume that the answer to your query IS to be found on page zr7 of the Home-NursinoTextbook in Appendix V where you are told how t~ re-dress a wound in a dead patient as part of the administration of .the . Last Offices and Care of the D ead. If my assumptlOn IS correct, the question should not be included in the official examination sheet.-N.C.F.

Treatment of Fractured Sternum P. L. (Shoreditch).-For the treatment of a patient suffering from fracture of the sternum, the Textbook simplY tells us " to place patient on his back in the most comfortable position and remove him to shelter." I am anxious to know (r) if I am right in my suspicion that the fracture is more serious than 1ve imagine it to be, and (2) if further injury is like(y to be caused to heart, lungr or stomach (to all of which the sternum is in close proximity) should the patimt be made to sit up before the ambulance arrives. Your kind answers on these points 1vill be much appreciated. (r) Fracture of the sternum is almost always transverse and due to direct violence, though it may result from indirect violence consequent on the bending of the body forward or backward and especially when fracture of sternum is associated with fracture of spine. It may also be caused by severe muscular action (or violence) as in lifting a heavy weight. In other words, .the degree of direct violence usually determines the nature and extent of injury to the sternum. Thus the bone offers little resistance to a blow of the fist, and though often struck violently as in a boxing match, it usually yields and quickly recovers its normal position without fracture. On the other hand, the direct violence may be extreme as when a man is caught between the buffers of a train, and the unfortunate victim may suffer from fractures of sternum, ribs, and spine, together with serious in jury to the organ within the thorax. From all this it follows that fracture of the sternum without other injuries is extremely rare. Hence the hesitancy of the Textbook in issuing more precise instructions about treatment of this fracture and also its insistence that patient must be removed in recumbent position. (z) I question seriously if further injury is likely to be caused to heart, lungs and stomach in the event of a patient who is suffering from fracture of sternum being made to sit up by some meddlesome person before the arrival of the ambulance man. At the same time such action would almost certainly aggravate the patient's condition if these associated injuries were already present.-N.C.F. Treatment of Heart Attack M. N. (Surbiton).~Please tell me if, as the result of a heart attack, the patient's breathing appears to be failing, it lvould be beneficial to perform artificial respiration. As patients suffering from heart attacks are not likely to present signs of failure of respiration except when they are in extremis I fail to see what good would be done by the performance of artificial respiration.-N.C.F. Humour in First Aid J. B. (Hampstead).-A pal of mine sprained his foot and 1vas sent to hospital. When he came home I asked him ,vhat the doctor had said, and I confess that I was surprised ,vhm he replied-" The doctor said that I was suffering from Newcastle Strain [" It took me sometime to realise that my pal meant" Metatarsal Sprain." Good! Next please! !-N.C.F.

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PRINCIPAL CONTENTS Editorial

A Course in Advanced First Aid The Medicine Chest

4 5

The Lymphatic Vessels & Lymphatic Glands

Nursing Correspondence News from all Quarters The Care of the Chronic Invalid in the Home Topical Notes for First Aiders & Nurses Queries and Answers to Correspondents

9 IO I2 14

NOTICE TO READERS. FIRST AID & ~~I!'IG is published monthly. Its aims and objects are the advancement of Ambulance work. First Aid and Nursing in all their branches. The EdItor mYltes readers to send articles and reports on subiects pertaining to these Movements and also welcomes suggestions for practical papers. All reports. etc.• should be addressed to the Editor, and should reach this office before the 8th of the month. Contributions must be accompanied (not nec=arilll JOT publication) by the name and address of the correspondent. URSING should be forwarded to the Publishers Subscriptions. advertisements and other business communications connected with FIRST AID &

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Editorial A Matter of Minutes

arrives-those few minutes when a man can bleed to

are vital, but the layman does not always appreciate that this is so. We were interested to see this matter admirably dealt with in the last issue of the Divisional Gazette of Nos. 30 and 182 Ambulance and No. 76 Nursing Divisions, S.J.A.B. The writer was asked during the course of a first aid talk: "What purpose can first aid serve, when within ten minutes of an accident occurring an L.e.e. ambulance is on the scene, renders first aid and removes the patient to hospital ?" The writer's answer is worth quoting. "Yes (he said), agreed that you can get am bulance service in ten minutes or so, but have you ever checked ten minutes on the minute hand ofa watchespeCially in an emergency? If not, ask someone who has had the misfortune to be trapped in a burning bUilding waiting for the Fire Brigade, or who has been in difficulties whilst bathing in the sea waiting for a rescue boat, how time passes. They will probably say that each minute seemed like an hour. Besides, consider the amount of blood that can be lost in ten minutes, the pain that can be suffered during that period, the effect of untreated shock, and of other complications, when only a few minutes may be a decisive factor between life and death if the patient is left to his suffering." That answer would, we believe, convince anyone; it conveys in a few words the importance of those decisive minutes before the ambulance

of attention. It is at a time such as this that the presence ofa first-aider can sometimes mean the difference between life and death, and always the mitigation of suffering. There are many occasions, too, where an ambulance is not available for a long time, and unavoidable delays, even where an efficient ambulance service is at hand, cannot always be prevented. In such a case is the unfortunate victim to suffer unattended while the crowd about him waits for the ambulance? Of course not, such an idea offends all our precepts of humanity. That crowds have stood by helpless because of their ignorance of first aid is only too often true, but the remedy is not to improve the ambulance service, but to enrol more first aid workers. The truth of this is often demonstrated, on such an occasion, when a first-aider among the onlookers arrives to take over control. The patient is treated, an ambulance or doctor is sent for, and he has the situation under control in a jiffy. He is able to do this because his training in first aid has given him the ability to handle such an emergency with confidence and efficiency. His presence makes all the difference in the world in those vital minutes before the ambulance arrives. In such a case first aid can serve no finer purpose than to provide that urgent treatment, without which a life might be lost, while the doctor or ambulance is on the way.

WE all know that in first aid, minutes, even seconds, death or suffer terrible agony and shock through the lack

FIRST AID & NURSING, OCTOBER, 1948

A COURSE IN ADVANCED FIRST AID BY

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

POISONS

modern life the narcotics form an important group of poisons since they are so commonly used for inducing sleep and for the relief of pain. \\,Iith the progress of medical science, new varieties of these drugs make their appearance almost daily. A narcotic is a drug which acts upon the nervous system and produces a tendency to sleep, it also reduces the activity of all the functions of the body. The two chief groups of narcotics are opium and its prepa.rati.ons and the barbituric acid compounds. Some authorItles 1nclude as a third group, chloroform and alcohol while others class them as deliriants. Opium is derived from the dried milky juice of a variety of poppy ; its chief ingredients are morphine and codeine, and these are used for many purposes. Thus, they are common ingredients of many cough mixtures which contain paregoric and chlorodyne while a linctus containing codeine is a popular remedy. Morphine itself is often prescribed by doctors to relieve pain. The barbiturate group includes many drugs which have become well known by name to the general public, e.J!'., phenobarbitone, luminal, allonal, soner)'l, medinal and a host of others. They are used chiefly as hypnotics, i.e., drugs which will induce sleep; in addition some are employed as sedatiyes to relieve nervous ailments. Poisoning through taking one of the members of this group is very common and may be accidental or suicidal. The accidental cases occur when, for example, a child gains access to a box of tablets lost or carelessly left about by an adult (listen to B.B.C. announcements!) Also when an adult himself takes an overdose, an accident which can occur more easily than is generally appreciated. If, for example, a patient has become accustomed to taking sleeping tablets regularly there is a risk that one night he may take the drug automatically and soon afterwards absentmindedly take another dose. For this reason it is a good plan for a patient who needs an hypnotic regularly to ask one of his relatives to take charge of his sleeping tablets and to give him the prescribed dose each night.

Opium Group The symptoms and signs of poisoning by the opium group are well known to the average first-aider. Soon after taking the drug, there is increasing drowsiness accompanied by giddiness and heaviness of the head. The patient passes into a state of stupor which leads on to coma. The face is pale but later becomes cyanosed. The pulse is slow and weak and the breathing slow and shallow ; in severe cases, Cheyne-Stokes breathing develops. The temperature becomes subnormal and the skin cold and clammy. A characteristic feature is the effect on the eyes which must always be examined in every case of unconsciousness. In opium poisoning the pupils become minute in size and are called pin point pupils.

Barbituric Acid Group The picture of a case of poisoning by one of the members of the barbituric group is not unlike that of opium. Symptoms and signs usually appear in a few minutes and include headache, giddiness and loss of muscular control. Occasionally a short period of mental excitement precedes the increasing drowsiness which is followed by stupor and coma. The pupils are smaller than normal but not pin point, while the pulse rate is quick. Otherwise the symptoms and signs of coma are like those of opium. A point of interest is that the coma caused by a barbiturate often lasts for a longer time than that caused by opium. Thus the patient may remain unconscious for several days, whereas with opium the period of coma does not usually exceed twelve hours. FIRST Am. (r) Ambulance.-All cases of narcotic poisoning should, whenever possible, be treated in hospital since medical methods are infinitely superior to those which can be undertaken in first aid. For this reason an ambulance should be sent for immediately and the patient removed forthwith. If a doctor is readily available, his services will naturally be of value, but there should be no question of delaying the message for an ambulance while obtain.ing medical aid. \Xlhile awaiting the arrival of an ambulance first aid should be continued. (2) Emetic.-This is essential but can only be given before the patient has become unconscious ; if given later there is a serious risk of asphyxia both when it is being given and when the patient vomits. Unfortunately, owing to the sedative action of narcotics on the stomach, the emetic may fail to act. Every effort, therefore, mu t be made to assist vomiting by giving copious draughts of luke warm water, tickling the back of the throat and repeating the emetic every five minutes. (3) Antidote.-The antidote for the opium group is permanganate of potash (dose, ro grains, i.e., as much as will lie on a sixpence) or an alternative, " Condy's fluid "_ dose, 2 ta blespoonsful. In both cases the antidote should be given in a tumblerful of water and repeated in half an hour if the patient is still conscious. Unfortunately there is no first aid antidote for the barbitone group . Doctors, however, administer by injecting, a drug called picrotoxin which, if given in big enough doses, will even produce convulsions. (4) Aperient.-A peculiarity of opium is that after it has been absorbed into the blood stream it is excreted into the stomach and intestines and hence can once more be absorbed into the system; it also produces severe constipation. For this reason it is a good plan to give an aperient such as cascara or Epsom salts, soon after administration of the antidote. (5) Stimulants.-It has already been mentioned that the narcotics reduce the activity of the functions of the body

FmST AID & NURSING, OCTOBER, 1948

and this applies particularly to the breathing. A true stimulant is a substance which will increase the activity of the bodily functions hence it is good treatment to give hot, strong coffee preferably containing glucose. If the patient is unconscious, a coffee enema with glucose can be administered. (6) General Principles.-The remainder of the treatment is that for an unconscious patient and includes loosening tight clothing and applying warmth. If the cyanosis is marked, inhalations of oxygen are valuable, while if the breathing becomes very shallow or Cheyne-Stokes, the oxygen should be combined with carbon dioxide as in the Novox apparatus. Failure of respiration calls for artificial respiration. If the coma is prolonged, the head and shoulders should be raised to prevent the risk of broncho-pneumonia.

Aspirin Poisoning This common drug is easily obtainable hence it is not surprising that it is frequently used in attempts to commit suicide. Its effects, however, are very variable and recovery often follows even a large dose. Soon after taking the drug, the patient experiences nausea; sometimes he vomits and thus automatically removes some of the poison from his stomach. An unpleasant symptom is singing in the ears and this may be followed by deafness. The patient becomes mentally confused ~nd. later may pass into a state of stupor o~ co~a. The skin 1S pale ~nd sweating profuse. The pulse 1S qtuckened and the breathing slow and deep. The treatment is similar to that for narcotic poisoning and includes giving, if the patient is conscious, an e~etic, an aperient and a stimu~a~t. ~nfortunately,. there 1S no suitable antidote, but elimlnatlon of the pOlson can be aided by copious drinks of sin1ple fluids.

Alcohol Many authorities class alcohol with the narcotics. Indeed, not many years ago, it was used as an ana:sthetic,

either by itself or in combination with chloroform-another narcotic drug. . The effects of small doses of alcohol on the body are well known. The patient appears more cheerful, excitable, loquaceous and often witty. These effects, however, are not produced by any stimulant action of the alcohol, as is so commonly supposed, but are caused by the removal of that nervousness and restraint which every individual possesses to a greater or lesser extent. Larger doses cause the speech to become slurred and thick. The pulse is quickened and the face is flushed. The patient may have difficulty in maintain.ing his balance and becomes unsteady in his gait. Often he is unable to perform satisfactorily muscular actions which require fine control such as writing his name or placing a key in a door. At this stage the patient may become temporarily mentally unbalanced, using bad language, aggressive, etc., thus giving the impression that he is delirious. In severe cases the patient becomes comatose. The face becomes pale and there may be cyanosis. The breathing is deep and stentorous. The pupils are equal in size but contracted unless the patient has been recently disturbed, since movement causes them to dilate. It is a grave sign if they become widely dilated and no longer react to light. The symptoms and signs of alcoholic coma may be very similar to those of other conditions such as cerebral ha:morrhage, head injuries, diabetic coma and ura:mia. Great care therefore is necessary in making a diagnosis. In most cases of alcoholic poisoning there is the characteristic smell in the breath, but this in itself is never sufficient to justify a diagnosis; often a patient who is feeling ill or perhaps about to become unconscious through some other cause will take, or be given, alcohol as a stlmulant, hence the breath mar smell strongly of alcohol, but the unconsciousness may be due to a totally different condition. FIRST AlD.-It must be emphasized that the severe cases of alcoholism are just as serious as those of poisoning caused by other narcotics ; they may end fatally, ~ence the principles of treatment are the same. as t~ose whIch have already been described for the narcot1c P01SOns .except that there is no suitable antidote, although coffee lS valuable.

The Medicine Chest By FRANK BERRY, PH.,C. Calomel See Mercury. Calumba The dried sliced .root of this East African plant contains useful bitter principles and is uscd in the form of infusion or t.incture in the tleatment of certain types of dyspepsia. Camphor This pleasant-smclling, whitc or colourless, crystalline substance is obtained by a steam-distillation process from the wood of a species of cinnamon tree which grows freely in Japan and Formosa. It may also be prepared artificially from one of the constituents of oil of turpentine. Camphor is somewhat difficult to reduce to nne powder but the process of powdering is greatly facilitated by the addition of a little alcohol or similar solvent. It is only very slightly soluble in water but dissolves more readily in alcohol, ether, chloroform, and vegetable oi ls such as arachis, olive, cotton-seed or sesame.

Exrernally, camphor is used as a counter-irritant and is a frequent ingredient in stimulating and pain-relieving liniments. ~hese produce a pleasant sensation of warmth when rubbed gently mto th: sk~n. Many ointments, especially those prepared for treatment of chtlbl~s and allied conditions, contain a proportion of camphor together wJth other counter-irrirants such as capsicum, eucalyprus or \vintergreen. Some typical preparations for external or local u e are : Ca//~phoratl'd Oil. This is also known as Liniment of Camphor and is a 20 per cent. solution of camphor in oil. . Compof/nd Camphor Lillimflll.- This is also known as Ammol1lated Camphor Liniment. It contains 12~ per cent. camphor and 25 per cent. strong ammonia sOlLltion in alcohol. . These liniments arc often used for application to the chest for relIef of bronchiti and similar conditions. . COli/pOI/lid ClJ/oral alld Call/p/;or Pailll.- This ~ons~ t5 of equal weIghts of camphor, chloral hydrate and carboliC ~cld ~n.d may be usefully applied to rei icn! the pain of acute fibroslus.

FIRST AID & NURSING, OCTOBER, 1948

Camphor Ice.-Is an ointment prepared by carefully dissolving of the salivary glands, pain and difficulty in swallowing, vomiting, camphor in a melted mixture of paraffin wax and soft petroleum diarrhoea, incessant desire to pass water, with only blood or albuminous jelly. It contains approximately 6 per cent. camphor. urine passed at each attempt, high temperature and quick pulse, loss of Camphorated Chalk.-A popular dentifrice, has been described sensibility and convulsions. Emetics should be administered, followed under Calcium Carbonate (see Calcium). by the usual demulcent drinks, but oil and fat should be avoided as Internally, camphor is given to ward off colds in the head and to these increase the solubility of the drug. relieve hiccough, whooping cough, colic and similar spasms. It induces perspiration (diaphoretic action), reduces feverish temperature (anti- Capsicum This consists of the dried, ripe fruits of a small shrub which grows in pyretic action), assists in removal of bronchial and allied secretions (expectorant action), and relieves griping and flatulance (carminative the tropical zones of America and Africa. The fmits are also known as chillies or Cayenne Pepper. action). It is frequently given by hypodermic injection to act as a The active constituent is a pungent and powerfully-irritating substimulant and restorative when collapse is imminent, especially in cases of pneumonia and acute fevers. Some typical preparations for internal stance called capsaicin. Capsicum preparations are given internally for their stimulant, tonic administration are noted below : Camphor Water is a useful vehicle for drugs used in treatment of and carminative action and are of great value in certain types of colds and influenza. It contains 0.1 per cent. camphor. Dose, dyspepsia. Tincture of Capsicum, dose 5 to IS minims, is given in liquid one to two tablespoonsful. to 2 grains, and Extract Spirit of Camphor is ~ 10 per cent. solution of camphor in alcohol. mixtures; and Powdered Capsicum, dose of Capsicum (known also as Capsicin or Oleoresin of Capsicum), Dose, 5 to 30 drops in milk or on sugar. Rubil1i's Solution is a much stronger solution of camphor in alcohol dose 1/100 to 1/30 grain, are frequently prescribed in pill form. Many Capsicum preparations are used externally as counter-irritants, and is frequently given in doses of 2 to 5 drops (on sugar) for relief being useful in treatment of neuralgia, lumbago, and certain rheumatic of diarrhoea. Camphor is sometimes prescribed in pill form (dose, I to 5 grains) affcctions. The following are in general use ; Capsicum Ointment is prepared by soaking crushed capsicum in and for relief of catarrh is occasionally included in compound warm ointment base for one hour and then allowing to cool and tonic-tablet formulae. It is an ingredient in the well-known set. preparation" Paregoric," which is a frequent constituent of cough Compound Capsicum Ointment, known also as Chillie Paste, contains mixtures. 2 per cent. of Oleoresin of Capsicum together with camphor, Camphor solutions for injection are prepared by dissolving camphor menthol, and chloral hydrate. in sterilised olive oil. Capsicum Liniment is prepared by dissolving a strong Tincture of Taking excessive amounts of the camphor preparations intended for Capsicum in a mixture of Alcohol and Oleic Acid. As it does internal use or the accidental swallowing of camphor-containing not redden the skin for an undue length of time this preparation liniments may result in symptoms of camphor poisoning. Such is particularly useful for use on exposed parts. symptoms include characteristic odour of the breath, faintness, gidCapsicum Plaster contains 2 per cent. of the oleoresin of capsicum. diness, disturbed vision, delirium, convulsions and ultimate collapse. Capsicum Wool contains the equivalent of about 20 per cent. An emetic should be administered and warmth applied to the capsicum and may be prepared by pouring an alcoholic solution extremities. A doctor will give stimulant hypodermic injections if of capsicin over compressed, absorbent cotton wool. It is usually necessary. Oral administration of alcohol or glucose is best avoided coloured pink with eo~in or other suitable dye. Capsicum Wool as these tend to increase the solubility and therefore toxicity of the may be enclosed in Absorbent Gauze and is then known as swallowed camphor. The accidental swallowing of one teaspoonful Capsicum Tissue. Many varieties of this wool or tissue are sold of camphorated oil, equivalent to approximately 12 grains of camphor, under popular proprietary names and find wide application in has caused the death of a 16 months old child within 7 hours. treatment of chest affections. Cannabis This is the plant known as Cannabis Indica or Indian Hemp, which Caraway grows freely in Central Asia and Northern India. The seeds of the caraway plant have useful carminative properties. C~abis is a useful sedative in treatment of spasmodic cough, Caraway Water is useful for relief of flatulent colic in infants and is a marua, asthma, dysmenorrhoea and migraine, and for this purpose pleasant vehicle for many children's medicines. may be administered as tincture or extract, the latter being usually Carbachol given in form of pills each containing to 1 grain. Excess of Cannabis may produce delirium and hallucinations and in This is a water-soluble, crystalline susbstance which, when given Eastern countries the drug is smoked in order to induce a psychological internally, either orally or by injection, stimulates the para-sympathetic state of pleasurable excitement. In view of the dangers of drug nervous system and is particularly valuable for relief of post-operative addiction the importation into and use in this country, of Cannabis, is intestinal atony and post-operative retention of urine. controlled by the Dangerous Drugs Act. The oral dose is 1/64 to r !16 grain and the dose by injection I/240 to Cantharides 1/120 grain. The.se are dried beetles obtained from Southern Europe. They are (to be continued.) sometunes known as Spanish Fly or Blistering Beetles and r:ontain cantharidin, a powerful vesicant substance. Preparations of Cantharides applied externally, act as powerful " FIRST AID & NURSING" ~ounter-ir~itants and are occasionally used to relieve deep-seated inflammatlOn, such as pericarditis, pleurisy and mastoiditis. These QUERIES and ANSWERS COUPON powerful ph'parations should not be applied over large areas. Traces of the highly active cantharidin are sometimes included in To be cut out and enclosed with all Queries. hair lotions to act as stimulant. Blistering plaster contains about 0.2 per cent. cantharidin. Octob~r, 1948. Symptoms of poisoning by cantharidin preparations include swelling

FIRST AID & NURSING, OCTOBER, 1948

The Lymphatic Vessels & Lymphatic Glands By

J. WELLS, M.R.C.S., L.R.C.P. CHYLE is the digested fatty matter absorbed by the lacteal vessels in the mucous membrane of the small intestines. It mixes with the lymph of the blood and is carried up the thoracic duct, through the upper part of the abdomen and thorax, where it is discharged into the left subclavian vein at its junction with the left jugular vein at the left side of the root of the neck. ' LYMPH is a fluid wl:ich escapes from the blood, through the w~lls of ~he capIllary blood vessels, into lymphatic spaces ill the tIssues and there serves to bathe and nourish the cells and tissues. Some of this lymph leaves the body in the form of sweat; the remainder passes into vessels known as lymphatics, which convey it to the back part of the abdominal cavity, whence it is carried either direct by the lymphatic vessels, or by opening into the thoracic duct to be finally discharged into the subclavian veins at the root of the neck. THE THORACIC D UCT is the channel for the transmission of lymph and chyle from the parts of the body below the diaphragm. It ascends from the chyle receptacle in the abdomen to empty itself into the left subclavian vein at its junction with the left jugular vein at the left side of the root of the neck as mentioned above. The lymphatic

Longitudlnal sectlon of a lymphatiC uessel (great{lj enlarqed)

Valves in the Lymphatics which keep the Lymph flowing in one direction, either to the Thoracic Duct or the Right Lymphatlc Duct.

vessels are very like veins in their structure, and they are spread over nearly the whole body. They are also like veins in that they have valves, but these are spaced more closely than in the veins, and when full, give a beaded appearance to the lymphatic vessel. These valves allow the passage of fluid in one direction only, that is, towards the right lymphatic duct, or the main thoracic duct. Also in the veins, the valves allow of the passage of venous blood, returning to the heart. This finally arrives there by two large veins, the inferior and superior venae cavae, which open into the right auricle of the heart. The lymphatic vessels carry the chyle and lymph by the right lymphatic duct or the thoracic duct and finally discharge it into the subclavian veins at their junction with the jugular veins, and enter the blood stream direct at these points, whereas the blood from the veins is carried by them to the right auricle of the heart. The lymphatic system consists of the lymphatic capillaries, lymphatic vessels, lymphatic glands, and two main

lymphatic vessels called respectively, the right lymphatic duct and the thoracic duct. The thoracic duct commences on the front of the spine at about the level of the second lumbar vertebra. It is much larger here than at its upper

RLght JuguLar ~

Right

t::;~allt'~~I \I I~\~ 'duct ,?I ~ ~

Righi subdav(f}.n ve,n Trachea

"I)'

vel..n

!, }fwraCLc I~k-

v duct .--....--", .........."'~ -~ ~ Left Jubctavwn

veln (Esophagus

Cham rf

L-1" 1~---7horaClc dad

ffjmpflaUC q/ands 1firou gh the th.orax

ThOf({c(C

Left J119u{Q,,-

vertebrae --f.'~~~ /'

PI bs cut aWD,/

THE THORACIC DUCT AND THORACIC GLANDS. Showing the Right Lympbatic Duct and tbe Tboracic Duct, opening into the junction of tbe Rigbt Jugular Vein and Rigbt Subclavian Vein, and tbe junction of tbe Left Jugular Vein and Left Subclavian Vein.

portion which enters the left subclavian vein, being four or five times as wide at its lower end. It then passes through the upper part of the abdomen, piercing the diaphragm and ascends through the thoracic cavity in front of the thoracic vertebra! to the left subclavian vein at the root of the neck. It is thus seen that the thoracic duct carries the lymph and chyle from the lower extremities, the abdomen, the thorax and the left side of the head and neck, and left arm. The right lymphatic duct carries the lymph from the right side of the head and neck and the right arm, and covers a much smaller area of the body. The lymphatic capillaries like the capillary blood vessels, are microscopic in size, with very thin walls, and it is in these vessels that the interchange of fluids and digested material takes place. The lymphatic glands, which normally are about the size of half a split pea, lie in groups, particularly in the axilla, groin, neck, inside the thoracic cavity and abdomen and along the anterior surface of the thoracic spine. They are also scattered about all over the body generally. The lymphatic glands playa very important part in the germ infections of the body. They bar the way to the general blood stream of poisonous germs which enter under the skin. \Ve may take as an example an infected or poisoned finger. If this infection spreads up the arm, the arm becomes swollen and painful and red streaks which are the inflamed

FIRST AID & NURSING , OCTOBER, 1948

LYMPHATIC

GLAND

L~mDhQtlc

vesseLs

lymphatics, can be seen as red lines travelling up the arm to the axilla. Here the lymphatics pass into the lvmphatic glands in the axilla. These glands become sw~llen and te~~er. The lymphatic glands being suppUed with many nulhons of lymphocytes and other germ destroying white corpuscles, the germs are killed and destroyed before they can enter the blood stream. This process of destruction of

the body, and also during adolescence to allow of the growth and development of the body as a ,,,,hole . The 'n rious food substances are digested in the alimentary canal. They are either converted into a soluble form or else separated into such minute particles that they are capable of being transmitted through fine and moist membranous structures. This ha,ing taken place, it i now necessary that the digested materials should enter the blood sy tem. Having entered the blood stream, they can now be conveyed to the various tissues of the body and added to their structures, while the blood at the same time removes from these tissues those materials which are of no further use and which are termed the waste products. The passage of the nutritious substances from the digestiye canal to the blood system constitutes the process called absorption. The proces of dige tion commences in the mouth, and continues throughout the alimentan' canal. The whole of the alimentan' canal is lined with ~ soft mucous membrane which is richly supplied with blood vessels, and as soon as the digestion of a food substance commences, the dissolved portions begin to penetrate the soft mucous membrane and pass through the thin walls of the minute microscopic blood capillaries . This is one way by which nutritious matter enters the blood, and having entered the blood stream, can be carried around to the different organs of the body. This is absOJption bl' the blood vessels. The blood vessels seem to have no choice in the rna terials they absorb. Every kind of food is imbibed by them, provided it is dissolved or reduced to such a finely di,ided state, that it is capable of permeating their walls. It has been purposely pointed out that the capillaries of the blood vessels are microscopic in size and that their walls consist of a single layer of cells, through which minute bodies .an? blood corpuscles can pass in and out of them, on thelr Journey round the body. The other process of absorption is carried on by a special system of vessels called. the lymp.hatic system, and the function performed by this system IS called the Absotptive D'stem.

TWO the poi~onous ge.rms .is called phagocytosis or cell-eating. If the illflammatlOn 1n the gland does not subside, but de,elops a stage further, the gland breaks down and an abscess containing pus is formed. Also, if the germs get through the ~lands without being eaten up or destroyed, then the I?OIsonous germs such as staphylococci and str~pto~ocCl enter .t~e blood stream, causing general blood p01somng, a conditlOn known as septicaemia. As firs~-aiders you may see or be asked to see a child with a pa1I1fui and red swelling in the groin. In such a case be caref~l to examine the foot and toes, also the leg and ?uttock, ill order to be sure that you are not dealing with an mfected .sore on these parts, which is causing the nearest lymph~t1c glands to the infected sore to become swollen and pa1I1f':11, before tr~ating such a case as a rupture. Such a case reqU1r~s.the servlces. of ~ doctor as soon as possible. The same condmon may arIse In the lymphatic glands of the neck, from ~n infected sor.e o~ wound on the scalp which may have arIsen from pedIculi or head lice in the hair or a scratch on th~ scalp when combing the hair. ' The lymphatIC an? digestiv:e systems are closely allied to eac~ o~her. Food IS ta~en In order to repair the waste WhICh IS cont1I1ually takmg place in the various tissues of

Spac es

bgtuJeen. IfltestLnaZ viLl t.-

LacteaLs

LacleaLs

b(ooduesseLs

rmST AID & NURSING, OCTOBER, 1948

The lY~I?hat~c c~pillaries are yery.minute microscopic ,essels, OrIgillatmg In the organs and us ues of nearly eyery pan of the body. Those lymphatics which originate in the .wal~s o~ the intestines diff~r from the other lymphatic capillanes, m that they contaln, during dige'tion, a fluid resembling milk in appearance. Owing to this difference they are called lacteal . (The Latin for milk is Lac). The inner surface of the small inte tine is lined b,- a mucou_ membrane ,,-hich is characterised by a yery g~eat number of minute hair-like projections called inte tinal yilli, which gi'Te the mucous membrane the appearance of ,eh-et of a slightly yello,vish or pinkish colour. Each ,-illus i supplied with a network of blood capillaries and also one or more lacteals . These blood ' Tessels and lacteals are situated adyantageously for absorption by them, a they are surrounded on all sides by digested food subs tances, there being only an extremely thin layer of tissue separating them. Therefore in the ,illi, absOl.ption proceed" rapidly, both by the blood yessels and the lacteal . This is also added to by means of other capillary blood yessels and lacteals, "'hich lie in the intestinal muco us membrane between the

The ab orption of food material as carried on by the lacteals, differ- from that of the blood yessel capillarie , as the former haye the power to select the fatty constituents from the YariO!.L products of dige.::tion, while the latter po" ess no power of election. During fasting, the lacteaL cor:tain a clear transparent fluid, clo<;ely resembling that "'h1Ch fills the other lymphatic capillaries, but durinodigestion, they contain the milky fluid called chYle, th~ change being due to the innumerable particles -of fatty matter absorbed from the intestine- . The chde is collected by lymphatic ,esseL which resemble thin' walled ,-ein_. The\-, like the Yein, , haye ,al\-e. which allow of the passage of fluid" In )ne directi0n only, that is, towards the thoracic duct. \'\ e ha,e now traced the passage of fond materials from the mouth until they finalh- enter the blood sy tem and which are then u:ed- to no~rish and su"t:1in th~ otaa~s of b the body generally.

Nursing Correspolldence Fluid Measures, etc. L. C. (\\'esterham) " 'ri tes : " Can ),011 tell me the practical limits of SlIcb !'agile meaSllreJ aJ "teaspoonful," "tablespoolljitl/' etc.) as the l'ariollS siZeJ ~f thest artides make a considerable difference to the dOJ-al':l' Also) I aJJJ mz'er Sllre about the term " in Tl'ater "-is there (! specific amollnt of il'ater required and should a greater aJJJouJlt be wed, does it in at!)' u'Cf)' impair tbe ~tficienC)' of tbe treatment? A teaspoonful is a dome tic measure that is approximately equiyalent to one drachm, and a tablespoonful to half a fluid ounce. I agree that the sizes of spoons ,ar~-, but everyone kno'ws the allerage size. The more accurate measurement would be by the use of a graduated medicine measure, but these are by no means in,ariably present in a home and many people would be ,'ague if the medicine were ordered in drachms or fluid ounces. \\' ith regard to the term" in water," it i left to the di.cretion of the patient-or nur e-to decide the amount. This can usually b= relied upon, although I am reminded of an Irishman who got into a bath three times a day and took the prescribed dose! It is u ual to fill up the medicine glass '\.,-ith water, following this with another drink if desired. The purpose of the water is to make the medicine easier to take, and it in no way impairs its efficiency, any more than would a cup of tea or a fruit drink taken shortly afterwards. ome medicines, such as cough syrups, should be sipped very lowly in an undiluted form in order to get the maximum effect, but the patient is ne,'er instructed to ta ke these " in water."

T. C. (Folkes tone) "vrites :I alll writing to ask if),011 can clear tip (/ doubt in JJl)' milld l'egardil1g l lentilotioll of (/ Jick room . . Halling been loid 10 keep it lJ'e/1 l'eJlti/aled) I hal'f I~rt lJ'IlIdoJl'J' or fanlight open tJlj!,bt alld dtlJ,) bllt fiNd that }J'hell the }}'iild b/oJJ'J (C

/T'

yilli, and also in the corre. ponding mUCOLl membrane of the large inte tlne, which has no ,i111.

Readers are iJll'ited to selld their ~TtlJ'si;7g Problellls for SOllltioil. Correspol7dence sbollid be brief and to the poil7t al7d addressed to the Editor (e First Aid 6"" ~Tlfrsi17g, )' 32 FiJubf{~J Sqlfare, LOJldoil, E.C.2.

V entilat ing the Sick R oom

blood. ve5seLs

from certain Qf(l1l'ferJ the draught is e_yaPtjot/aI6' strong and tbe ;'ain also bloll'J- iI/to the room. lTnder such cOl/di/i(ilj,i ll'offid lem'ing the door ;l'ide opeN be cOJlS:dend adequate I'entilation )},itb JJ'illdo}}'J closed." Ventilation from the door of the room mer~h' letS in the stale air frnm the re, t ot the hou, e. 1£ the roOln lla' a . a.h window the lower sash might be rai 'ed for six to nine inches and a board fitted across the opening. An overlapping thus occurs at the junccio_'l of the top and bottom ashes, allowing a current ot air to enter between them in an upward direction, thus a,-oiding a draught. 'rbi ' is most effecri,-e when a good fire is burning, for a large amount of air is escapi~g u? tho: chimney ~nd, therefo~e, air must come into the room to replace it. El:en when the ,,-eather i too "Tarm for a fire the wind blowing across the top of the chimne~- will aspirate a good deal ~f air, so that it is important to see that the chimne~' i' not blocked.

A Water Softener Problem B. L. (BrightOn) writes : " I ban recentlj' adJ'iHd a JJJ()tber who has (l maillS Jl'ater softener not to JUe tbij' 7J'ater for ber bal!)"s dri,,/u. Call ),ot! etldorse this l'im' alld also let me klloJ1' !l'hether tbe addi, iOIl ol lime u'OIr/d rect{b' the /OSJ- of J-alts. If so) }}'/.!at qualltit)' ,fhollid be !(Jed ?" \,\ cater becomes ha.rd because it ab.orbs the soluble compounds of lime (calcium) '\-h~lst it_ is flowing_ unde:around or on a river bed. The actlOn ot a ,,-ater ,ohener 1S ro chan ae the 'oluble lime into an insoluble compound, \'Thich then form. a "ediment. Therefore, to first remo,'c lime and then add it ,vould not be a logical process. Howeyer, very hard water mar tend to produce constipation, but if this water is boiled ,omc of the lIme salts are remoycd, formino- the fur thu collecL on the in,'ide of the kettle, and th~ water would then be sufficientl~- softened. Lime . alts are necessary for the hardening of bone, so that it is inadvisable to soften water unduly for infant" f~cds.

FIRST AID & NURSING, OCTOBER, 1948

News From All Quarters when, after what at one period seemed Vice-President W . L. Clatke, M .B.E., THE ST. JOHN AMBULANCE aDivision hopeless quest, their perseverence was thanked the Mayot for the opening of the rewarded by hearing the Comm issioner for hut, and also for the support and encourageBRIGADE. the London District cono:ratulate them, in ment she had always so readily given the Surgeons' Con ference and Din ner As we have already briefly announced, the week-end Conference and Dinner of the Surgeons of The St. John Ambulance Brigade will be held at the Royal Hotel, Woburn Place, London, W.C1, on Saturday and Sunday, 30th and 31st October. Principal features of the programme will be : SATURDAY (2 p.m.) Address of welcome by the Chief Commissioner, Lieut.-General Sir H . R. Pownall, K.CB., K.B.E., D.S.O., M.e. Address by the Surgeon-in-Chief. CIVIL DEFENCE and the implications of Atomic Warfare, by Sir Ernest Rock Carling, F.R.CS., F.R.CP., F.F.R. 6.30 p.m. Reception in the Dining-room by the Surgeon-in-Chief. 7.00 p.m. DINNER. Principal Guest, the Lord Webb-Johnson, K.CV.O., etc., Hosp italler of the Hospital of the Order of St. John. SUNDAY (10 a.m.) TRAINING :METHOOS. USE OF FILMS for training, by Dickson Wright, Esq., M.S., F.R.CS., Deputy Chairman of B.M.A. Committee on Films. 1.00 p.m. LUNCH . 2.I5 p.m. ARTIFICIAL RESPIRAT WN, by Dr. F. C Eve, M.D., F.R.CP., Hull Royal Infirmary. With demonstration of" rocking" stretcher. 0 3.3 p.m. Conference of District and County Surgeons. Prince of Wales's District BROMLEY DIVISIONS COMBINED RECRUITING WEEK The week 6th to 1Ith September was one of intense activity for members of the Bromley Divisions, including the Cadets, and the results may be judged from the fact that over twenty applications have been received for membership to the Brigade. The events of the week included a series of three public demonstrations, the showing of slides at the local cinemas, a write-up in the local Press, the distribution of 4,000 bookmarkers and 1,500 handbills, and, as a grand finale, " A Grand Dance." At the last demonstration a surprise item was the presentation to the No. 21 Ambulance Div ision of their 50 -year Jubilee Certificate by District Officer Hallock and a Divisional President's badge to Miss Scorer (Nursing Cadets) by Area Cadet Officer White. The Demonstration programme included items by all four Divisions. While the teams were working a narrator explained to the public exactly what was going on. It is hoped to make an annual feature of the week and work will shon~y be started on next year's campaign by the Public Relations Committee. WANDS WORTH A ND SOUTHFIELDS Saturday, September 18th, was a memorable day for the 98th Wandsworth and Southfields

the presence of ~ large ~nd d istingu ished Division. He also extended a cordial welcome company, "upon their tremendous enthusiasm to the Rev. Kenneth Howell and expressed and energy in turning a tent into a hut." The the hope that he would spend many happy occasion was the opening ceremony by the years in the parish of Wandswonh of which Mayor of Wandsworth of the First Aid Hut he had so recently become the Vicar. NIr. erected entirely by the members of the Division Clarke in stating thal the building of the hut on a Wimbledon Common site near Tibbets had been done by entirely voluntary labour, Comer. acknowledged the assistance g iven by Colonel A guard of honour, augmented by the 88th Lambert, the Chief Ranget of the Conservators Nursing Division, was inspected by the of Wimbledon Common, and to Miss H. M. Commissioner of the London District (Major Benham, J\..R.I.B.A, who came to their A. e. White Knox, O.B.E., M.C) accompanied rescue and ironed out many difficulties. by the Mayor and the Vicar of Wandsworth. County of Berksh ire During the inspection Supt. Brown very St. J ohn Nursin g Conference happily presented those members of the A Reg ional Nursing Conference of the St. Division who had been particularly active in the building of the hut, the party then J o hn Ambulance Brigade was held at the proceeded to the platform when the Commis- Great Western Hotel, Reading, on Saturday, sioner stated that in 1947 over 37,000 cases October 2nd, and was attended by 170 Nursing were taken care of in the London area alone. Officers from Berkshire, Buckinghamshire, These had been dealt with by personnel D orset, Hants and Oxfordshire. The President numbering 135,000 and by taking an average of the Conference was Mr. e. A. Poole, the of 3 or 4 hours, as being the extent of their St. J ohn County Commissioner for Berkshire, duty, meant that those good people had and the Chairman, the Hon. 1\[rs. Lesli~ carried out half a million hours of duty. Gamage, County Superintendent for BerkAnything that can be done to help in the shire. The morning session was devoted to organicomfort and facilities for the work of the members of the St. John Ambulance was a sation matters and the speakers were .Mrs. Girouard, the Assistant Superintendent-invery worthy object. Chief, Nursing Corps and Di visions, and Miss He stated the hut had cost £300 and already Harrison, M.B.E., Chief Staff Officer, St. John had dealt with 64 cases. The Rev. Kenneth Howell, Vicar of \~ands Nursing Divis ions, at Headquarters. In the afternoon there were interesting worth who conducted the Serv ice of Dedication likened the work of the members of addresses by Miss G. Ceris J ones, Matron of Westminster Hospital, speaking on "St. St. John Ambulance to the Good Samaritan. J ohn Help in Hospitals," and by Dr. E. J. It was in this spirit that the St. John Gordon Wallace, M.B., Ch.B., of the Health. Ambulance Brigade carried on theit Christ- Centre, Weymouth, and Area Medical Officer [ike work in caring for the injured and of Health, Dorset, who spoke on " The Brigade alleviating suffering, it was for no personal and National Health Service." gain they did this work, they sought only to St. John Ambulance Brigade in Berkshire is serve for the good of others. "In this sin- very active. It has NO.1 Berkshire Air Unit, stained, war-scarred world with its selfishness, the first unit of its kind in the Brigade, the suspicion and hate," he said, " it stands out nurses of which accompany invalids who go as a symbol of goodwill-as a banner for by air, and on December 16th, 17th and 18th, Christ and His Kin£,dom." at the T own Hall at Reading, there will be a An impressive service of dedication ended Christmas Fair at which there will be the St. with the singing of" Fight the Good Fight" John Exhibition of illuminated models, most and the Lord's Prayer. of which were on view at St. James's Palace The Commissioner called upon Supt. Brown earlier this year. to present the key of the hut to the Mayor READING who, amid loud cheers, unlocked the door and The Ambulance and Nursing Cadet (Junior declared the hut open, and after an inspection Section) County Competitions were held the party returned to the platform when the recently at Oxford Road Schools, Reading. Mayor said that the building of the hut The Ambulance Cadet winners were the te~m carried on the unbroken tradition of the work from Wokingham Ambulance Cadet Division of St. John and this in itself was of momen- captained by Cadet Cpl. D. Pither with 266 tous importance to-day. She warmly con- marks out of 400, the runners-up being the gratulated the Division on its wondelful team from Reading Great Western Ambulance achievement in overcoming all the difficulties Cadet Division with 259 marks . The Nursing which attended any sort of building in these Cadet winners were the team from Reading days, and in erecting the hut which was to be South Nursing Cadet Division captained by put to such noble purpose. Cadet Beryl Pummell with 149 marks out of In wishing the members of the 98th Division J 80, the runners-up being the team from every success, she stated how pleased she Finchamps tead Nursing Cadet Division with was to see that the 88th Nursing Division 117 marks. The winning teams will represent there, and to learn that they, too, were to be Berkshire at the Regi onal Cadet Competitions assoc iated with the splend id serv ice th is to be held at Weym outh in October. As there First Aid Station offered. were no entries in the Senior Section, a team

FmST AID & NURSING, OCTOBER, 1948 from Read ing Great Western Ambulance matches, gymkhanas, sports meetings, conCadet D ivision captained by Cadet Sergt . J. certs and many other events . The total membership of the Corps, AmbuWise will represent Berkshire (Senior Section) lance, Nursing and Cadets on 31st December at the Regional C,9mpetitions . last was 207 . County of Buck inghamshire NO.3 Ambulance D ivision was disbanded on loth May, but some members of this WOLVERTON DIVISIO N Division transferred to No. 1 Ambulance It is with regret that we report the death of Division. Mr. S. A. Webber. He joined the Wolverton FIGURES Division in 1921 , was made a Serving. B.rC?ther For accidents, 371 ; transport, 3,535 ; total, of the Order of St. John in 1940, and Dl ~ lsIO~a l 3,906. Tota[ mileage nearly 36,000. Superintendent in 1941. He had to reltnqulsh Public Dulies :this position owing to ill health. Ambulance Divisions 196 1,487 hours 6II 2,654 Nursing Divisions Cadet Divisions 23 273t "

September 18th, a competltlon which is becoming one of the most popular in the north-west. Twenty-nine teams from various parts of Lancashire and Yorkshire entered. Ten teams competed for the" Wilby Shield," the judge being Dr. C B. Ball, M.B.E. Liverpool Exchange Division were the winners, Nuneaton British Railways, 2nd, and Warrington HQ. Di vision, 3rd. Ten teams also competed [or the Dr. Woods Challenge Cup, Dr. R. N. K irk being the judge. The winners were CrosfieJd's Works, Warrington, Fleetwood Ambulance Diyision, 2nd, and Liverpool Exchange B Team, 3rd. The third test was for the Nursing Divisions. Nine teams competed for the \VI iJby Rose Total Bowl, the judge being Dr. Hughes. Horwich Loco. Works were 1st, Didsbury B.R.CS., 2nd, and Manchester L.:\1.S., 3rd. County of Warwi cksh ire O ver a hundred men and forty women took THE HOSPITAL SERVICES DIVISIO part in the Open Indiyidual Test. ~'i nners COVENTRY (CENTRAL) CORPS were: Women-Mary Farrell, Bury. MenAt 2 a.m. on the 18th August a collision ]. A . Ball, uneaton. The best local member occurred between a lorry and motor-coach was Aubrey Blacker. on the outskirts of Coventry, resulting in ST. ANDREW'S AMBULANCE eighteen persons being injur.ed, many of them CORPS seriously. News of the aCCident came to the Throughout the year, members of the Corps notice of Ambulance Officer Truslove of the in Edinburgh, do first aid duties at seyeral Hospital Services Division ~it.hin a few theatres, cinemas, speedway, racing, football minutes of its occurrence. ReahzlOg that the matches, and during the summer r~~nths at number of casualties would cause a heavy Portobello Beach. At the time of wntll1g, the strain on the staff of the accident department International Musical Festiyal is on, and this at the hospital, he immediat~ly made . an offer added attraction has been the means of drawing of assistance to the hOSpItal, whIch was many more visitors to the city. The Festi"al accepted. has meant much extra duty for members. In a few minutes Ambulance Officer Mr. McWatt Green, who is the St. Truslove contacted several members of his Andrew's Ambulance Association Secretary Division, some of whom had had casualty in Edinburgh, organised the duries o.f the THE LATE SUPT. S. A. WEBBER ward experience, and they were despatched first aid sections and it must have entalled a to the hospital arriving soon after the first Superintendent Webber will be remember~d victims of the accident. They were kept very great deal of planning to cover. the duties by his many Ambulance friends as the Capt~l1n busy during the night, two, Ambu~a~ce successfully. This ",,'as made pOSSibLe by the of Wolverton "A" Ambulance Team. Du~mg Officer Brown and Pte. P. Gilbert, remalOmg co-operation of the yarious sections and his many years of leadership the ~eam gamed until 8 a.m ., and earned the deep gratitude of members of the Ambulance Corps. The members attended both indoor and outdoor many successes, amongst .,,:hlch were: the patients, who in some way or other had performances, including Symphony C~ncerts, L.M.S. Railway Final CompetJtlon (1932. ~d found out that they had volunteered theu Opera, Sadler's \'(:'ells Ballet, prar.n~tlC Art, 193 8)' L.M.S. International CompetitIOn help. . Huddersfield Male Voice Cholr, Plplllg, and (193 8 )'; The" Dewar Shield" and " Tr~mble On completion of their work, they were Highland Dancing, and the Highland Ga.mes, Trophy" (I935. and I937). At .the Bngade also thanked by Dr. Lancaster, Casualty Officer, which were held at Murrayfield InternatlOnal Jubilee CelebratIOns In 1937, t~l~ team ~as of the hospital. Rugby Ground. Many casualties were very successful in winning the Bntlsh Empue grateful for first aid assi~tanc~. and they West Riding of Yorksh ire Competition. included people of other nat1on~l!tles. The members of the team acted as bearers BRIGHO USE . Verily a labour of loye, first ald worker~ all The Annual Inspection of the Bnghouse at the funeral which too k place at Maldenover the country are doing a grand l?b. Corps was held on Tuesday, September 7th. Their reward is the satisfaction they receive combe, near Torquay. About forty mem~e.rs of th~ Senio~ Arr:b~~ance that the time spent on training and the County of Somerset and N u rsing Divls10ns, With thel! DIVISionaL knowledge gained is being put to such good and Corps O fficers, an.d abo~t sixty Am?ulance BATH CITY DIVISION use. When on 25th August a party of French and Nursing Cadets lUcludmg the Bughouse BRITISH RAIL WA YS Corps Band and their Officers, were present children belonging to the employ~es of the Western Region . ' Societe de Chemins de Fer Franca~s (French oo~ra~. 11'. F. A. Drinkwater, Chief Mechanical They were inspected by ASSIstant C0rI?-rr: 1SN.U.R.) visited Bath under the auspIces o~ the County Superintendent, they were entertall?-ed sioner H. Harrison (S.W. Area) West RldlOg Engineer's Department, Swindon, has been at the Pump Room, Bath, by Bath Nurs mg of Yorkshire, accompanied by Mrs. Balden appointed Divisi.on~ AII.Jbulance S~cretary for the Swindon DIVISIOn m succeSSIOn to Mr. Divisional Supt. Miss Appleby and other (Area Cadet O fficer). After the tour of inspection, Mrs. Bal?en R. N. Patton, who has resigned from the post. local members. The Mayor of Bath welcomed . the visitors at the Pump Room, who were addressed the Nursing Division. She pra1sed SHREWSBURY Mr. . J. Cooper presided at a dinner held conducted round the Roman Baths by the the smartness of those on parade, and app~aled for more members. Assistant CommISSioner at the Old Post Office Hotel, Shr~wsbury, Spa Director. H . Harrison then addressed the whole .parad.e. when the lon a service awards gallled by He told them that when he was a p!lvate m members of the Shrc,vsbury and Here~ord W est Surrey the ran ks Brighouse was looked up to as classes were distributed by Mr. . H. Bnant, GUILD FORD the home 'of first aid and hoped that ere long Div isional Traffic Superintendent. Mr. J. F. The Annual Report of the Borough of this would be true again. H.e wanted the Anstey, District Goods Manag~r ; Mr. V). H. Guildford Corps states that the pas~ year ~as members to increase, so tha~ ~!lghouse would Webb, Divisional Locomotive SUf?e~u:ten been one of much activity and an mcreasmg be the pride of the West Rldmg. dent; Mr. J. A. Denney, D~\'ls~onal Engineer; Mr. J. H. Swann, DlvlSlOnal number of calls have been made on Ambulance, RTH . .. Nursing and Cadet Divisions for attendance.at SADDLEWO M bers of the Saddleworth D1VISlon held Ambulance Secretary; and Dr. F. H. Edwards public functions. These have includded ~~~es theire~ixth annual competition on Saturday, were present. at the Lido, cinemas, football an CrIC et

FIRST AID & NURSING, OCTOBER, 1948

FIRST AID & NURSING , OCTOBER, 1948

THE CARE OF THE CHRONIC INVALID IN THE HOME BY

AGNES E. PAVEY, S.R.N. Diploma in Nursing

Bland yet poten t iodin e

(Uni versity of London) Chronic Diseases of the Central Nervous System TWO of these diseases - multiple or disseminated scleros is and progressive muscular dystrophy-~re, llnfortunately, diseases of the young; the former occurrIng between the ages of 15 and 35, whilst t~e .ratter usu~lly commences in childhood, although the vlCtlms often INe ll11til middle age.

THE SPEECH.-This becomes slow and deliberate, the patient placing an equal stress upon ea~h syllabl~, w~ch o-ives a curious staccato effect, but even 1f the patlent hves for ten years or more after the onset of the disease the power of speech is not entirely lost. . . In the later stages of the disease the patlent becomes helpless, bedridden and incontinent. This may demand months, and sometimes years, of difficult and untiring nursing. Bedsores are very apt to occur and so also are skin rashes. InBammation of the bladder (cystitis), exhaustion or some intercurrent infection such as a common cold or bronchitis, may terminate life.

Multiple Sclerosis The cause of this disease is still unknown and no cures have been recorded. It is a condition in which scattered areas in the brain and spinal cord degenerate and then become replaced by a kind of scar tissue-hence the term " disseminated sclerosis," sclerosis indicating an abnormal Genera l a nd Nursing T reatment Although a survey of the progressive nature this conhardening of tissue. It is this alteration of structure that makes the disease incurable, although for some unaccount- dition appears most depressing, with understanding and able reason most patients undergo periods of striking but care the patient may have some years of effective and even temporary improvement. These remissions make it difficult enjoyable life. His own optimism is of great help and it to assess the value of any treatment given, for they may occur must be encouraged. Any form of treatment, if given with even in the absence of treatment. confidence, is likely to be followed by improvement, and this improvement may be increased by the natural remisOnset and Course of the Disease sions which the disease undergoes, and during which the The early symptoms are vague, but sooner or later patient may even be able to return to work for a time. typical changes can be noted in the muscles, the eyes and He must, however, avoid becoming overtired. He may the speech and these become more marked as the disease develop an aptitude for a new job. Even if one arm advances. becomes completely disabled the other may have good THE MUSCLES.-At first the patient may be conscious movement and control. For example, a telephonist of 26 of weakness in the leg muscles, he feels that his body is years of age continued to control a switchboard for some " off-balance" and he has a tendency to stumble, so that years after the left arm became practically useless as a he needs a stick for walking. Remembering that the result of muscle changes in this disease. disease seldom occurs after the age of 35, this need of Special talents may be discovered and developed. These support in walking is significant. The muscles do not patients are often artistic and have a good sense of colour. waste and pain is . seldom present. Later, the gait may They may be encouraged to draw or to paint. Pastel become a sort of tottering run in which various articles are work is suitable, for this needs less finger control than does grasped for support until the destination is reached. the holding of a pencil or brush. As long as the eyes These patients retain an urge to try to walk long after their remain unaffected these activities may provide an interesting power to do so is lost. They often make attempts sur- and often a remunerative occupation. reptitiously and so may receive some very hard falls, but Those who smoke may eventually need to have a they seldom break bones. The muscles become stiff as cigarette placed between their lips and lighted for them, well as weak, and this makes it extremely difficult to lift up the ash tray being held when necessary. Pipe smokers a patient who has fallen, for he or she is a dead weight and may require help in filling and packing down their pipes, is unable to assist. However, falls do not daunt such which may need lighting and relighting before the smoke patients. They are terribly anxious to walk and they usually is finished. The general health must be maintained by good believe very firmly that they will eventually succeed and food, fresh air and moderate exercise. Every kind of that they will get well again. Another muscular difficulty encouragement and help should be given to maintain that the . patient experiences is what is known as an muscle power for as long as is possible. The patient should " intention tremor," especially in the hands. When at rest never remain in bed even for a day, for Bexion contractures the muscles are quite still, but when a deliberate attempt is may develop quickly and prevent him from ever walking made, to pick up an object or to lift a cup or glass to the again. Regular walks should be taken, even if these are lips, a shaking movement commences which becomes slow and tedious for the perso n jn charge. The patient worse as the patient tries to control it. Eventually this should be warned not to try to walk when he is alone makes it impossible for him to dress or feed himself. because of the danger of falls. \Vhen walking becomes THE EYEs.-When the patient attempts to fix his gaze impossible the patient should get up in a wheel chair, upon an object to one side of him an oscillating movement and he may need helping into this . While in bed a cradle of the eyeballs may be seen. This becomes more marked as should be used to take the weight of the bedclothes off disease progresses and, in addition, double vision may occur. the limbs, and movements should be practised. E specially

Although highly active, ( Iodex' is entirely bland even on open wounds. It penetrates to the deeper tissues and does n ot harden, crack or stain the skin. Chilblains~ b ruises, painful muscles, and swollen joints qu ickly yield to its soothing and resolvent properties.

Bandages , if employed, shoulr;i be light and loose, NOT tight or air-excluding.

, 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 patient.

• IODEX ~ Iodine Ointment

MENLEY & JAMES L I M I T E D , 123 COL D H ARB 0 U R LAN E , S. E . 5 XN12

MATHAPLAS

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wJj

WM ., MAT HER

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'0 the le.d,"g . daoly

papers are building strong goodwll! for these new Mathaplast dreSSings . Specially prepared by t~e maker.s of Mathaplast Fabric ElastiC DreSSings, they fill a definite demand fo: a w~hable dressing which is proof against 011 ~nd grease whi!st fitting snugly and toning with the skin.

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FIRST AID & NURSING, OCTOBER, 1948

should the legs be stretched out and the feet be pushed against the bottom of the bed. Regular passive movements should be given by the nurse several times a day. If, in spite of every care, contractu res are threatening, splints may be applied behind the knees. One of the few things that cause pEin in this disease is " flexion spasm" of the muscles, and this is often troublesome in the later stages. Massage mar help in warding off contractures and spasm. ~'hen the patient becomes unable to move of his own volition two people will be required to give the necessary nursing care. The arms, legs and body must be moved regularly although it often requires considerable strength to overcome the stiffness of the muscles. \V'hen turned on to the side for washing, changing of sheets or routine care of pressure points, the patient must be held, for he cannot maintain his own position and may easily fall out

of bed. Constipation may be present. For this, a glycerine suppository or a simple enema is usually better than an aperient, and the resulting action is more easily prevented from soiling the bed. In incontinent patients a urinal may be placed in position. A special type is procurable for women patients, and, as patients who have reached a stage of incontinence with this disease are usually unable to move without help, it is often possible to keep the bed dry by this means. When swallowing becomes difficult, soft, easily masticated foods should be given, although the patient may be very slow in taking his food he must not be hurried or choking may ensue, or food may be aspirated into the lungs, causing pneumonia.

Topical Notes for First Aiders & Nurses Diphtheria Inununization In vieu- of the new extensive drive, organised by the London County Council, to increase the degree of protection against diphtheria among the children of London, it is interesting to recall the history of diphtheria immunization. Until the early years of this century diphtheria was probably the most killing of the infectious diseases, the death rate in the extensive epidemics that occurred being over 50 per cent. With the production of antitoxic sera and its prompt administration directly diphtheria was diagnosed, or even suspected, the death rate fell to 2 per cent. of the cases thus treated. Then arose the question of preventing the occurrence of the disease by making the child develop his own immunity to the infection. The first steps in this procedure were taken in 1913, but it took another 25 years before immunizarion could be made available to all children in this country. The incidence of diphtheria was found to be greatest between the ages of three and five years, so that the protection of the pre-school child was seen to be of paramount importance. The free immunization campaign launched by the .Minister of Health !n Ig,j.I has showed the most striking results 111 London, for cases of diphtheria dropped from r844 in 1940 to 936 in r947, and the number of deaths from 67 to 22. Seventy-five per c:ent. of Londo~'s chi~dren under the age o.f th.uteen are now ImmunIzed, but the present aim I~ to reach roo per cent., for it is believed that If all children were immunized a completely p~otected population would grow up and th~dlse~se would die out in time, diphtheria becom~g,. ill the future, a condition of purely acadcml~ illterest. Apart from the saving of younlS' lIves and. of several million pounds in hospItal expenditure annually, it is estimated that immunization now frees 2,500 nurses in England and Wales for other work. The new campaign is intended to supplement the personal persuasions of medical officers health visitors and the staffs of welfare centres' and the weapons to be used are posters: leaflets, newspaper advertisements and cinema slides; but the -l.rive in London is only a part of a national-wide campaign. National Health Questions in Parliament During the recent short session of Parliament the Minister of Health was asked many

questions relating to the operation of the new Health Service. Some of his answers were somewhat evasive, but others gave a definite ruling regarding the questions that the public are asking, and cleared up some misapprehensions. For example, when asked why persons entitled to free spectacle lenses were not permitted to have these lenses fitted into their own frames, he answered that they were permitted to do so. He also stated that dental benefit was free to everyone, whether insured or not. In answer to a question about the promised Health Centres, Mr. Bevan replied that twenty-six dispensaries from which medical and dental services were provided previous to July 5th were still operating as health centres. The building of aile new centre, on a developing housing estate in London, had had his approval and other proposals were under consideration. Another Member asked why, seeing that Section 28 (r) of the National Health Service Act (194 6) empowered local authorities to make arrangements for the purpose of the prevention of illness and that chiropody was essentially a preventive service, he was discouraging local authorities from establishing or opening foot clinics. He replied that he had told local authorities that if experience shows the need they might put proposals before him but that he. did not w~t t~ plunge into ~ general chltopody servIce wIthout more advice. One wonders how experience can show a need before proposals to give a chirpody service have even been placed before the Minister. Belladonna Poisoning in Children Most parents have read with interest and in some cases, alarm, the accounts in th~ Press of five children in the Portsmouth area who had picked and eaten belladonna berries in mistake for blackberries, in a public park. It was found, on investigation, that a belladonna plant was intermingled with a blackberry bush. This is by no means uncommon in a country lane. All first-aiders will be aware that the symptoms of belladonna poisoning come on some hours after the berries have bc~n eaten, and that they include hot, flushed Skill, dry mouth, restlessness delirium dilated pupils and vomiting. i£ vomiting occurs early, the later symptoms are less severe ~or some of the poison is eliminated before It can be absorbed. The children in

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(to be continued.) question returned home about 5.30 p.m. One of them vomited about an hour or so later, but it u'as not until about 9 p.m. that symptoms of delirium came on in the other children. All of them were admitted to hospital for treatment and, fortunately, made a good recovery. A reminder that permanganate of potash, 4 to 5 crystals to a pint of water, is an antidote-emetic in belladonna poisoning may not be amiss, but it needs to be giYen \"hile the berries are still in the stomach if it is to be really effective. It is often followed by a dose of Epsom Salts to help in the eyacuation of poison from the intestines. The Minority Report The Minority Report of the Working Party on Nurse Training, published one year after t?e much discussed Majority Report, has one sIgnature only, that of Dr. John Cohen, who felt unable to sign the Report drawn up by the other three members of the W/orking Party. He felt that the problems of nursing had not been sufficiently related to the general problems of man-a.nd women-power and the needs of the country, and he thinks that until we have a comprehensively planned health scheme in operation for the whole of the country we cannot truly assess our nursing needs. -r:'hat, of course, involves a velY long term polIcy and the need for mote nurses is a very urgent one. The Report provides much food for thought and most of it is highly constructive, stressing the fact that the function of the nurse is to reduce the incidence and the duration of sickness. It is a pity that all the limelight of the daily Press should have been focussed on Appendi.-x III, in which is published the complaints of some ex-students but this is the most easily quotable sectio~ of the Report. Surely, no one is so ill-informed about present-day conditions in hospitals that he or she reallY believes that petty tyranny and outworn discipline are significant causes of the mu.ch discussed nurse-ShOI1:age. However, the eVIdence shows that they have been in s,?me cases, sufficiently important to lead a gul to change her plans for her life and to abandon her intention to train as a nurse. The same charge can be brought against individuals in authority in every other sphere of work or training, and it is regrettable that so much stress has been laid upon such causes of nurse-shortage when the other side of the picture--the happy surroundings, the satisfy109 work and the good co-operation and unde~standing that is usually found among hospital staffs at the present time-is ignored.

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FIRST AID & NURSING, OCTOBER, 1848

FIRST AID & NURSING, OCTOBER, 1948 WARWICK &

Queries and Answers to Correspondents

TUNSTALL'S

hFIRST AID" TO THE INJURED & SICK. Edited by NORMAN HAMMER, M.R.C.S.,

I.-Ail Queries must be accompanied fry a "Query Coupon" Postural Haemorrhage" -lvhich figures in the ne1V S.J.A .A. cut from the current issue of the Journal) or) in case oj Oueries examination sheets. Meamvhile) please accept tlry best from abroad) from a recent issue. thanks. This question has caused considerable discussion and 2.-The Textbook to which reference mcry be made in this column is the 39 th (I937) Edition of the S.J.A.A. Manual of First ';;rill disappear from the examination sheets when these are Aid to the Injured. reprinted. The original idea was that in his reply the candidate should describe the effects of pcsture-standing, OUR THANKS TO THE DOCTOR sitting Or recumbent- on the bleeding from which the Once again it is our pleasant duty to tender \.\'armest patient was supposed to be suffering.-N.C.F. thanks to Dr. N. Corbet Fletcher, O.B.E., for his valued services as our Honorary Medical Correspondent. Artificial Respiration and Pregnancy " Queries and Answers to Correspondents" is probably W'. H . (Forest Gate).-At Divisional Practice recentlY the the most popular feature in the journal. Certainly the question arose as to the method of artificial respiration to authoritative advice contained therein, combined with the be used lvith a female patient in an advanced .rtate ojpregnancy. spice of common sense and kindly good humour, and the The questioner had in mind the danger of causing internal helpful counsel provided in solving the most puzzling iJ?jury ~y pressure on abdolllinal muscles ry use of Schafer'S problems, are greatly appreciated by our readers. method. The well-known initials" .CF." have been appended I quoted page I49 oj Textbook, paragraph 1. "This to the answers to queries in this section for thirty-three lJlethod is to be used onlY 7vhen it is impossible to fum patient years and a wealth of information and advice has been on to her face ." Your rulillg .will be much appreciated as made available to correspondents from all quarters. your altSJvers have been very helpful in sett/ing previous Readers will be interested to learn that the Doctor recently discussions. completed forty years in the Ambulance Service, having Of course you are right. In all cases of advanced pregstarted in I908 with the old L. .\X'. Railway Centre. nancy when it is impossible to tum patient face downwards, This is a fine record, on which we offer our sincere Y0J-l should select Silvester's method, if the need for congratulations. artificial respiration should arise..CF. Our readers, we feel sure, will juin us in expressing Resuscitation heartiest thanks to Dr. Corbet Fletcher for the grand work which he has done in helping and advising those of us who S. C (\V'arrington) .- I recentlY attended a lecture 011 " Resuscitation/' and was faulted ry the lecturer for incorrect have problems to lay before him. That he may long continue timing when demonstrating Schafer'S method of artificial to spread enlightenment is the sincere w.ish of all of us [_ respiration . He declared that pressure should be maintained Editor. for one sefond only) 7vith the oiject of starting the breathing Laying-Out Dressing fry a " gasping" motion. F. L. (Dartford) . -r~dh reference to the quCly 2vhich zv",_~ I pointed out that the Textbook reads) "T2vo seconds published under the above heading in tjJe September isstle of _pressure) three seconds relaxation." In reply to this the FIRST AID AND NURSI G, I think thal the ans/ver to the lecturer declared he was not a St. John man, and that I tvas quely is to be found on page 23 of the Supplel11ent to Textbook. probablY referring to Silvester method. There 1ve are told under Treatment of Wounds to " Spread He also declared that the diaphragm is a " dome" shaped out a clean handkerchief, triangular bandage or to)vel and muscle and agreed, lvhett a member of the class likened it to on il place ~II necessary eqUlp11lent." Fttrther) I suspect the upper half of an inverted light globe. that the qu~sttOn should reallY be " Lcrying-Out of Dressings" ; He also stated that Silvester's method should never be and I belzeve that the question figures lhus in lhe n82V used on a patienl ,vho has fractured ribs. S.J.A .A. examination sheets. As I am beginning to suspect thal my time would be As I ~rote in my previous reply, I could only guess at better spent on the Textbook) I 7vould be grateful for your the solutlO~ of the query. In any case, the question is not ruling on these points. as clear as lt should be and I concede that your guess is as You are quite correct in suggesting that time spent in good as mine.-N. CORBET FLETCHER. reading the Textbook is most profitable. It is also correct (I) that the diaphragm is dome shaped (or as the Textbook Examination Howler on page I43 puts it, "a large arched muscular partition .M. R. (Cannon Street).-In a recent examination one candidate which separates the chest from the abdomen"); and /~~s asked h01V he .7vould classify fractures according to the (2) that the Silvester method should not be used in cases of znPl1y of the bone ttselj. He caused considerable amusement fractured ribs. As to the timing of the movements of lvhen promptly and confidently he replied-" Green stalk) artificial respiration, it should be realised that both with compacted and communicated 1" Schafer and Silvester, pressure occupies two seconds and Good 1 Next please 1 1- .CF. relaxation. three seconds. The pressure period is necessary because tlme must be allowed for the compressed air to Treatment of Postural Hremorrhage leave the lungs, a result which could not be obtained in a F. L. (Dartf?rd-.--:Now in my tUnt I 2})ould like to ask you pressure period of one second. Finally, for crive me for to explam what tS meant ry the question-" Treatment of correcting your mis-spelling of "Silvester."~N .C.F.

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S\te\Cb&t5,

The Cadet National Competitions THE r~cent St. Joh.n. Cadet National. First Ai~ and Home NurSing Competitions (some details of which we give on another page) were notable for several reasons. In the first place the event was honoured by the gracious presence of H.R.H. Princess Margaret, and what made the occasion all the more distinguished was the fact Princess Margaret was paying her first visit to the Cadets as their Commandant-in-Chief. Princess Margaret was in fact wearing St. John uniform for the first time, and what more fitting opportunity than this great gathering of boys and girls representing the coming generation of the St. Joh n Brigade. It was the second National First Aid and Nursing Competition, and twenty-one ambulance teams and the same number of nursing teams competed with that zeal and enthusiasm which one has come to expect among Cadets. They were of course finalists of eliminating contests which had been going on allover the country, and the youngsters who demonstrated their skill at that time, and who received their awards from their Royal Commandant, were the cream of the Cadet teams. But they represented every boy and girl in the Cadet movement, and one was glad to see the honour conferred on a very vital and important section of the ambulance organisation. These ambulance and nursing Cadets will one day be taking their places in the adult diVisions, and

on their training now, no less than on those who t rai n them, will depend the skill and efficiency of the ad ult divisions in the days to come. The Cadet moveme nt of the St. John Brigade was founded in 1922. Ages range from 11 years to 17, and Student Divis ions are ope n t o entrants from 16 years up to the date of their 21st bi rthday. Both boys and girls must take a course of first aid and gain a certificate before they can be enrolled , and the girls later have also to obtain a certificate in hom e nursing. In addition, Cadets may earn proficiency in twenty-one different subjects, including aeroplane accident aid , ch ild welfare, cooking, swimming and life saving, camping, and handicrafts. A Cadet obtaining certificates of proficiency in twelve subjects is entitled to wear the Grand Prio r's Badge. The duties Cadets undertake are in hospitals, day and residential nurseries, and at medical comforts depots : their activities include bookbinding, hospital library work, toy-making and knitting for overseas civilian rel ief. Besides all this, they are able to enter for annual national competitions in first aid and home nursing, drama, music, painting, and essay writing. It is grand work, and fine training for a youngster, designed to equip him, or her, for service to their fellows in adult life. The Cadets have been honoured in their Commandant-in-Ch ief. It is a gracious tribute to the work of a splendid bod y of young people, and well deserved.

FIRST AID & NURSING , NOVEMBER, 1948

A COURSE IN ADVANCED FIRST AID BY

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

POISONS

It\" our last article, we cliscuss~d the narcotics. Some in a tumblerful of. lukewarm water and its action assisted

readers may have been surpnsed to ha\"e found these poisons de-scribed before the irritants and corrosives. The reason was that nowadays cases of narcotic poisoning are so common and it is always a good plan, when thinking of a list of causes either for the benefit of an examiner or in an actual case, to put the most common ones first. Strictly speaking, however, if we kept completely to this rule, the order would be still more different. Poisoning by gases, to be described in a later article, would probably be top of the list if we excluded food poisoning which so often is an illness rather than an accident.

Irritant Poisons These must be clivided into three clistinct groups as follows :(a) Animal Irritants such as bad meat, decaying fish, etc., which produce the conclition commonly known as ptomaine poisoning. -(b) Vegetable Irritants, e.g., poisonous berries, fungi, etc. In this connection it must be remembered that germs are in fact minute forms of vegetable life ; hence many cases of gastric influenza produce symptoms and signs very similar to those caused by the irritants except that the temperature is raised. (c) Chemical Irritants such as arsenic, mercury, iodine and many others. SYMPT01fS AND SIGNS.-The symptoms and signs produced by an irritant vary somewhat according to the poison that has been taken. As would be expected those caused by the ingestion of a fungus or bad foodstuff cliffer from those produced by the chemicals, The characteristics of poisoning due to food and fungi, etc., are those of gastro-enteritis, a clisease which wa~ cliscussed in a former article, The patient develops severe. pain in his upper abdomen which gradually extends and becomes colicy in character similar to that experienced by every reader at some time or other in his life through having eaten sour apples or taken an over-dose of castor oil. The pain is accompanied by vomiting. Later there is diarrhoea. In severe cases there may be signs of shock. The ingestion of an irritant chemical produces similar symptoms and signs although they are often greatly intensified; thus the vomit may contain blood and the shock is severe. In adclition there is generally a burning sensation in the mouth, throat and neck. Some irritants stain the mouth, thus iodine produces a yellow or brownish coloration, while corrosive sublimate, a preparation of mercury used as a clisinfectant, stains the mouth white. FIRST AID.-The first step in treatment is to empty the stomach and this is accomplished in first aid by giving an emetic. Emetics in common use include salt-z tablespoonsful, mustard-z teaspoonsful and Ipecachuana wine-z-4 teaspoonsful. Whichever is employed it must be administered

by giving subsequently copious drafts of luke warm water and also by tickling the back of the throat with a feather. If, five minutes afterwards, vomiting has not occurred, the first-aider should repeat the dose. It will be understood that it is not always easy to make a patient vomit; this is one reason why meclical methods are so superior to those which can be employed in first aid; the doctor, of course, will remove the poison by washing out the stomach, bu t this procedure requires special equipment generally only available in hospital. In adclition, the doctor possesses in injection form, an emetic more reliable than those used in first aid. When vomiting has ceased, an antidote should be given if such exists for the poison concerned. Some of the more important irritants and their antidotes are as follows : Mercury and corrosive sublimate-white of eggs or milk. Iodine-starch, made into a paste, Lead-Epsom or glauber salts. Phosphorus-permanganate of potash, dose as fo r opium. If the firs t-aider is in doubt as to what ant.idote to give, he must remember the valuable tip of 'phoning up a chemist and enquiring, for chemists possess books of reference to which they can quickly refer. Following the antidote, an aperient should be given with the object of removing through the bowels, any of the poison which entered the intestines before the emetic took effect. Castor oil is generally employed for this purposedose, two tablespoonsful for an adult and one-two teaspoonsful for a child, depencling upon its age. Oils should never be given, however, in cases of poisoning with phosphorus or cantharides since these substances dissolve in an oil and hence are then readily absorbed into the blood stream. The remainder of first aid consists of giving demulcents liberally and treating for shock.

Corrosives The corrosive poisons are so called because they burn the parts with which they come into contact. They are divided into two groups, corrosive acids and corrosive alkalis. The corrosive acids include sulphuric acid (oil of vitriol), hydrochloric acid (spirit of salts) and nitric acid (aqua fortis). The corrosive alkalis include caustic soda and caustic potash, strong solutions of washing soda and ammonia. Experience in teaching has shown that many students of first aid do no t know what is meant by the terms acid and alkali. T he name acid was given originally to certain substances which possessed a sharp sour taste and which were produced by plants in the course of their growth, for example, citric acid in lemons, tartaric acid in grapes and oxalic acid in sorrel. Chemical analysis showed that these substances contained a gas or vapour called Hydrogen and

FIRST AID & NURSING, NOVElYIBER, 1948

the term acid is now used to describe any chemical com- patients who have taken acid poisons include lime water pound which contains this gas and which possesses the and a solution of soap. A useful tip to remember is that power of turning the colour of a piece of blue paper stomach powdeLS so frequently used for the treatment of called litmus paper, red. An alkali is a compound which indigestion are also alkalis and hence can be used in an dissolves readily in water producing a solution w4ich will emergency. Some authorities do not, however, recommend neutralise an acid, It is distinguished by its power to the use of bicarbonate of soda since when mixed with acid change the colour of red litmus paper to blue. it generates carbon dioxide, a gas which might distend the \Vhen an acid is mixed with an alkali, a neutral substance stomach and cause it to perforate. called a salt is produced. This has no effect on a piece of The antidote for an alkaline poisoning is of course a litmus paper, This elementary principle of chemistry is dilute acid such as vinegar or lemon juice. Citric or tartaric made use of in the treatment of poisoning by corrosives, acid, dose one to two teaspoonsful dissolved in water, SY?-fPTO:\lS AND SIGNS.-A patient who has taken a dose may be given as an alternative. of a corrosive poison at once experiences a severe pain in After giving an antidote the first-aider must proceed to his mouth, throat, neck, chest and abdomen; retching and give demulcents liberally in order to soothe the burnt organs. vomiting soon follow, the vomit often containing blood. Suitable demulcents include milk, oil, thick barley water, Se,ere shock accompanies the symptoms. flour made into a paste, and gruel. In adclition, if the poison is volatile, i.e" vapourises Shock must be treated in the usual manner and pain easily, and gives off fumes as in the case of hydrochloric may be relieved by the application of hot fomentations to acid, further symptoms and signs occur through 'inhalation the front of the neck and the pit of the stomach. of the poisonous vapour. These symptoms may be those If the patient has taken a poison which gives off fumes the of partial asphyxia, caused by swelling of the tissues of the first-aider must maintain observation for asphyxia caused throat, and respiratory passages . by swelling of the tissues of the throat. When there is A characteristic feature of poisoning by a corrosive is difficulty in breathing, often accompanied by the sound as staining of the skin and I?ucous membr~n~, t~us, hyd~o if there were an obstruction within the throat, the patient chloric acid produces a white coloration, rutnc aC1d a reddish must be propped up to facilitate breathing. Inhalations of brown, and sulphuric acid a cliscoloration which varies from oxygen may become necessary and should breathing fail a pearl-grey to black charring according to the severity of artificial respiration must be immediately undertaken. Carbolic Acid the case. TREATME T.-The first point to remember in the treatThis well known disinfectant is a dangerous poison. ment of a case of poisoning by a corrosive is the effect of It is usually taken in the form of lysol, phenol or cresol. the poison on the mucous membrane which lines the The symptoms and signs of poisoning are very similar oesophagus and stoma~h. A strong corrosive produces to those of the other corrosives except that the pain someulceration and destruction of the mucous membrane and times disappears owing to the anresthetic action of the drug other coats of these organs. For this reason it is dangerous on the mucous membrane; for the same reason vomiting to give an emetic since this might have the effect of,causing does not always occur. The best antidote for carbolic acid or any of its derivatives perforation o~. the oesophagus or stomach dunng the is liquid paraffin, dose 10 ozs., alternatives include Epsom strain of votrUung. The first step in the treatment is to giv~ a? antidote w:hich or Glauber salts, one tablespoonful dissolved in half a will neutralise a poison and convert 1t lDto a relauvely pint of milk or water. The treatment otherwise is similar harmless salt. Alkalis suitable for administration to to that for other c )rros ives.

The Medicine Chest By FRANK BERRY, PH.,C.

vapourised on heating, It is soluble in water, alco hol, glycerin, and C ar b 0 li C A C1'd d ' l' h 1 I Crude carbolic acid separates as a dark-coloured, oily liquid when olive oil. Liquefied phenol i~ ?repared by , IS so \'mg p eno crysta s coal tar is fractionally distilled, and by appropriate purification can be in distilled '.Tater, the qua~tHleS bemg adjusted so that the product obtained in the form of colourless crystals , contains 80 per cent, by weIght of pure phe~~l. , , ' Carbolic acid is known also as phenol. The name phenol is given by Carbolic acid has been widely used as a ?lS~eC[an~ ill the mdust:lal chemists to many series of substances having a certain type of chemical and ,domestic, sphere and as an antiseptIc m hospital . and SUrglca~ tmcture, but in connection with med icine, when used without further ro~tll1e," It IS, nm\', ho\\'~yer, ~a~gely superced,e,d, b) proP~I~:~(, designation, the name phenol is presumed to refer to the specific armse,p~lC' which" owe their aC[IYlty ro a non-Htltant but Ib ) germIcidal phenolIC substance knmyn as chlormetaxylcnol. , h substance more common1y k nown as cat'b 0 1-IC aCI"d . Phenol readily absorbs moisture and tends to become pink in colour \ The antiseptic properties of phenol solutlons depend on t ,e CO~1on keepinO', Ie should therefore be stored in well-closed containers in centraiion of phen()l an,d on t~e n~ture ,of the so lvent. olutlons In b f)' h oiloralcoholha,-e \'erdlttlcantJscptlcactLOn, Strongaqueoussolutlons a cool place away rohm 19 t, _ al'e "'austic in their ac~ion hut this causticiry is reduced by addition of Phenol has a c aracterIst1c "carholic" odour and is readily '"

FIRST AID & NURSING, NOVEMBER, 1948

glycerin. Weak aqueous solutions, approximately I per cent., have a induces early recovery. Effervescent preparations owe their effervesuseful antiseptic action and by producing a mild local anresthesia tend cence to the liberation of gaseous carbon dioxide formed usually by to relieve pain. interaction of sodium bicarbonate with some acid constituent of the These properties have led to the use of phenol solutions as wound mixture (usually citric or tartaric acid) in presence of water. Such dressings but their use is accompanied by danger owing to possible preparati~ns stimulate the stomach and promoting secretion of absorption into the system with consequent development of toxic gastric acids and enzymes and are often of value in treatment of chronic symptoms. Such solutions should never be applied as dressings to the gastritis and in controlling vomiting. extremities as they are liable to cause gangrene if evaporation is Carbon Dioxide Snow prevented. When applied to the skin, pure carbolic acid and strong solutions This is semi-solid carbon dioxide formed by sudden release of the thereof, produce a sensation of burning which is soon followed by compressed gas from its storage cylinder. The" snow" or fro7en gas numbness and a characteristic whitening of the skin due to coagulation has a constant temperature of - 80°C. and evaporates slowly. By of proteins. The resulting burns may be very severe. Phenol burns are collecting in a suitable receptacle the material can be moulded into usually treated by immediate application of glycerin or alcohol, both any desired shape, such as-a stick or a crayon, and may be finely pointed of which by their solvent action aid removal of the phenol without with a pen-knife. This substance has a destructive action on tissues promoting absorption. and is used for removal of naev i, warts, moles and certain types of Phenol enters into the composition of many mouth-washes, gargles, ulcer. It is applied with light pressure for a period of up to about ear-drops, inhalations, sprays, ointments and suppositories. It is not one minute according to the condition being treated. Obviously, the often administered internally although it has been used in small hands of the operator must not come into direct contact with the quantities as a carminative and in the treatment of certain types of " snow." gastritis. In some localities an unofficial phenol mixture is sometimes taken to relieve colds and allied complaints. It should be clearly Carbon Tetrachloride This is a colourless, volatile liquid with a characteristic odour someunderstood that this is a very weak aqueous solution of phenol and great care is necessary when purchasing, to make one's requirements what resembling chloroform. It has been used in doses of 60 minims perfectly clear, otherwise there is a risk of being supplied with a for treatment of hookworm and tapeworm. It is extensively used in stronger phenol preparation with consequent serious and possibly fire extinguishers and in the dry-cleaning trade. Excessive inhalation fatal results if swallowed. Carbolic Acid is very poisonous; twenty of the vapour may cause severe toxic symptoms involving particularly drops of the pure acid have been known to cause death, although with the liver and kidneys, and cases of poisoning sometimes arise when the prompt treatment, recovery has occurred after taking much larger substance has been employed in poorly ventilated premises. Treatment quantities. Symptoms of carbolic acid poisoning include (if swallowed) should be on general lines with due regard to whether the poison has characteristic odour of the breath and intense burning and whitening been swallowed or inhaled. In the former case emetics, warmth and of the lips, mouth and tongue. There is usually faintness, giddiness and purgatives should be employed, and in the latter case, warmth, fresh depression, passing into unconsciousness and severe collapse. The air, artificial respiration and respiratol), stimulants are indicated. pulse is rapid and irregular, breathing stertorous, skin cold and clammy, Further treatment may involve glucose and calcium therapy. and the pupils of the eyes contracted, this latter symptom sometimes Carbromal leading to confusion with a case of opium poisoning. Urine is This is a white, odourless, tasteless powder used as a sedative. Like diminished or suppressed and may be of a greenish colour, darkening on exposure to air owing to presence of excreted phenol oxidation the bromides it is of value in cases of insomnia due to worry or exciteproducts. Vomiting is often difficult to induce. Death occurs from ment, but is not so effective if sleeplessness is caused by pain. It is paralysis of the respiratory and cardiac centres. The approved method given, usually in tablet form, in doses ranging from 5 to 15 grains and of treatment for cases of carbolic acid poisoning is described in the should be followed by a hot drink. official Textbook. (to be continued.) Epsom or Glauber salts act as antidotes by reason of their power of combining with carbolic acid to form harmless phenolsulphonates, but they must be administered freely in order to neutralise all the acid. In view of the solubility of carbolic acid in oils, it is not advisable to AN APPRECIATION administer any oil other than liquid paraffin unless instructed to do so DEAR SIR, by a doctor. On many occasions during the past few months I have felt an The patient must be kept warm and artiEcial respiration applied if irresistable desire to write you to express my keen appreciation and respiratory failure threatens. Hospital treatment will almost certainly include intravenous injection delight at the nature of the articles appearing in our" First Aid & Nursing" for so many months past: I do trust the articles under of warm saline containing added sodium bicarbonate. the names of Dr. Belilios, Sister Pavey and " The Medicine Chest" Carbon Dioxide will remain permanent features as well, of course, as the valuable This is the gaseous product formed by living animal tissues and lectures by the various surgeons who contribute to our little exhaled from the lungs during the respiratory cycle. magazine. I find that words seem perfectly inadequate to express It is obtained as a by-product of many fermentation processes and by one's appreciation for such an excellent publication as "First Aid the action of heat or acids on limestone and other carbonates. & Nursing" and I do not doubt that in voicing my opinion I am also Carbon dioxide is heavier than air and is colourless, odourless, and echoing the sentiments of many hundreds of your readers. a non-supporter of combustion. For medicinal use the compressed Once again, many thanks to you and to our surgeons who give us gas is stored uncler pressure in suitable metal cylinders. It is a powerful so ungrudgingly and freely the benefit of their knowledge and respiratory stimulant and in cases of failing or suspended respiration valuable time. such as is often associated with drowning, certain types of poisoning, Yours, etc., electric shock, pneumonia, or asphyxia of the new-born, the adminiMARY DONOGHUE. stration of oxygen containing about 6 per cent. of carbon dioxide often London, S.W.

Letter to the Editor

FIRST AID & NURSING, NOVEMBER, 1948

Topical Notes for First Aiders and Nurses Art Therapy in Illness remains for voluntary efforts in the field of ma y be claimed seven weeks before the On all sides we are hearing of the extension culture and in the care of the family, the aged expected date, but it cannot be claimed later of the idea that there is a curative value in and other special groups of people. He than three months after the birth_ beauty. The person who is acutely ill may be points out that the better organisation of more or less oblivious of his surroundings, State provision merely releases voluntary Schools for Epileptic Children ~though it is agreed that most epileptic his short convalescence is cheered by the action, but it by no means removes the need floral gifts of his friends and he is usually for it. It sets it free to explore new avenues ch1ldren ought to be, and indeed are, in quite g lad to rest and allow his mind to l ie and to develop fresh sociological methods in ordinary schools, it is realised that unless fallow for the time being. He is up and about helping those whose needs lie outside the there is good co-operation between the again before he has had time to feel dreary, prov ince of the State scheme. He suggests doctor and the teacher and the latter underand the inevitable comings and goings in a reforms that could be made in the laws stands the needs of epileptic children, there are busy hospital, combined with the efforts of governing Friendly Societies and Charitable bound to be difficulties. There is no evidence the occupational therapist, save him from Trusts, and that there should be re-examina- that, as a group, epileptics are less intelligent feelings of monotony. With patients who tion of taxation of voluntary agencies, an than the rest of the population, but there still are undergoing a long illness and with those enquiry into the conditions of the physically remains about 1,500 epileptic children in this who are chronic invalids, the case is quite handicapped, the extension of public grants countt)' who need to be in special schools. At present, there are seven such schools in different. The realisation of this, through his to voluntary agencies and specialised training England and Wales, and they accommodate own exper ience of extreme boredom as a of the staffs of these agencies. In this book, about 700 children. A vel)' enlightening patient in a sanatorium some ten years ago, Lord Beveridge has done much to counteract lecture concerning these schools was recently stimulated Mr. Adrian Hill, R.B.A., R.I., the growing feeling that the new national given at the Institute of Public Health and seriously to consider the influer:ce of ~rt in service has removed the need for the con- Hygiene by Peter Henderson, 11.D., D.P.H. keeping the patient mentally all ve durmg a tinuance of voluntary work, and he shows He said that, broadly speaking, the same type long-term illness. He knew that if, as an how wide are the opportunities for properly of education was given in these schools as artist, he could continue his drawing and organised voluntary effort in increasing the ""as g iven to non-epileptic children, but in painting, the wheels of the clock would g? health, happiness and well-being of the addition, instruction was given in some round much faster for him. With the enthus1- community as a whole. subject that might afford a means of earning astic co-operation of the medical and nursing The New Health Centres ali velihood later on. These include cookery, staff he was allowed not only to employ his Many valuable comments and suggestions laundry, needlework, weaving, rug and soft own time in creative art but to enliven the toy making, carpentery and gardening. In hours for the other patients. That was the regarding the proposed Health Centres to be some schools the commercial subjects, dressbeginning of a new therapy that has n:ll;de set up under the National Health Scheme are making, shoemaking and wood and metal rapid strides in the last ten years. The Brltlsh contained in a Report recently issued by the work is of a sufficiently high standard to give Red Cross Society developed the idea and British Medical Association. As everyone the pupil entry, on leaving school, to some of started a picture library, realisin!S .that th~re knows, free clinics were in operation at the best London offices, workrooms and were two aspects to consider--art1stlc crean on voluntary hospitals long before the new Act workshops. Dr. Henderson stressed the and art appreciation. 1fr. Adri~.Hill gave a came into operation, but these often showed importance of out-of-schoollife and said that very interesting account of th1s ill a lecture overlapping and inco-ordination. :vith the the children should have pocket money and at the recent Nursing Exhibition and services given by local authorltles. For learn its value in the local shops. They should Conference at Seymour Hall, London, arr~nged example, ante-natal clinics were conducted by go home for holidays, and play games, such as by the Nursing jUirror. The Red Cross P1cture doctors who never attended a confinement, cricket, football and hockey, with teams from Library now has reproductions of the best and if the midwife needed medical aid she other schools. The school library should be paintings, both old and new, and serves often had to call in a doctor who had had no kept up to date. Daily and weekly newspapers, nearly a hundred hospitals in Britain. The opportunity to examine the patient before- wireless broadcasts, schools journeys and pictures are hung in cubicles, wards and hand and the health visitor who called on the \Tisits to the cinema all help to keep the recreation rooms and are changed every few young mother and her baby often. had no children in touch with ordinary life. eat but weeks. Art therapists teach the patients how contact with the doctor who was 10 atten- attractive clothing is important, for the to use their eyes in appreciation, and many dance. If medical officers at the clinics did no epileptic child needs all the self respect he patients are encouraged to try to draw or home visiting, this would necessitate" swap- can command, and he should have a locker ping horses in mid-stream" if the patIent paint for themselves. They o~ten fi~d an became unable to attend the clinic. The where he can keep things that are his very absorbing interest in ~his, ~d 1t provl?eS a Report stresses the necessity of uniting the own. new topic of conversatlon v.:1th o~her patlent~, The effectiveness of the education and social replacing the customary dlScuSS10n of thelt work of the general practitioner with_ t_hat of training is put to the test when the child leaves the clinic and it advocates the prov1s10n of complaints. They do, however, need the comore beds in hospitals where patients can be school and enters employment. Many epileptics operation and encouragement of doctors, can maintain themselves and live satisfactory nurses and other members of the staff. Art treated by their family doctor. liyes; but many will, sooner or later, fail in therapy not only helps t~em thr~ug~ a Claiming Maternity Benefits the struggle. This is due less to their own difficult period but it has ennched the!! llves, fault but to public ignorance. He suggested Many young mothers who are en;ployed for they are henceforth enabled to take a ~o~e that an organisation should be created that informed interest in both natural and artlst1c outside their homes appear to be losmg the would act for the epileptic in a similar way, benefits of the Maternity Allowances because beauties. ational they fail to send in their claim early en:mgh. and with the same force, as the The allowance of 36s. a week for thirteen Institutes for the Blind, the Deaf and for The Third Beveridge Report Diabetics respectively, and that the proposed This Report is very timely,in its appearance. weeks commences six weeks before the baby Institute for Epileptics should have adequate It is called" Voluntary ActlOn, A Report of is due, providing that the mother. gives up funds and a whole-time staff, so that they could Methods of Social Advance" (Allen and work during this period. The cla1m should not only serve the needs of the epileptic but Unwin, price 16s.) It will prove ?f. great be sent in seIJetI weeks before the expected should enlighten public opinion, so that the interest to all who are able and wllllng to date of confinement for if it is made later greatest need of the epileptic- regular workgive voluntary service and who sometimes than this part of the allo'wance may be lo~t. 'rna,' be met. "If you would make human have a few shillings, or even pounds, to. spare. The attendance allowance of £1 a week tor beings happy, give them a task ar:d a cause.; He describes the new Health ServlCe as four \:veeks must be claimed within ten days and the harder the better. They rlse to thelr providing a national lIlinilllullI standard of li~e, of the birth. The normal grant of £4 towards full statUre only when challenged." and he shows how much room there std! the expenses incurred at the confinement

FIRST AID & NURSING, NOVEMBER, 1948

News From All Quarters Order of St. John (Major-General Supt. Tidmarsh thanked the :l\1ayor for THE ST. JOHN AMBULANCE J.Secretary, E. T. Younger), Countess Mounrbatten of attending, and said the Dh-isions had covered Burma (Superintendent-in-Chief St. John every duty they had been called upon to do BRIGADE. Ambulance Brigade Nursing Corps and during the building of the headquarters, and Brigade Surgeons' Conference Dr. N. Corbet Fletcher (Surgeon-in-Chief) presided at the 5th Annual Conference of Brigade Surgeons held at the Royal Hotel, London, on October 30 and 3I. Some ISO surgeons were welcomed by Lt.-General Sir Henry Pownall (Chief Commissioner) who was accompanied by Lt.-General Sir Otto Lund (Deputy Chief Commissioner). Following the opening address by the Surgeon-in-Chief, Sir Ernest Rock Carling spoke on cc Civil Defence and the Implications of Atomic Warfare" which was followed by discussion. At the Annual Dinner, which was held on Saturday evening, Colonel the Lord WebbJ ohoson (Hospitaller of the Order) was the guest of honour. The Rt. Hon. the Lord Mayor proposed the toast of" The Order," and other speakers were Surgeon Rear Admiral Sir Henry Colson, Major-General J. E. T. Younger (Secretary of the Order), Sir Otto Lund, Dr. J. R. Hamerton (who proposed the health of the Surgeon-in-Chief) and Mr. F. H. Edwards, F.R.C.S. Sunday morning session opened with a talk given by Supt. G. Kirkham on the running of a Division of the Brigade, and Asst, Com~issi.or:e:r F. A. Trott on how to keep interest In dIvlSlonal work. This was followed by "The Use of Films for Training" by Mr. Dickson Wright, M.S., F.R.C.S. (Chairman of B.~.A. Committee on Films) who, with the aSSIstance of Dr. Stanford showed four films of interest. ' Mter the luncheon interval Dr. F. C. Eve gave a talk on Artificial Respiration which was accompanied by demonstrations of the Rocking Method and other methods of artificial respiration. . Mter .a general discussion on Brigade Items a sIncere vote of thanks was voiced by those present to Dr. Corbet Fletcher for presiding, and to members of his staff for the able arrangements made for the Conference. Cadet National Competitions H.R.H. Princess Margaret attended the second St. John National First Aid and Home Nursing ~ompetitions and presented the awa~ds. PrIncess Margaret, who is a Dame of Justlce of .t~e Order of St. John, was paying her first VISIt to the St. John Cadets as their Commandant-in-Chief. Among those.who attended the presentation were: The PrIor of the Order of St. John (Lord \Vakehurst), the Secretary-General of the Order (Brigadier W. G. Barne) , ReceiverGeneral (SIr Ernest Burdon), the Hospitaller (Lord Webb-Johnson), Director of Ambular;c~s (Col. Sir Bertram Ford), Chief CommISSIOner .St. John Ambulance Brigade (Lt.~cneral SIr Henry Pownall), Chief CommisSIOner S.t. John .\mbulance Brigade Overseas (C?l. SI~ James Sleeman), Lt.-General Sir ClIve Lld~ell (late. Chief Commissioner), Deputy ~hIef CommIssioner St. John Ambulance BrIgade (Lt.-General Sir Otto Lund)?

Divisions), Lady Dunbar-Nasmith (Deputy Superintendent-in-Chief), Mrs. Girouard (Assistant Superintendent), It. Guthrie Moir (Chief Officer Ambulance Cadets), Miss Virginia Cunard (Chief Officer 1 ursing Cadets). Twenty-one ambulance teams and twentyone nursing teams competed. Results were as follows : A..\IDULAl"1CE (~IAx. 400) SENIOR j ID"OR Fairbain House, I.Brampton, London .. 303 Yorks.. 2. Oxford City .. 262 2. Higbbury, 3· Southwick, London .. Sussex .. 256 3. Letchworth .. 4· Shepshed . . 251 4. Blidworth 5· i\linehead 249 Colliery.. 6. March .. 242 5. Hereford .. 7. Dean and 6. South Ashford Chaprer 7. Weymouth .. Colliery " 239 8. Dulfryn Aruan 9. Exeter.. 8. Llanelly Town 233 9· Brampton, 10. Ardwick Yorks 231 II. ['orest Hall .. 10. Wyken .. 216 I.

294 293 289.5 289.12

272.6 272.1 269 260 257 25+ 200

TROPHIES White Knox CupSchooling CupFairhain House (London) Brampton (Yorks) New Zealand CupJarvis CupFairbain House Highbury (London) NURSING (MAX. 420) SENIOR jw"'lOR 1. South Wigston 309 I. Weymouth 32 7 2. Southwick 2. Rotherham 302 30 3 Blackpool 3· Rotherham 300 300 3· 279 4· Southgate 4· Kington 299 278 .. 288 5· Chehnsford 5· Heme Bay 6. Oxford .. 255 6. Chadwell Heath 275 7· Halesowen .. 249 7. Treharris 274 8. Sherwell 8. Chelmsford 23 6 267 Minehead 261 9· Portrush Girl 9· Guide Co. 22410. Arthur Faire 259 II. Ballymena 243 12. La Sagesse .. 21 5 TROPHIES Moumbatten CupDunbar-Nasmith CupSouth Wigston Weymouth Senior Individual CupCunard CupSouth Wigston Kington, Rotherham Tweedale TrophyBedmaking Troph\'South Wigsron HaJesowcn .

Prince of Wales's District CHINGFORD DIVISIONS The Deputy Commissioner, Ald. Denys Lowson, supported by the Mayor and Mayoress, officially opened the new headquarters of the 132 Chingford Division and 85 Nursing Division on Saturday, October 9th. Among those present were the Presidents of both Divisions, Mr. Geo. Little, J.p., and Mrs. Maltby, the Deputy Mayor and Deputy Mayoress, members of the Chingford Council Dist. Supt. Miss Workman, M.B .E., Coun~ Surge<;m Dr. Thompson and many representatIves of local organisations. The Rector of Chingford, Rev. D. P. Grant ~.A., dedi~ated the building. Mr. Geo~ Little, thanklng the Deputy Commissioner for performing the o~er;ti~g ceremony, spoke of the work of the Dtvision. They had built the headquarters in their spare time and wired the premises for lighting and he~ting, all the more commendable because the Division did not have a builder or electrician among its members.

every member was justly proud of the achievement. Lady Supt. Miss Embleton seconded_ The Mayor, Councillor Hart, said that he, like most people of Chingford, was proud of the St. John Ambulance Brigade, because they were always on duty where,er people gathered together, and e,erybody felt a sense of security wherever the black and white uniform was seen. In the evening a Celebration Dinner was held, and attended by Ald. Lowson, the Mayor and Mayoress, Dist. Supt. Miss \'<7orkman and District Officers of the Eastern Area. SUTTON DIVISIO Realising the need for more members, personnel of all the local Ambulance, Nursing and Cadet Divisions, launched a recruiting dri,e in September and held meetings in various halls in the vicinity of Sutton Cheam Carshalton and \X'allington. Div_ /Supt. F. P: .Morris stated that the reason for the recruiting drive was because it had become necessary to increase membership in the Brigade to enable the Divisions to carryon efficiently, and as the demands on services had trebled that of last year, it became apparent that an appeal would have to be made. Teams ftom the Ambulance and Nursing Divisions later held demonstrations of first aid, ambulance work and nursing_ The patients for this purpose were provided by the Wallington group of Casualties Union. As the direct result of these recruiting demonstrations, etc., three classes in first aid were started in the area, to be followed later by a class in borne nursing. . Duke of Connaught's District BOROUGH OF GUILDFORD The death is reported of Dr. Cecil Pryor Lankester, M.R.C.S., L.R.C.P., at the age of 74· He is remembered with gratitude for his work with the St. John Ambulance Brigade and the British Red Cross Society. The follow ing bars to the Long Serv ice Medal have been awarded: Dist./Officer B. W. Wells (40 years' service), Corps Officer S. A. Fossett (30 years' service), Corps Supt. MISS B. ~eeves (25 years' service), Corps Officer MISS D. PhtllIps (25 years' service), CorI?s Officer H. V. Simmons (20 years' serVIce), Sgt. H. C. Farler (20 years' service), H./Sgt. W. J. Duntze (20 years' Service). The bar awarded to the late Corps Supt. ]. D. Rutter was handed to Amb./Officer Mrs. Rutter. Berkshire READING .On October 12th a Supper and Dancing Display was held by members of Reading Central and Reading West Nursing DiviSIOns to c~leb.rate the .completion of twenty years' servIce III the Bngade by Div. Superintendent Mrs .. D. \X'<?~dward of Heading Central NurSIng Dtv1sIon. During the evening Corps Supt. Miss E. C. Sudul, on behalf ofth~

FIRST AID & NURSING, NOVEMBER, 1948 members of both Divisions, presented to Mrs . Since its fonnation carl\" in 1941, Dr. Coil ins, Woodward a necklace as a roken of apprecia- a'Di,-isional urgeon, ha been respon-ible flf tion. The Dancing Di'play \\"a- giyen by the all the fir t aid train ing of the Taul1[on pupils of ::\li s Au tin's School of D ancing. D iyision. fIe hal> alwa\-s 'hown a great At the end of the eYening, ::\lrs. \, 'ood\"a;:-d interest in the work of the Br igade and has done was handed a bouquet. Those present included much to further it' cau e in the County of County Officer H. F. Skidmore and ::\k. omerser. Skidmore, Corps TranspoI[ Officer \. Baugh A friend to all mcmbers of the T:!Unmn and membe r.. and friends of the Brigade. Diy ision, he is frequently tt) be SCLn .H [he . \\-eekh- practicc.'. Lancashire PRESTO 1 West Riding of Yorkshire The Annual Gcncral \1cet in g of the PresHln Corps ,,-as held recently at ~ Chapel \\"'alks BRICIIOLF Headquarters. The Mayoress of Preston was present, and the Corps Surgeon, Dr. c.. ~l. Willmott, occupied the chair, supported by the Corps President, H. Cah-ert, Corps Supt. c.. F. Millington, -urs ing Corps upt. Miss Toulmin and .\mbulance and 0:ur in~ Corps officer . ' Mter upt. ::\l ill ington and ~ursing Corps Supt. Miss Toulmin had pre ented their repons, the ::\layoress made the follow ing presentations: Service Medal to Supt. G. Baines (Headquarters Dh-.), Sen-ice ::\ledal [Q Supt. J. Sharrock (Leyland Oi,' .), Service Medal [Q ,-\mb. Officer W-. \\' ilson (Headquarters Di\-.), First Bar to Corps Surgeon C. :1\1. \'(I illmon, First Bar to Pte_ J. Darl ington (Frenchwood Di,-.), First Bar to Cpl. F. Hargrea,e (Leyland Di\-.), First Bar [Q Cpl. \'\i . G. \\'el h (Leyland Diy.), Third Bar ro Corps Officer \'('. H. Johnstone, Third Bar [Q Ptc. T. Gray (Headquarters Diy.), Sen' icc Medal to ursing Cadet Officer Miss Barton, \"X'arrant of appointment to Corps Treasurer to G. Sumner, \\'arrant of appoimment to Corps ·Secretary to R. T. Butterworth, also 78 Medallions, Labels and CertiEcates. The Mayoress said she was yery pleased to have had the opportunity of discm-ering the extent of the good wor performed by the members, and cxpressed a hope that they would continue their sen' ices to the community. BLACKBGR The Blackburn Corps regrcts the loss of ex-Sergt. F. Crossland, \\'ho died after a short illness on September 16th. A former member of the R. .A.S .B.R., he sen'ed all through the last war. About twcnty-four officers and mcmbers of the Corps, blith ~\.mbulance a~l d ursing Divisions, were present at the iuneral,. a a token of appreciation for the good and fatthful service he had rendered during his sixteen years with the St. J ohn Ambulance Brigade . Leicester MELTON MOWBRAY On Saturday, August 28th, the above Division held its annual Flag Day . The swn of £137 4s. rd. was realised, and of .this nearly [,35 was raised by the splend ld eHorts of two members, Ptes. R. Dunkley and J. Stapleford, who were on duty fo~ street collection for tweh'e hours, almost w!thout a break. SOMERSET TAU TON On the sanction of lIis ,fajcsty the b~ing, Dr. \VI. J. Collins, of Salisbury House" Bil~et field Taunton ha been admitted as a Serving Bro;her of the' Order of St. John of Jcrusalem. This honour has been conferred in recognition of untiring service rcndered to. the St. John Ambulance Brigade over a perJod of several years.

9 a~recJ

to become het Presidt,nt,

:ll1d

the

r~\ ised arrangements arc \)perari\c fn1m \, (

October, 191'" The Rc~ ion IS d i, ided 1I1tt) nine d I tIlCt comparable \\" ith the (erriwl"\ 3Jmini '(erc~i by the Oper,1(ing District "uperintendt'nts, :Yith an Honor:lry Diqrict 'CCft't:'\f\' appointed l!1 cachO' Thc\" arc: 0Jo. 1 Oistricr hin"-" C fl)SS, \ [ r. 1i. L. Denton, coD i~l. Sll~r·. KnebWl1rth; );0. ~, D\)(1CaStt:r, \1r. I. \\ i1.'on, Hccrrical Office. \kchan\cd l.n~i;1eer's Dep.Htment, DOnCIS(Lf _ :-"\1. " " "t tingh~lm, \ Ir. J. Sander~()n. c \) S(,Il\l>l1'\\JSlt'\", 0:e\\ Hasford ; '\, (). 4, Linwln, \Ir. 1 . \l i(chell, •\ preSental ion was made nn Tue~da\" Engineer's DL'p:lrUnent, lk)s(on _ ". 0. 'j, evening, O ctobcr 5th, tt) \l r. J. Bwckks< Leeds, \[r. F. l. llngblltWll), 't~Hilln \laslcr, upr. of thc ~ onh Di\ isil n tlf the Bright use Pudsey, Gree!ride: o. l), \hnchL'~ter, \lr. C~)rps, on hi hell1g pLlced un the re e~\"l' list \. D. n'lpe, GnL)js \CCl)lInr" Office, Dean 'atre( completing 45 year' sen' ice_ gate; ~ <J. ;, ~rr:ltf()rd , \11. ll. C)icman, It was in 1903 th:1t _\Ir. Brocklcss joined rhe upertnrendenr'$ 0.0. N (\\ llrks Office, Brigadc as a PriYa[c, later becoming a Corporal , Li\ npl)ol '(Iee r Sutlon; -ll." Cambridge, and in LC)22 \\'a' n'ade an \mbulancc Officer. \[1'. R. \. Taylor, 'UtlL)n \Ia~tc' r, ClmbridgL' ; In 192b 27 l:e was alsn Officer-in-Charge nf -0. n, ~or\\"ich, \11'. \ . \\ '. Bilham, c L) the Cadet Di\ i ion, and in It)34 ,ya prol~l\lted Dis(rict ' uperimendcm, :-"L)f\\'ich Thllrpe.' to DiyisitJnal Supr. of the ' orth Di\ i'ion, Each District is sub-dl\ ided inm areas, \\ ith holding that position until being placed on qualified ambulance delegates appL)inted in the resen'e Ii r. each. In tbe 1914 I ' war he served with the _\11 the District COll11l1llteemen, \\ ho arc R .. \.::\LC. In lC)39 he \\"a made a en ing qualified ambulance men. \\- ill hold llffice fl)r Brother of the O rder of t. John. threc Ycar', and they \\ ill function under the The presentation of an electric clock \\'as District 'ccremries. 'Their dlltie~ arc principalmade by Diy . upt. \\'. Fisher, and Corps ly propaganda in the particular arc.1S: the Supt. H. Hir t wa ' in the chair. Mes age' uf co-ordination of class and l!1St[llction:ll \\"t)rk . congratulation were recei,ed from \sst. and as ist the D i 'tIlct SeCI"<_Hn ll1 the nrgan iCommissioner H. Harrison, and Disr. Officer sation of (he :\.mbuhnce l\1I1~re(l[I\l\1. ~Ihey \Y. G. Robertsha,,-. \cting Cadet Officcr will mect as directed by (he DlstrlCt 'ecre tary. Miss Kershaw presented a bouquet of Rowers Western Region to Mrs. Brockles-. .l\ presemat ion of ambulance ll)ng sen icc awards gained by members \If the staff in the Major Carver Cup Competition The result of the Competition, ,,-hich tOok Birmingh3m Diyision \\"3S held 111 the Tt)\\"l) place at Hull on October 30th, "as: 1, \'\ ath Hall a~ LcamingtOn on 23rJ. October. \lr. ;\[ain Colliery; 2, Bamburgh "'fain Colliery; ;\.. Y. R. Brown, Di\ isional SuperimenJel1l, 3, Dairycoates, Hull; 4, Hull City Police; \\-as in the chair and \\as suppnned by the ::\byor, Councillor C. Purcdl; \lr. R. 5, Grimsby D ocks; b, Hull tation: 7, Pontefract Col!iery; L, Ea -t Riding Police, Burgoyne, Regional 'tatf Officer: Mrs. Burgoyne; .\[r. 1.• \. \\ anen-hll1g, District 9 , Leeds City Police; 10, Hull Rly. Ladic" On the proposal of the Chairman, '111'.. Good; :'lanager -; ~[r. Y. J. 11. \\ ebb, Di\-isional Locomoti\c upcrinrendent: '1[1'. Oakes, the follo\":ing ' -ote of thanks was R. F. \'\'ilson, Di\ i ional Engmcer; \[r. P. carried : "That this gathering of mbulancc -\ustey, _ \ mbul~u1Cc Cenrre 'ecrcmry; .\11'. workers \\-ish to place on record our sincere J. \. ::\[artin, \ssistant Centre 'ccrc tar),; thanks for, and appreciation of, the great help and Mr. E. ]. Hancock, Di\i~inna l \mbulance so freely giyen to _\mbulance workers as Secretary; - and othcr 1"o1il\\ a\' officials, also lecturers: exam iners, coaches and judgcs for local doctors and officL'l"s of thl' Brig-Jdt', approximately fifty years each, b\ Dr. K. [{. including Dr. 11. \lason and Dr. C;. Cla}·tl)!1, Beyerley of W'orsbro' Dale, and Dr. J. :01. al'o ::\lajor E. ,'. Phillips, Cllunry CummisHermon of Hessle, and extend our good sioner, and \[ i s Orton. wishes for a speedy recovery to Dr. Hermon." The awards wcre prC'cnted b~- \[1'. and \[1'.. cc I may say," added 1\1r. Oakes, " that the Burgoyne. 1It. _\. H. Swadling presented an two gentlemen have been honoured by the illuminated address to Dr. 11. \[ason in Order of St. John, Dr. Beverley as Knight of recoo-nition of the 11ft\" years' sen icc to the Grace and Dr. Hermon as Commander, raih.::a ambulancc mLl~'ement in Leamington. y which you will, I am sure, agree are \Yell and The Rt. llon. l\.othony Eden \\"a ' present for truly deseryed, and no\,' on behalf of all a short time and spl)kc in appn:ciation of the present at this gathering to-day, I mOye a large amount of yollU1tan sen ICC rendered vcry hearty and cordial Yote of Thanks to by ~members of the fir t aid mOycmenr. these t,,\-o' gcntlemen for thei r ,cry long ;\1r. Burgoyne stated that [he life blond ()C service to thc caus of First J\id." any oraanisation of this kind 1S a c(>!lS[,lnt Ao\\' orne\\' recruits and he made an appeal for renewed activity in bringll1g amhuLlIlce BRITISH RAILWAYS classes and facilities to tile norice of all Re-Organisation of the Eastern Region members of the stall' \\ho had not taken The new organisation for thc Eastern Reg il)n alhantage of them, ' particuhrlr the younger of British Raih\ a\"s is now almost complete, element and n::w entmnts. lle referred to lhe and the four centres of the St. John Ambulance stah\-arrs who had gained lO:1.Q en icc awards A.ssociation (G.c., G.E., G . . and:\I. & G. .) as the very backbone ol the ambulance arc substituted by one centre, known h 'nce- organisation: in fact the ': salt ?f the earth " Corth as thc Eastcrn Region. The Chief and a splend id example (ll slIstall1l'd dl.!yotton to n good c:nlf:L'. Regional Officer, \11'. C.l'.. Bird, ~r.i\I., ha

FIRST AID & NURSING, NOVEMBER, 1948_ 10____________________________________________________________________

The Lungs and Respiration By

J. WELLS, M.R.C.S., L.R.C.P. The Organs Concerned in Respiration THE trachea or wind pipe consists of a series of cartilagenous rings whi~h are arr~nged so. as to be complete in front, but deficient of cartilage behind. Th~se rings are surrounded externally by .~brous connect:ve tissue, which also joins these extremltles, so completing the tube behind. This connective tissue also fills the spaces between the rings. I t is thus seen that the trachea is a resistant and elastic tube, which, though always open for the passage of air, will yield ~ith t~e bending of the neck, and will also allow of the distenslOn of the oesophagus, which lies behind the trachea, against its posterior surface,

LARVNX: rHYROIO ~~

C~RTlLAGE

~RICOID CARTILAGE

1RACIJ£A_ .

Air sacs, or alveoli (enormously enlarged), of the lung. It is from these sacs that oxygen is absorbed into the body and carbon dioxide is breathed out.

R.((jJ..JT 8RONCI-/US

BAS£ OF LUNG The two lungs, showing how the main bronchi enter and branch in their substance. In the right lung the sU1face has been cut away to show how the air tubes branch.

where the cartilage is absent. The epiglottis is a piece of cartilage fixed to the trachea which guards the opening of the trachea, when food or drink are swallowed. It exactly fits the opening into the trachea, so that the food passes over it, into the opening of the oesophagus, when swallowing, and then by peristaltic movements, down this organ, food passes into -the stomach. The first two cartilagenous rings are much larger than the others which number about ten, and are called the thyroid and cricoid cartilages. The thyroid cartilage is also known as Adam's apple and it is behind this cartilage that the vocal chords are situated. The second or cricoid cartilage is the only complete cartilagenous ring in the windpipe, and owing to this, does not so freely admit of the distension of the oesophagus at this point, which is placed behind the trachea and thus accounts for the pain felt in the upper part of the throat when swallowing a large and hard substance, such as a solid piece of food which has not been thoroughly masticated. The bronchi, right and left, resemble the trachea in their general structure, with similar rings of cartilage and fibrous tissue. The cartilages are also incomplete behind. The bronchi again subdivide into smaller and smaller tubes

called the bronchial tubes, which again subdivide into bronchioles, which are of microscopic size and finally enter the air-cells. In the bronchial tubes, the cartilagenous rings are incomplete, and become more and more so as the tubes subdivide into smaller branches, until in the smallest tubes the cartilagenous rings disappear altogether. The trachea and its branches are all lined internally . with a delicate mucous membrane, the inner surface of which is covered by a layer of (iliated cells. These cells are covered with minute hair-like processes called cilia (Latin, Cilium, an eye-lash). These cilia by their continuous motion, tend to move any foreign matter which may come in contact with the inner surface of the air passages towards the mouth. Thus the lungs are kept comparatively free from particles of dust derived from the air we breathe, and during inflammation of the lining membranes of the tubes, the sputum formed by this is forced towards the larynx and finally discharged by coughing. The lungs, right and left, are spongy and elastic bags, consisting of air-tubes, the bronchi, bronchioles, air-cells, blood vessels and elastic tissue. They fill the thorax with the exception of the space occupied by the heart, the great blood vessels, the oesophagus and the trachea. The oesophagus passes through the thorax and after piercing the diaphragm, enters the cardiac end of the stomach. Both right and left lungs are divided by deep depressions into lobes. The right lung having three lobes, and the left lung two lobes. The lobes are again divided by lesser depressions into lobules, and each lobule is a very small representation of the whole lung, being supplied with its own system of air tubes and blood vessels.

FIRST AID & NURSING, NOVEMBER, 1948

The lungs are supplied by dark venous .blood by. the pulmonary arterie~ :vhich proceed ~r?m t~e nght ventncle. These arteries dIVIde and subdiVide mto smaller and smaller branches penetrating every portion of the lungs, until at last they form capillary networks, which cover and lie on the walls of the air-cells. These walls of the air-cells are extremely thin as are also .the wall.s of the capillary vessels, and can only be seen With the aId of the microscope. . . Thus the venous blood is brought In contact with the fresh inspired ~ir. which is ~ake~ into the lungs during inspiration. It IS In these capillanes that the venous bl~od becomes converted into arterial blood, by exchangmg carbonic acid gas collected in the tissues of all parts of the body, for oxygen gas absorbed from the air, co~tained in the air cells. The venous blood thus changed mto pure arterial blood is collected by capillaries and bX the uni~n of these into the venules and small veins, whlCh form, m their turn, the larger veins, ,ultimately. giving rise ~o the four pulmonary veins which pour theu contents directly into the left auricle of the heart. Inspiration consists of drawing air into the air-cells of the lungs. . . Expiration consists of e:cpel~& au from t~e l~ngs. . Respiration consists of mspuatlOn and expuatlOn: It IS the completion of a breath. Although we are contmually inspiring and expiring air, ~he lungs ar.e never empty once the air-cells have been distended by au. The amount of air 20 to 30 cubic inches, which enters and lea:res the lungs'during quiet res~iration is small compared w~th ~hat which remains in the au-cells of the lungs after. explrati~n. If we take the average respiration in ordinary qu~et breathing as fifteen per minute, this means that we respire or breathe 21,600 times each day, and under normal conditions we never notice anyone of the~. . . Tidal air is the amount of air, 20 to 30 'CUbiC ~ches 1? the adult, which passes in and out of the lungs In ordinary quiet breathing. . . Stationary air is the amount of au, about 20~ C~blC inches that still remains in the lungs after each respuatlOn. The' supplemental air, which amounts to about 100

AIR CELL

APILLARY BLOOD VESSEL SURROUNDING

TI-IE A IR CELL

BLOOD CORPUSCLES Air-cell and Capilliary.

cubic inches, is the amount of air left in the lungs after a forced and deep exp!~a~ion.. . The residual au IS the au, amountillg to about 100 cubic inches, which cannot be expelled from the lungs .. We now see that the lungs contain about 230 CUbiC inches of air after an ordinary inspiration, that is, 200 cubic inches ~f stationary air and 30 cubic inches of tidal air. Mter a deep and forced inspiration, we can add a further roo cubic inches to this, making a total of 330 cubic inches, thus inflating the lungs to their full capacity. This extra 100 cubic inches, which is added ~fter a de~p and forced inspiration, is called the compl1mental aIr. An adult person at rest respi~es ~n an average about 15 times per minute, or 21,600 urnes ill 24 hours, therefore in 24 hours, this would amount to:.. 30 X 15 X 60 X 24 equals 648,?00. CUbIC mches or 3;:5 cubic feet, there being 1,728 CUbiC mches to the C~blC foot. This quantity is greatly increased by phYSical exertion. It should be pointed out and observed th.at young children breathe much quicker than adults; that IS, about 30 times per minute. (to be continued.)

THE CARE OF THE CHRONIC INVALID IN THE HOME BY

AGNES E. PAVEY, S.R.N. Diploma 111 Nursing (University of London) Muscular Atrophy . HIS term covers a group of dis.ea~es of somewh~t ?illerent types, but having many s~ar ch~ractenstics,. the essential feature being a progreSSive wasting or de~enora tion of the muscles so that power of mo~em~nt. IS lost. Some affect very young children, commen~mg m infancy, or the child may appear quite normal unt!l about five to seven years of age. Other forms make theu appearance at adolescence. Males are more commonly affected than females. In the early stages the child ~evelops a ra0er waddling gait, he tends to/all easily. and It may be noticed that he has difficulty in getting up agam. In fact, he d~velops a curious manner of doing this. He turns on to hIS face,

rises on his hands and knees and then put~ both hands o? his thighs and" walks up himself:" That IS, he works ~s hands upward one at a time, labonou.sly clamber~ on to ?is feet and eventually straightens out his b~dy untIl he gaills the erect position. At this stage of the dIsease the muscles of the shoulder and the thigh are f?und to be ~asted, except that the deltoid muscles, which form a kind of epaulette over the shoulders, become much larger. SO?O the muscles of the calf of the leg. Th~ symptoms steadily progress until the child becomes be.dnd~e~, and he often grows extremely fat as the result of InactiVity. . With another type the symptoms do not appear until. the third decade of life, that is between twenty and thirty,

FIRST AID & NURSING, NOVE MBER, 1948

and although no treatment has ~een found to effect a cure) the limbs. A fatal termination occurring within three to the progress of the d~sease can. oft~n be checked as !ong ~s four years. The condition is now treated on exactly the the patient takes qUlrune, whlCh IS usually prescnbed In same lines as pernicious an xmia-with injections of liver doses of 10 grains daily. extract-when a complete cure usually results. The Other forms of muscular atrophy develop in middle life p atient needs to be kept at rest in bed until recovery is well and these usually run a more rapid course, terminating under way, and he is then given exercises which aim at fatally in 1:\vo or three years. re-educating the muscles to carry out movements steadily In all these conditions the relief of symptoms that give and accurately. \'V'hen he first attempts to walk again he distress and patient nursing is, unfortunately, all that is may require to be supported by two people. Later, he can possible. But, as with all other chronic. disabling con- manage with sticks, and eventually he can walk quite ditions, a great deal can be done to make lIfe tolerable and unaided, but the liver treatment requires to be con tinued jnteresting by a nurse who has imagination and under- throughout life. standing. It is important to maintain muscle funCtion as EPILEPSY long as possible, and to prevent the patient from becoming bedridden by 'giving him every assistance in getting up and Epilepsy may affect persons of any age-from infancy to about. When he is no longer able to walk, a wheel chair senescence-and although the patient is not a chronic becomes a necessity. It is a common experience that with all progressive invalid in the ordinary acceptance of the term, the general diseases for which no cure has as yet been found that the management of his life requires care and thoughtful superpatient and his friends are apt to become the victims of vision. He may be subject to frequent minor fits with sellers or practitioners of" quack" remedies or treatments. occasional major ones or he may have minor or major This cannot altogether be g uarded against and one may epilepsy only. The fits may occur almost daily or at intervals argue that they provide interest and hope for a time, that of weeks or even months, and it is not unusual for them the patient makes a maximum effort on his own behalf and to occur only at night or when the patient is resting. When that the suggestive effect that something is being done is free from attacks the patient is usually both mentally and always helpful. But too often money is spent on such emotionally normal, but in some cases the temp erament treatments that would be much better expended on the may be altered. A child with epilepsy may become intractprovision of extra comforts or the relief of strain or anxiety, able, guarrelsome, untidy and most destructive with his by employing someone to undertake work that the patient toys or his clothes. In very severe cases commencing in is no longer able to do, although capable of supervising and childhood there' may be mental and physical deterioration, giving instruction; for example, domestic work, gardening the patient becoming dirty in habits, incoherent in speech and, finally, bedridden. or business procedures. Minor Epilepsy, or " Petit Mal" Arthritic Atrophy The attack may be only a momentary disturbance of Occasionally, a condition of rr..uscular weakness and consciousness with a brief, convulsive movement of the wasting occurs in arthritic patients, and when the arthritis face or hand, the patient then continuing his occupation has been treated, it is found that increasing exercise may or conversation where he left When consciousness is promote a re-development of the muscles and an increase lost for more than a few seconds he may not be able to in strength, whereas in other types of muscular atrophy proceed with his speech or action immediately, unless he exercise and massage do not influence the progress of the is reminded, and in some subjects normal consciousness disease. does not return for some minutes or even hours. During this period he may catry out acts in an automatic manner Pressure on Nerves or Arteries for which he is quite irresponsible and which may even A more hopeful type of muscle wasting and increasing contravene the law or cause him or others serious injury. loss of power in the upper limb may be due to abnormalities When consciousness finally becomes normal he may have of the first rib, causing pressure upon nerves and arteries. no recollection of his conduct during the" post-epileptic" The symptoms often commence when a change of occupa- period, but this automatism is not common in minor tion puts more strain upon the limb, for example, when a epilepsy. woman who had hitherto worked in an office undertakes rather heavy housework or a young mother begins to Major Epilepsy, or " Grand Mal" carry her baby on her arm. In early cases, a change of The attack is characterised by four stages: an aura or occupation coupled with massage and exercises of the premonitory stage, sudden Joss of consciousness with muscles of the shoulder girdle helps to elevate the shoulder rigidity, convulsions or jerky movements, and a postand so releases pressure. \'\!here this is not successful or epileptic stage in which the patient may sleep soundly or practicable, operative treatment often meets with complete undergo a phase of « epileptic mania" during which he is success. not responsible for his actions.

off.

Diseases of the Spinal Cord

General Management of the Epileptic By no means all of these diseases aye incurable. A good The patient should live as normll a life as possible, and deal of chronic invalidism resulted, at one time) from a this is especially important in children, who should attend condition occurring in middle life known as subacute school and be subject to ordinary discipline. Attacks degeneratior: o~ the spinal cord, the early symptoms of seldom occur during periods of mental concentration, WhiCh are tinglIng, coldness, wetness and swelling of the and even'intensive study does not bring them on. The feet and hands, increasing in severity and extending up general health must be kept at the best possible level, and

FIRST AID & NURSING, NOVEMBER, 1948

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FIRST AID & NURSING, NOVEMBER, 1948

this im-olves good food at regular mealtimes, healthful exercise, fresh air, adequate rest and avoidance of constipation. Alcohol should not be taken at all. Adults must not work under conditions jn which a Et may be dangerous. Fire, ,,-ater and machinery are the chief sources of danger to the epileptic. He should not swim, ride a bicycle or drive a car, and should take a bath only when someone is at hand who knows of his disability and can give assistance if necessary, for an epileptic can drown in a few inches of water. There is no reason why an epileptic should not marry, provided that the partner to the marriage knows about the condition and accepts the handicap. Transmission of the disease from parent to child is most exceptional. In se,-ere cases the patient is obviously unEt for marriage or for any normal life. Their employment presents difficulties, but an aimless existence often aggravates the condition; so that some kind of occupation should be

found. If mental deterioration occurs, institutional care may become necessary. The Use of Drugs There are several drugs that are most useful in controlling epilepsy, but they need to be taken regularly over a period of some years, and usually three times a day. The cruef among these are the bromides and phenobarbitone. There is no evidence that the prolonged administration of these sedatives have any harmful effect upon the patient's mentality. Most physicians give regular prescriptions to their patients, who generally carry the drug with them, in the form of tablets. It is thought that most of the lost phenobarbitone that forms the subject of broadcast announcements has been cc mislaid" by epileptics during the hazy period of the aura or during the post-epileptic stage. (to be continued.)

Nursing Correspondence Readers are invited to send their Nursing Problems for solution. Corresponde;zce should be brief and to the point and addressed to the Editor First Aid & Nursing," 32 Finsbut:y Square, LondoJZ, E.C.2. C(

The Taking of Aperients and Purges A. T. ( orwich) writes : -

should be taken on awaking and another on going down to breakfast. This meal should commence with fruit, (( I should be pleased to have some expert advice on the use of such as stewed prunes or Egs, half a grapefruit or an aperients and purges. Could you inform me on the best types and apple, and be followed by coarse oatmeal porridge and their comparative uses, also on the strength to use and the dangers other breakfast dishes as desired. The foods to be avoided of overdoses, if any." or limited are fried foods, pastry and cakes. Mter breakConstipation is by far the most common disorder of the fast an attempt should be made to empty the bowel. If digestive tract, but the taking of aperients and purges is purgatives must, at first, be taken, these should be in the never an ideal way of overcoming it. A balanced diet, minimum effective doses. Of the vegetable aperients the adequate fluid intake, a moderate amount of exercise and least habit-forming is cascara, and it may be taken in the development of a habit of regular evacuation are tablet form or as the fluid extract. The action of saline measures that are much to be preferred. Many people aperients can. usually be obtaine~ equally as well by taking become" bowel conscious," and it has been shown that adequate flUIds. Many advertIsements claim that these worry and anxiety with regard to bowel function often aperients are weight reducing, but the weight is lost leads to chronic constipation. merely by the loss of water, not of fat, and when the Practically all aperients are habit-forming drugs and they taking of the advertised substance is stopped the water is fall into two classes: The vegetable products, such as replaced in the tissues and the weight is regained. Two rhubarb, senna, aloes, cascara and castor oil, which act by substances are obtainable that neither irritate the bowel nor exerting an irritant effect on the intestines; and the cc salts," dehydrate the tissues. These are liquid paraffin and agarwhich act by osmosis, that is, they attract water into the agar. The former acts as a non-irritating ·lubricant. Its intestines from adjacent tissues. Bowel action is, normally, main disadvantage is that it tends to leak out of the bowel the outcome of the stimulus supplied by bulk in the lower and soil the clothing. Agar-agar is a dried preparation intes.tine, either of food residue or of fluid. The taking of made from seaweed. It can be given in shredded form or apenents causes an artiEcial stimulus followed by a comas a powder, the dose being one teaspoonful or more plete em~tying of the lower bowel and, consequently, no according to need. It is non~absorbable, but it takes up a nor.mal stunul,;!s to evacuation on the following day. If the large ~mount of water, formmg a soft, bulky mass. It is taking of apenents becomes a habit the normal function is sometimes made into an emulsion with liquid paraffin. gradually lost, by disuse, and this results in intestinal Many. proprietary preparations of agar-agar, however, stagna~ion .. Moreover, the hurried passage of food through contaill. a purgative drug which, is to a large extent, the di~estlve t~act prevents an adequate digestion or resp~nsIble .for their action, whilst the percentage of agarabsorptlon, partIcularly of minerals, vitamins and tissue- agar IS relatively small. building substances. Dyspepsia and other gastric disorders A Complaint of the Eye may follow. A. R. (London, E.c.) writes :_ Hot or ~old water taken on an empty stomach is an " I have recentlY had a swelling on the upper lid of my rye, excellent stunulus to bowel action, so that a glass of water rather like a stye~ Within 24 hours a white head formed in the

FIRST AID & NURSING, NOVEMBER, 1948

centre of the J).l)ellillg and) tlsing hot water and an f1.J'e ointli}ell!) I 1~las able to clear the Vie tip. l\.~011) a jriC1ld of mille ]lith nho/IJ I u'ork has the same thing. Is this coincidence, or is this kind of thing infectiom ?"

Un ijOYJlZ by

Styes and sinular condition usually denote a lo\\'er~d re, istance of the individual to infection, for the outer skin, or epidermis, normally contains t~e germ .t~at are r.esponsible. Their function is to help ill the diSIntegratIon and loosening of dead epidermal cells, ~o tha~_ they ~n be rubbed off by daily friction or by washing. \\ hen reSIstance is lowered these germs-of a species known as the stap0,lococctIS albus-penetrate into the dermis, or true s~, and cause inflammation and suppuration, the germ becorrung more virulent in the process. Infection could be spread only b~r direct contact during the d~scharging stage or by indirect contact through the medium of face flannels, towels or handkerchiefs. a that I should imagine that, in the case of your friend and yourself the cause was in a lowered resistance. Incidentally, your treatment was on very sound lines.

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Protective Materials T. B. (London) "writes :-

S.J.A. DRESS for Officers and Ambulance Sisters. Made from good quality Sanforized-Shrunk material. Bodice unlined.

" IFdl ),011 please settle all aJguJJletJt Oil ~he ad~'ljabilif.J' ~f tlSing rubber or 11),lon drawers for babies. I thmk I am correct 1Il expressing the opinion that plastic materials are equal!), harmjitl inasmuch as thry do 1Iot absorb lJIoistllre ."

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The purpose of using rubber or plastic drawers o:er a baby's napkin is entirely for the comfort and cr::m';T.en:en~e of the person holding the ~I:ild, or, ~vhen the child IS ill his cot or pram, to pre,-ent s01ltng the lillen and blan.kets. The result, to the baby, is that excretions are kept ill contact with the tender skin of the buttocks and thighs, and mar make this skin red and sore. The use of such waterproof materials is therefore inadvisable for routine practice, although fo~ a short p~riod on a special occasion, when it might .be embarrassing if the b~by: became "\\et,. suc~ protectIon may be regarded as l?errrus.s1ble. If a baby 1S :veJ trained from birth, by holding him out over a little receptacle before and after feeds, it is surprising ho\:' clean and dry he can be kept and how few napkInS are reqUIred.

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This is the sixth edition of Aids 10 Practical Sursing \yithin tcn year of its original publication and for this reason it requires no ,,·ord of praise from us, e\' en though it is pleasing to learn that it is bcing 0 , widely uscd and is serving so useful a purpose. EYer), effort has b~en made to keep the textbook up to date and in line \vith ch~g1t:g methods as these become established, and time will proye that It wtll continue to be useful to new students by proyjding a sound knowledge of tbe art of nursing as an introduction to the most essential part of their training. The book opens with a most interesting history of nursing from tbe earliest days down to modern times, and it is pleasing to find reference to the part played by the Order of St. John, the St. John Ambulance Association, and the Voluntary ursin~ ~~rps under which titlc the authoress evidently designates ursing DIVISJOD of the St. John Ambulance Brigade.

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FIRST AID & NURSING, NOVEMBER, 1848

FIRST AID & NURSING, NOVEMBER, 1948

Queries and Answers to Correspondents I.-All Queries must be accompanied by a "{2uery Coupon." cut JrotJ1 the current issue oj the Journal, or, tn case ojQuenes Jrom abroad, Jrom a recent issue.

Elevation of the upper limbs above the head causes enlargement of the chest cavity and consequently expansion of the lungs. When this happens pr~ssure on the v~nae 2.-The Textbook to which reference may be made in this column cavae (the large venous trunks) at then entry to the nght is the 39 th (r937) Edition oj the S.J.A.A. Manual of First side of the heart is lowered, with the result (r) that these vessels dilate, (2) that the return of venous blood to Aid to the Injured. the heart is facilitated, and (3) that the bleeding from the Carriage of Stretchers nose is lessened.-N.C.P. R. T. (Moulton).-In the General Rules Jor Carriage of Stretcher Definition of "Pressure Point" (Textbook, page 224), 2ve are told to carry the patient Jeet S. (Swindon).-It is a curious Jact that the Textbook does Joremost, 1vith three exceptions. It seems to me that it would not attempt to define a pressure point. So in our difficulty be advantageous, as a general rule, to carry patient head foremost. we ask you kindlY to solve our problem . All who hmJe had experience oj carrying stretchers know A pressure point is the exact point along the course of that the Bearer at the head tires long before the other Bearer, an artery at which the onward flow of blood through the and it is 110t ea.f.J for the rear Bearer to call a halt 1vhene2Jer desired. Also, although carrying the heaviest portion, he vessels can be most effectively stopped by digital or instrumental pressure.-N.C.F. cannot see the ground so as to overcome obstacles. It will also be noted that in lifting and lowering, the Bee and Wasp Stings forward Bearer governs the rate oj motion and owing to the lightness of his load he has a tendency to go too Jast Jor the S. T. (Crawley) .-To settle a dispute ~'}Jill you please give the correct procedure for treatment Jor bee sting and wasp sting ? other Bearer. Besides, any prqjection, such as splints, is not Also willyou please give the name of each sting and ifpossible easilY evaded. The suggested change would correct this. the chemical Jormula ? Another advantage is that on arrival at the ambulance the patient 1vould be in a position Jor loading, and so the present In the treatment of stings by bees or wasps you cannot movement would be avoided. It would also enable a better do better than follow the instruction in the Textbook. watch to be kept 011 the patient's general condition, which These will be found effective for either type of injury can now on(y be done by glances backward oj the spare and in actual circumstances it would be extremely difficult Bearers. I notice that in the R .A .M.C. Manual oj Training it in most cases for the first-aider to decide for or against states that 1JJhen shoulder carrying, patient is to be carried stings by bee or wasp. The exact chemical constituents of head first, but ,vhen he is borne at arms length he is to be the poison injection is of academical interest only and cannot assist first-aiders in their work.-N.C.P. carried Jeet Jirst.

I shall be interested to learn ifyou consider this Rule should Foreign Body in Stomach be amended. In stretcher carrying the main obj ect is the comfort of U. M. (Cardiff).-Please tell me what is the best first aid treatlJIent for a person ,vho has swallowed a pin or a needle ,vhen the patient and not the convenience of the Bearers. Conmedical aid is not available. sequently my advice is that if you adhere to the instructions of the Textbook you cannot go far wrong.-N. CORBET Since there is no immediate danger to life or part, except PLETCHER. from attempts to make the patient vomit or by administration of aperients, no first aid is indicated. The patient Examination Howler should be told to keep quiet or if a child to go to bed O. B. (Exeter).-In a recent ,examination I asked one candidate until medical aid is available. If this be long delayed no what in his opinion is the most important point in the treat- harm can result from giving stodgy food or perhaps sandment of a patient suffering from bleeding Jrom the nose. wiches composed of thin slices of bread with a layer of I confess I was staggered when he replied" I would tell patient cottonwool between the slices.-N.C.P. to stop breathing ! " Good! Next please! !-N.C.P.

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'FIRST AID

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nose-bleeding) we are told to place patient's hands above his head. Several of us discussed this question recentlY but no one could supplY the answer, so we decided to submit it for our kind explanation.

To be cut out and enclosed with all Queries. Novem ber, 1948.

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Treatment of Nose-Bleeding L. P. (Shoreditch). - Please tell me why, in the treatment of

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MANUALS OF FIRST AID

TWO ·BESTS ,-----------------•

By N. CORBET FLETCHER, O.B.E., M.B., B.C., M.A. (Can tab.). M.R.C.S.

AIDS

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EffiCIENCY IN FmST-AID.

COMMON

Price 6d •• post Id.

"Without doubt the book will be 0/ great .ervice in the training of thos< jor whom it designed. "-British Medical Journal.

Articulated & Disarticulated

ERRORS

FIRST-AID. Third Edition. 6d.. pOst Id. Error. in Fird-Aid Detailed and Explained. " This book givu a clearer insight int. the method. and di/liculties of emergmeu treatmtnt bu lavmen than the offieial TextboQit itself. "-Lancet.

AMBULANCE COMPETITION TESTS. Stretcher. Individual and Question-Si« Folders. Price 6 for 1•• 6d •• post 3d. Each Folder contains special article on CompGtitions: No. I. Training of Corppetiti(}n Tearns:. f'Jo. 2, Conduct of Team i.n Competition Room; N o.3. Common Errors in CompetllJon; No.4. Further Errors In Treatment; No. S. History of Competition Tests' No.6. Preparatio" of Tests. •

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FIRST AID & NURSING, DECEMBER, 1948

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FIRST AID & NURSING Editor: DALE ROBINSON, F.R.S.A., F.S,E.

tension in the apprehensive patient may N ervous frequen tly give rise to a headache 1Chich has no relation to the underlying condition but which may well retard the benefits of specific treatment.

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PRINCIPAL CONTENTS Editorial

A Course in Advanced First Aid

The Medicine Chest

Nursing Correspondence

News from all Quarters The Lungs & Respiration Topical Notes for First Aiders & Nurses The Tuberculous Patient in the Home Queries and Answers to Correspondents

8 10 11 12

NOTICE TO READERS.

LONDON

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Editorial Elementary Medicine WE are glad to announce a new series of articles by Dr. Belilios to follow his course of Advanced First Aid which is concluded in this issue. It will be entitled " Elementary Medicine," and will deal with a number of ailments which all students of first aid and elementary nursing hear about in their daily lives. The series begins by discussing the causes of disease and the importance of germs, and continues by describing such ailments as the common cold, bronchitis, pneumonia, diseases of the heart, etc. Dr. Belilios informs us that a course of lectures on this subject has been given at the Wimbledon Technical College for several years. It has proved popul~r and certificates have been awarded to successful candidates. We are sure that the new series will be as popular with our readers, and be just as interesting and instructive as the series just concluded. We believe there is a real need for such instruction in conjunction with the training of first aiders and nurses. Of c~urs:, there will be critics who will say that It IS wrong to teach these diseases to laymen; that the doctor should continue to remain a man of mystery, and the public should be kept III-informed, just as in the past there was opposition from many, doctors and otherwise,

on the teaching of first aid and home nursing. This attitude, although it still prevails in some quarters, is pathetically out of touch with the times. There is a tremendous amount of interest taken in these subjects, and it is by no means a morbid interest as some people contend. Certainly the interest first-alders take in the subject ,Is anything but morbid; in fact, their keenness and enthusiasm ensure that instruction cannot fail to do good. The little knowledge theory has been explodedlook at the Radio Doctor, for example. Everyone will agree' that he has done a lot of good, and has emancipated those who for many years have been teaching on those lines, introducing medicine almost surreptitiously into their lectures on first aid and home nursing, a step which has sometimes been frowned on by the official organisations. We may remember, however. that the Red Cross have given the subject the measure of their bleSSing, and have, for example, published a manual of tuberculosis in which the complaint is well described. We feel certain that Dr. Belilios' new course of articles will be most useful to our readers, and will be widely welcomed. Any contribution from that able pen is likely to be a valuable feature, and in this case th~ subJe~t matter attaches special interest. The first article will appear in our next Issue.

FIRST AID & NURSING , DECEMBER, 1948

A COURSE IN ADVANCED FIRST AID BY

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

POISONS-(conc/usion) Poisoning from Gases and Fumes

mine or tunnel or in one of the factories where carbon the previous article it was mentioned that poisoning dioxide is used. The gas is employed for many purposes, caused by the inhalation of gases was not uncommon. for example, the manufacture of effervescent drinks, beer The subject is a big one and can only be briefly described and other products . It is also used as a fire extinguisher in an artlcle of this kind ; nevertheless, it is of considerable and to produce cold. In the severe cases, marked shortness importance to first-aiders in whatever sphere they work of breath accompanies headaches and the patient sweats and particularly to those who a :e employed in factories. profusely; soon he becomes unable to stand and passes In addition to the gases such as carbon dioxide and into coma. carbon monoxide, which will be described, it must be Carbon Monoxide is also a colourless and odourless gas remembered that many chemicals give off fumes which but much more harmful in its effects on the human body may be inhaled. Some chemicals are more volatile than than carbon dioxide. It is present in the exhaust fumes of others, i.e., vaporise more quickly, hence poisoning through motor cars and in the fumes given off by coal, coke and inhalation may be acute or chronic. The acute cases may charcoal stoves. It is the chief ingredient of coal gas, result from the more volatile chemicals such as trich- which, however, is supplied with a distinctive odour so lorethylene when, for example, the patient inhales a large as to lessen the risk of poisoning should an escape occur. dose within a short space of time. Various gases employed in industry for heating purposes Chronic cases occur when a worker repeatedly inhales contain a high proportion of carbon monoxide, for example, small quantities over a prolonged .period of time. The producer gas and water gas. effects of the repeated inhalation of a vapour naturally It is not surprising, therefore, that poisoning from carbon vary consjderably. Some chemicals, such as Benzine, affect monoxide is relatively common both in civil life and in the blood. Trinitrotoluene (T.N.T.) affects the liver while industry; about 200 cases occur yearly in the factories alone. workers who use mercury are liable to develop in the Carbon monoxide affects the human body through its course of time a series of symptoms which include action on the blood where it combines with the hremoglobin tremulous movements of the fingers and other parts of the (red colouring matter) in the red blood corpuscles causing body, inflammation of the mouth and gums, and a form of them to become unable to carry oxygen round the body. nervous debility which causes the patient to become The symptoms of poisoning include giddiness, tightness depressed and to sleep badly. of the chest, headache, loss of use of the limbs and unconFirst-aiders are chiefly concerned with the acute cases of sciousness . Sometimes, however, warning symptoms are poisoning which occur when workers or others are suddenly absent and the first sign may be sudden collapse. overcome by fumes or gases. Nevertheless, those who work An important feature of poisoning by carbon monoxide in factories are sometimes given the job of keeping an is the cherry pink colour of the complexion. This eye on the workers to see if they are becoming affected by characteristic must never be forgotten since most cases of the chemical employed. Under factory regulations, workers in certain dangerous trades have to be inspected by a ~sphyx.ia are associated with cyanosis. If, therefor~, a responsible person at regular intervals, and unless the first-aider rescues a patient from a gas oven he m1ght assume that the cherry pink colour was a good sign; in factory employs a nurse that" responsible person" may actual point of fact, the pinker the patient's colour the more be the first-aider. It will be appreciated, therefore, that serious the case. industrial first-aiders should familiarise themselves with Hydrocyanic Acid (prussic acid) is a gas which smells like those chemicals which are used together with the symptoms and signs liable to occur both in acute and chronic cases of bitter almonds . When inhaled it rapidly produces death. poisoning. In addition, various preparations of prussic acid, called In this article it will be only possible to describe acute cyanide, are equally poisonous. They are used for various cases, taking, as examples, some of the commoner gases purposes in industry. which are used. Symptoms and signs occur within a few seconds and Carbon Dioxide is a colourless gas without an odour; include pain over the heart, palpitations, giddiness and it is continuously produced by the human body in the mental confusion. The patient rapidly becomes unconcourse of its action and is removed by the breath. The scious and convulsions precede death . ill ~ffect~ that it causes when inhaled are occasionally Chlorine is a well-known gas to those who have studied not1ced ill everyday life when individuals are crowded first aid in chemical warfare. It is one of the lung irritant together in a badly ventilated room, but the symptoms poisons . Within a few seconds of inhaling the gas, the pro~uced are ver~ mild, comprising headache and a feeling patient begins coughing, spluttering and panting for of disc?mfort WhlC~ soon pass off when a patient gets intu breath. There is pain in the chest and a feeling of suffoca?pen au. More senous symptoms will result if the patient tion. The eyes and nose begin to run and discharge 1S e:ll.-posed to a higher concentration as may occur in a copiously. Sometimes, after the patient has recovered

FlRST AID & NURSING, DECEMBER, 1948

fro m the immediate effects, more serious symptoms and (r) Removal.-The patient must be speedily removed signs fo llow and are caused by dropsy of the lungs. from the source of danger. The first-aider!' must take Chlorine poisoning occurs amongst those who work precautions to protect themselves from the poisonous with bleaching powder or other substances which contain fumes . Removal should be carried out with the patient the gas . A few years ago, two cases occurred from cleaning in the recumbent position, i.e., on a stretcher or by the lavatory pans by the use of chloride of lime and hydro- method known as the drag-carry. chloric acid. (2) Artificial Respiration.-If the breathing has ceased Nitrous Fumes are a danger in some factories . They are or appears to be weak and irregular, artificial respiration produced in various industrial proces~es and also giv.en off should be performed. It should, however, be avoided when nitric acid is exposed to the au and reacts wlth an whenever possible, in case3 of poisoning with the lung organic material as, for example, if it is spilled on a wooden irritants . floor. (3) Inhalations of Oxygen.-These are of great value and The effect of the fumes is similar to, but more dangerous when the Novox apparatus is available it should be than, chlorine for the initial symptoms such as irritation of employed. the eyes and throat, cough and ~ightness of the chest ~ay Oxygen is generally given in combinat.ion with carbon be so slight that they pass unnoticed. After a latent penod dioxide, a suitable mixture containing 93 per cent. oxygen of some hours, however, the symptoms may return, the and 7 per cent. carbon dioxide. In cases of poisoning with cough increasing in severity and being accompanied by carbon monoxide, inhalations of oxygen should be kept up difficulty in breathing. D ropsy o[ the lungs develops, the for three hours after the breathirlg has become normal. patient becomes cyanosed and his heart embarrassed. In (4) Shock.-Of particular importance in the treatment of severe cases, unconsciousness precedes death. poisoning due to gas is the p~ovision of warmth and res~. The patient should be kept lymg flat except when there IS Gases Evolved from Solven ts The name solvent is given to a liquid which possesses marked difficulty in breathing necessitating the" head and the power of dissolving another subst.ance. ?olvents are shoulders raised" position. A long rest is most im120rtant of considerable importance in numerous mdustnal processe~. in cases of poisoning by nitrous fumes and also ~1~h the Thus, trichlorethylene, a solvent for fat and grease,. IS lung irritants owing to the risk of a relaps.e. The glVillg of employed in many factories and also in the dry-clearung fluid drinks, etc., should be undertaken as ill cases of shock. (5) General Principles.-All the usual general principles . ' industry. Many of the solvents are highly volatile and theu fumes for the treatment of asphyxia should be applied as far as possible. It is essential to maintain observation of the extremely poisonous. . . .. . A purified form of trichloret~ylene, ca~le~ tnlene, IS .u~ed patient in case of a relapse. The treatment of poisoning by prusslc aC1~ and cyanIde in medical work as an anresthetlc, hence It 1S not surpnsillg that the effect of trichlorethylene on the body is similar to differs somewhat from the above. If the pat1ent has been that of a narcotic. Even short exposure to the fumes gassed by prussic acid itself, artificial .respiration must be . produces a condition known as trichlorethylene intoxi~ation. undertaken immediately, whether breathing has ceased or not, The patient becomes very drowsy and complaills. of while stimulating measures such as .dashing cold water on headache and giddiness; he may. develor a heavy fee~ng the spine can be adopted. Inhalations of o~ygen are of in his back and have difficulty 1n standing or speakIng value. If a cyanide has been taken an e~et1c should ~e coherently. Nausea and, vomiting may follow and ur~ess given whenever there is time. The ant1dote 1S photographic speedily rescued from the source ?f danger, the. patient hypo, dose, half teaspoonful in a tumblerful of water. may pass into a state of coma and dIe fro~ asphyxIa. . This instalment concludes the series " A Course in Advanced Various other solvents, mostly possessmg long chem1cal First Aid." Next month Dr. Be/ilios commences a. fmv and names have similar effects on the body. FIR;l' Am.-All cases of poisoning cau.sed by ~he interesting series Ofl " ElelJl'tJ~ary 1\1edic~tJe." E.ach 2fJsta~meJJt inhalation of poisonous fumes are treated m a SImIlar will comprise a c(jmplete artlcle. An mtroductlotl appealS on page 3 of this issue. manner as follows :-

The Medicine Chest By FRANK BERRY, PH.,C.

consists chiefly of Sodium Sulphate. An artificial Carlsbad Salt may be prepared by mixing together : . Sodium Sulphate dtled 22 grains Potassium Sulphate... I grain Sodium Chloride 9 grains colocynth. . . Sodium Bicarbonate... IS grains Together with caraway and cinnamon, cardar~lOm.s are an ~ngredlent The above quantity is equivalent to approximately one pint of the of the Compound Tincture of Cardamoms whIch IS extensIvely used natural water. as a medicinal flavouring and colouring agent. Ca rron Oil . S tl d Carlsb a d Salt This preparation: named after the steel works at Carron ill co an This is he mineral constituent of the aperient Carlsbad Water. It

Cardamoms These are the dried, ripe seeds of a plant which grows i? Southem India and Ceylon . They have useful carminative properties and are often prescribed in conjunction with purgatives such as aloes and

6 where it was first used, is made by shaking together equal quantities of Lime Water and Linseed Oil. The resulting creamy liquid was at one time a very popular dressing for burns but is now seldom used. Cascara Cascara Sagrada (Sacred Bark) is the dried bark from small trees which grow on the Pacific Coast of North America. The bark is collected in spring and early summer and must be stored for at least one year before being used medicinally. During this storage period chemical changes take place, certain undesirable properties associated with the unmatured bark disappear, and its medicinal value is thereby greatly enhanced. Cascara is a mild laxative which acts directly on the large intestine and is particularly useful in cases of chronic constipation especially when associated with ha:morrhoidal and allied conditions. It is usually administered as an extract. Liquid Extract of Cascara is made by extracting from the coarselypowdered bark all the water-soluble matter, concentrating to suitable volume by evaporation and adding sufficient alcohol to preserve the product. Dose, t to I teaspoonful. It may be given direct as liquid or enclosed in soft gelatine capsules. Many compound laxative mixtures include extract of Cascara as an essential constituent, its bitter taste often being minimised by inclusion of magnesia or masked by addition of liquorice, aniseed, coriander, saccharin or glycerin. Dry Extract of Cascara is made by carefully evaporating the liquid extract to dryness under controlled conditions of temperature and pressure. The average dose is 2 grains, usually presented in the form of sugar-coated tablets. Doses up to 8 grains may be taken if necessary. There are many compound formula= for aperient or laxative pills and tablets. These usually include Dry Extract of Cascara with the addition of one or more of the extracts of aloes, belladonna, ginger, nux vomica, podophyllum or rhubarb. Cascarilla This is the dried bark of a small tree indigenous to the Bahama Islands. An infusion of the drug is used as an aromatic bitter tonic. Casein This is the chief protein constituent of milk in which it is present to the extent of 3 to 4 per cent. and from which it is precipitated as a clot or curd by the action of acid or rennet. Soluble casein may be prepared from casein by treatment with alkalis and is available for medicinal use as a yellowish white, watersoluble powder which has a characteristic taste. Casein is rich in those amino acids which are essential for satisfactory nutrition of the body, and is a vital ingredient in many infant and invalid foods. By suitable treatment with acids or enzymes the casein molecule may be partially split into its component amino acids and the resultant hydrolysate forms a useful basis for amino acid therapy. Such therapy provides a substitute for whole protein food and is of value in treatment of patients who are unable to ingest or absorb protein because of severe gastro-intestinal or allied disease, such as gastro-enteritis, ulcerative colitis, general peritonitis, or intractable peptic ulcer. Protein hydrolysates, of which hydrolysed casein is a typical example, are prepared botb for injection and oral administration. This amino acid therapy has been proved capable of saving lives in the late stages of starvation and in recent years has been extensively employed in treatment of exhausted victims of concentration-camp starvation diet. Cassia Bark This is obtained from an evergreen tree which grows in Eastern Asia. It closely resembles cinnamon and has similar antiseptic and carminative properties.

FIRST AID & NURSING , DECEMBER, 1948 Cassia Pulp This is obtained by extraction from the pods of a leguminous plant native to India but cultivated in many parts of the tropics. It has a prune-like odour and a sweet taste due to its 50 per cent. sugar content. It has a mild laxative action and is an ingredient in Confection of Senna. Catechu This is a plant extract rich in tannin and is a powerful astringent useful in treatment of diarrhoea, bleeding from the alimentary tract and for relief of relaxed sore tbroa t. It is given in form of Compound Powder or Tincture often associated with other astringents or sedatives. Caustic Potash See Potassium Hydroxide. Caustic Soda See Sodium Hydroxide. Celery The dried ripe fruits or seeds of the cultivated celery are used in making a decoction which is a common domestic remedy for rheumatism. The oil extracted from the seeds is issued in pill and capsule form as a nerve stimulant and anti-rheumatic. Cetyl Trimethyl Ammonium Bromide (C.T.A.B.) This is one of a group of compounds which have the property of depressing the surface tension of water and therefore Bnd application as wetting agents, emulsifiers and detergents. A one per cent. solution of this substance in water is soapy to the touch and forms a good lather. In view of its destructive action on many bacteria it has been used in hospital practice as a cleansing agent especially in cases of burns or wounds where the surrounding skin is ingrained with dirt or soaked in oil or grease. It has also been used to sterilise surgeons' hands in gloveless surgery and for securing a sterile area for operative procedures. Cerium Oxalate This is a slightly pink, odourless and tasteless powder. It is used in treatment of chronic vomiting especially when associated with pregnancy and is given in form of powder or cachets. Dose, 2 to IO grains. Chamomile Chamomile consists of the dried flower heads of the chamomile plant. These are often used externally in form of poultice or formentation for relief of inflammation. An infusion is taken internally as a bitter to improve the appetite and aid digestion. Charcoal Charcoal is obtained by burning wood such as willow, poplar and beech with as little air present as possible. Charcoal has a remarkable power of adsorbing gases and certain other substances. It is used medicinally in form of powder, lozenges, tablets or biscuits for treatment of dyspepsia associated with stomachic or intestinal distension. Charcoal is often prescribed along with pepsin, bismuth, soda or kaolin. In view of its adsorption properties, finely powdered charcoal may usefully be given in many cases of poisoning, especially with poisons of vegetable origin such as strychnine, morphine and most poisonous seeds and berries, and some mineral poisons such as corrosive sublimate. In such cases it may be given in water in unlimited quantities. A more highly adsorbent type known as Activated Charcoal is obtained by heating thc ordinary variety in steam or certain other gases and subsequently drying. Activated Charcoal was used as an adsorbent in war-time respirators and finds many industrial applications in p1lrification and decolourisation of chemical and medicinal products. (/0 b~ (Qnlinlled.)

FIRST AID & NURSING, DECEMBER, 1948

N nrsing Correspondence Reade~s are invited to send their Nursil7g Problems for solution.

Correspondence should be brief and to the pomt and addressed to the Editor" First Aid & Nursing," 32 Finsbu,:y Square, London, E.C.2.

Control of Weight of Unborn Infants Chilblains B. J. (Ilford) writes ; T. M. (Royston) writes ;" I am interested in the pre-natal treatment, currentlY mentioned, ." EvelJl J'ear about this time) tl0' two children) ,vho nvrmal!J that is used to control the weight and size of unborn infants. Call elljOY p'erfect !Jealth) suffer with chilblains on hands and feet. It you give me an outlinp of the diet, etc.) that achieves this resttlt ? " seems lmpoJszble to prevent them-I hat-'e tried courses of calcium Seeing that pregnancy is a perfectly natural condition, and cod liver oil) withcut success) but I wonder if you can advise no pre-natal treatment should be given to control the me of some effective treatment? " weight and size of the child, other than the ordinary The very multiplicity of drugs and other substances that sensible management of the life and diet of the expectan't have been advertised for the prevention and cure of mother. Some young women believe that the smaller the chilblains is, in itself, an indication of their inefficacy. baby the easier the birth, but this is by no means true. The There is no satisfactory explanation of their occurrence or baby will probably be smaller when the mother's diet had of ~he ~ction. of remedies. Experience suggests that been inadequate, and recent studies have shown that calclUm 1S of unportance, but how or why it exerts an adequately nourished women have fewer complications influence is not known, and blood tests show no abnorduring pregnancy and labour than do inadequately mality in calcium content of persons prone to, or suffering nourished women, even though their babies are longer and from, chilblains. Cod liver oil is taken for its \Titamin heavier and the general health of the babies is much content, and this is important for general health. Artificial superior to that of babies born to mothers whose diet has sunlight treatment appears to be very helpful in some been poor during pregnancy. If carbohydrates-starches cases, particularly if given in the autumn prior to the and sugars- are taken in excess of the body's needs they onset of chilblains. It should be given to the whole body. may be stored as fat; and any undesirable gain in the In many children's and general hospitals artificial sunlight mother's weight or the development of an overweight clinics are held in the physiotherapy department, a number baby may result in a cli1Iicult labour. of children sitting in a ring around the sunlight lamp, clad The extra food requirements in pregnancy are indicated only in bathing drawers and goggles. A few minutes by the additional ration book that is issued to every irradiation is given to the front of the body and then the expectant mother, which entitles her to one extra pint of children turn round and the back is irradiated. It is milk daily, 50 per cent. more meat and cheese and an important, at all times, to keep the extremities warm, for extra allocation of both shell and dried eggs. In addition, all other methods fail if this is neglected. The children orange juice is supplied by the local Food Office and so should sleep in a warm bed. Flannelette sheets might be is cod liver oil, which may be taken in liquid or in capsule used, and arms and legs must be kept under the bedclothes. form as preferrecL These extra rations supply all the Thumbsucking additional factors that are of importance in order to ensure D. L. H. (Streatham) writes ; the health of the mother and a good start in life for the " lHy JOIl) who is nc,w 3 )'ears of age) cUIlstant!;' sucks his infant. The amazing improvement in the development, health and contentment of babies that has been so evident thumb. Is this practice harmful? ~f so) how would )'(;1{ advise during the past nine or ten years is an unanswerable me to stop it ? " Thumbsucking usually starts in infancy because the baby argument for the adequacy of pre-natal food priorities. is bored and when he begins to get about under his own steam he finds so much of absorbing interest that, usually, Morning Headaches he forgets to suck his thumb. \\Then this habit persists it A. S. (St. Albans) writes : " Will you please ask jlour tlTsing Correspondent if she call is often found that, with the thwnbsucking, there is some offer any reasoll as tv why) after an exceptional!J cold night) J correlated habit with the other hand, such as pulling an wake up with a splitting headache. J always sleep with tlJe ear or a lock of hair, and this is done quite unconsciously. windvws wide open and seem to wake up )'pith mjl boc!J1 very warm It is sometimes easier to prevent this correlated habit than and head cold, which of cl-urse under the circ",mJtances is qllite to prevent the thwnbsucking itself, but the latter usually stops with the cessation of the former. 0 force should be understandable." The only reason I can suggest for the headaches is the used to prevent these habits, but the c~ld should ~e marked difference in temperature between the body and helped and his co-operation gained. The Wise parent will the head, which may cause variation in the circulation with divert the child's attention whenever he commences to suck resultant ana:mia or congestion of the brain. Is the bed his thumb by giving him something else to do, or. by 0 allusion to the thwnbsucking in a draught that could affect the head ? D oes the headache playing with him. pass off shortly after getting up and moving about, when should be made. In time, the child forgets about it ; whereas the circulation is more equalised ? If so, my theory may be constant admonitions to desist merely focusses his attention . correct. In any case, one is always conscious of a certain upon the habit. Apart from its social aspects, thumbsuc~illg can be a degree of tension in a cold area of the body, and I should suggest that unless the hair is quite thick a small shawl potential cause of deformities of the jaw, WhICh becomes so might be placed over the head and of course, any draught narrowed that the teeth are too crowded, as a result of which the front ones may project in an unsightly manner. should be excll,lded.

FIRST AID & NURSING, DECEMBER, 1948

News From All Quarters Hampshire (Isle of Wight Area) resume of the history of the Order. Major THE ST. JOHN AMBULANCE R YDE E. S. B.ur~ Hamilton, M.C., O.St.]., F.R.C.S. AMBULANCE DIVISION (Commlss~oner No. IV District), who was First aid a~a~d.s to members of the Ryde accompanIed by Mrs. Burt Hamilton, responBRIGADE. Ambulance DIVISIon and the Isle of Wight

ded to the toast of the Order. County Nursing Division were presented by the Surgeon Dr. E. M. McAlpine, O.O.St.J., Mayor of Ryde (Councillor S. R. Bird) at a proposed the toast to the guests. The Chief Prince of Wales's District Social held at Ryde on Thursday, lIth Constable of Liverpool, Mr. C. C. Martin 86 (HORSEFERRy) DIVISION November. The County Commissioner, Dr. (President. of . Liverpool "A" Corps) was The w inter programme promises to be both F. ~. B. H. Kennedy, M.B.E., O.St.]., J.P., present. wIth hiS wife, and responded with a preslde.d and opened the proceedings by very witty speech. Among the guests were interesting and instlllctive. On 18th October Mr. W. Whitechurch extendmg a hearty welcome to the Mayor also Asst. Commissioner W. H. Gastall L.S.A., gave a talk on "The Blood," and and Mayoress, Councillor S. R. and Mrs. D.C.M., B.Sc., F.R.G.S., and Major Spence; brought along a complete transfusion apparatus Bird. (District Secretal),). Over 130 Officers and Awards were then presented as follows ; - fnends were present and enjoyed the dancing to illustrate his talk. Next time we give a RYDE DIVISION pint of our blood, we shall at least know how and whist which followed. The Officers' Labels; J?iv. Supt. A. Maybury, Cadet Mess Committee, who were responsible for our particular .blood-group is determined I Saturday, 13th November really combined Supt. L. Rider, Sgts. A. Bushell and J. the arrangements, were congratulated on the business with pleasure. Twelve of us (drawn Sparshott, Cpl. R. Oxford Privates Jenkins success of the everting. both from members of the Division and from H. Adams, G. Scovell, F. 'Petty, R. Prescott' the G .L.c.c. first-aiders) were taken on a A. Hodges, D. Jolliffe and Mr. H. Collyer. ' BARKER CADET CHALLENGE SHIE LD Nine Ambulance Cadet teams from LancaVoucher; Private R. Caws. conducted tour of the Lecture Rooms and shi!e competed for the Barker Cadet Challenge Museum o.f .the Royal College of Surgeons. 1. W. NURSING DIVISION Shield on Saturday, 27th November 1948 Voucher: Amb. Sister E. Comben. Mr. T. WIllIams, who very sportingly gave Exchange Divisional Headq~arters' Certificate: Amb. Sisters J. Nash, M. Anson at up one of his afternoons off to show us around ' Liverp?ol. He~ton Park (Manchester) wer~ exp!ained v~ry clearly, and in great detail, th~ J. Hall. St. John Ambulance Association First Aid the wmne!s WIth West Derby (Liverpool) varIOUS exhIbIts. On Monday, November 15th Mr. H. Certific4 te : Mr. L. Ballard, Mr. H. Coffen, and ArdwIck (Manchester) second and third respec~i vely. The co mpetition was organised Anderson, F.R.C.S., came along to Harwood Mr. R. Raynor. The County Commissioner then presented by DlV. Supt. L. R. Lewis, S.B. Corps Terrace and supervised a team of members who dealt with a typical industrial "accident." Warrants of Appointment to Div. Supt. A. Surg~on G. C. Wallace Hay, S.B., was the He e~pressed his approval of their work, and Maybury, Amb. Officers J. Jolliffe F. Bartrum examIner for the individual test and the ' team test was set and judged by Co~ps Officer promIsed to come along on November 29 t h Sgts. A. Bushell and J. Sparshott.' In presenting the Warrant to Div. Supt. A. W. H. Walker. to lecture to the Division. ~aybury the County Commissioner paid high tnbute to this Officer, saying that they Leicester and Rutland Berkshire were v~ry fortunate in having him as their READING About 80 Officers and Cadets attended the Officer In Charge. He had proved himself a On Saturday November 20th a First Ald good leader and had set a high example in ~emembrance Day Serv ice. The parade was Competition v;as held by the St. John Ambu- Iu:o~ledge of first aid. The County Com- ill charge of Co unty Cadet Officers Mr. E. lance Association for the George William ~s~I<?ner also paid high tribute to the Heywood Smith and Miss E. L. Wollaston. Brc:un.stone Cadet Nursing Division.-Parents' Palmer Cup. The winners were the Great DIVISIonal Secretary, Sergeant J. Sparshott. W~stern T eam N o . I, captained by V. O. Dlv. Supt. A. Maybury then proposed a evenmg and enrolment ceremony was held on Cnpps (Great Western Ambulance Division very hearty vote of thanks to the Mayor of November 17th. County Cadet Officer Miss E. L. Wollaston enrolled six Cadets at their S.J.A.B.) and the runners-up the tea~ Ryde for presenting the awards. captamed by D . J. Davies (Reading Town Sgt. J. Sparshott then proposed a very new headquarters. Leicester Cadet ]\-lursing D ivisioll.- A "Bring "A" Ambulance Division, S.J.A.B.). There h~arty vote of thanks to two Ambulance was also a Pairs Test which was won by SIsters of the Island Nursing Division- and Buy" Sale on N ovember 20th was opened G: T: Davis and ]. Emmons (members of the J. Hall and J. Nash-for the valued assistance by County Cadet Officer Miss E. L. Wollaston wJ?ll111g team). The cup and individual they had given to the Division during the and presided over by their Superintendent' prIzes were presented to the winners by past year. Miss D. M . Poole: Result was about £3 0 . ' County Commissioner Mr. e. A. Poole who S.outh Wtgslon Student Nursing Division.-A At the close of the presentation a bouquet also . handed his badge of office to' Hon. of chrysanthemums was presented to the SOCIal evening was arrang ed on November President,. Reading Corps, Lt.-Commander Mayoress by Joyce Sparshott, the 9-year-old 20th to celebrate the recent achievements at W. Mornssey. The Team and Pairs Tests daughter of the. Divisional Secretary. the National Cadet Competitions. The chair we!e set and judged by Dr. C. A. Boucher Th~ preser:tatlon was followed by a Social was taken by County Com. G. F. Browne. (DIV. S.u~g~on, Reading Town "B" Ambu- EvenIng which wa~ thoroughly enjoyed by lance.DlvlSlon), Dr. ]. Hazleton (Div. Surgeon, m~mbers of the Bngade, their families and Lincoln Readmg Town ~'A" ~bulance Division), fnends. and Dr. W. Talt (DIV. Sur~e.on, Reading STAMFORD DIVISION Great Western Amb~lance DI.vlSlon). During Lancashire T~e annual parade service and dedication one C?f the tests, which consIsted of treating serVIce of the new ambulance was held a . child supposed to have fallen out of a LIVERPOOL recently. wmdo~, the ~xamining doctor was called to The fir.st annual dinner since the war, of the T~e Mayor (COllO. Bernard Clarke, J.P.) a genUIne aCCIdent of a child who had fallen Bngade m Liverpool, was held on Saturd.l}' preSided, supported by the Mayoress, the from a window. The "patients" for the November .zoth in Liverpool. ' Marquess of Exeter and the Marchioness of tests were members of the Casualties Union. The PreSIdent of the Officers' Mess, District Amo?g those present were the Mayoress of Officer Wm. E. Searl, O.O.St.] ., presided and Exeter (President of the Stamford Division) Readmg (Mrs. Kersley) and Mr. O. Well- propos.ed. the toast to H.M. The King. Asst. Capt . .G: B. Armstrong, M.B.E. (CountY belov:e, recently appointed Vice-President of CommISSIOner Col. G. C. E. Simpson, O.B.E., CommiSSIOner), Dr. W. A. Hawes (Divisional ReadIng Corps, who had to leave before his T.D., F.R.C.S., Commander of the Order in Surgeon), Ald. H. Deer, J.P. (a Vice-President and .Chairman of the former Mayor's War Badge could be presented. proposing the toast of the Order, gave a short Chanty Fund, from which £1,000 was given

to the Stamford Division to make possible the purchase of the ambulance), Mr. \Y/. A. J. Brick, J.P. (Secretary of the Fund), Ald. S. Bassendine (a Vice-President of the Division) and the Rev. J. Hands (Rector of St. Iichael's, Stamford). Among the large gathering present were officers and membcrs of the various Brigade Divisions from both Stamford and Bourne. Dr. IIawes, speaking of Stamford's ambulance service, said that up to 1925 (when the Brigade's first vehicle was purchased) there was no ambulance in the town at all. He described the conditions of transport as they then existed, and went on to pay tribute to the officers and members of the Stamford Divisions, of whom he said: "Their friendship I cheri!;h; they are a body with whom it is an honour and pleasure to serve." Continuing, Dr. Hawes remarked on the great increase in ambulance work in the last twenty years. In 1926, II2 patients were dealt with and there wete 12 accidents, and the ambulance travelled 940 miles, while in 1947 there were 385 patients and 81 accidents and the mileage had risen to 8,9I1. Giving details of the purchase of the ambulance, Dr. Hawes said that besides the £1,000 received from the War Charity Fund, some £30 came from local villages, and the Division's own efforts raised £258. The ambulance had cost £888, £120 had been spent on equipment, and approximately £ 300 was left to cover outstanding expenses. The Division celebrates its Silver Jubilee next year. Div. Supt. W . R. Newell has held the appointment since the foundation of the Division. Somerset BATH CITY DIVISION On November 20th, the Annual" Bring and Buy" Sale was held at Headquarters in aid of Divisional funds, and opened by Mrs. T. Fry. Among those present were Assistant Commissioner Dr. Beath, and Mrs. Hugh Nicholson, President of the Nursing Division, together with County Officers Miss St. Lo Wilkinson and Mrs. Selwyn, and County Nursing Officer Miss Leedham Fuller. On November 23rd, members of all Divisions had an opportunity of seeing a most interesting film shown at Headquarters, " Accident Service," showing the present-day facilities available in treatment of serious accidents and the rehabilitation of the patients in normal life on recovery.

recipients by Mr. D . S. Inman, D .G .:\L, Liverpool. During the evening, presentations were also made to ~rr. W. Ross (recentl y retired) of Lime Sueet Station staff, by "-lr. T. C. Byrom (D.P.11.), and Mr. W. H. Bird (retired) of the Police Dept., by Inspector S. Smith in the u navoidable absence of "\Ir. F. J. Finney. The Dedication of Mr. Lam b, D.\I.P.S., presented the" De Vere Shortt " Cup and pnzes to the E dge Hill a new Ambulance Motive Power D ept. l\mbulance Team, which at Stamford tro phy was competed for on the 13th N ovember. Southern R egion MARSH CCP CO \ IPETlTION The Inter-Works Competition between Brighton and Lancing \X orks for the" \1arsh " Cup, was held in the Staff Canteen, Brighton Wor ks, recently. A large enthusiastIC audience, which included 1 1r. and '\Irs. Gransha,v, Brighton Works Manager ; _\1 r. F . Illston, Lancing Wor ks Manager; D r. and "\Irs. StL1rtaford ; TAUNTON DIVISION On account of their popularity last year, the Dr. B. A . R. Pitt, D ivisional Medical Officer; Taunton Division is organising a further Mr. F. A. T rott; Regional Centre Secretary; monthly series of Old-time Dances this Mrs. Rosenberg and Mr. and "\1rs. Goddard , winter. The first dance, held at St. George's w ho watched the Team Test, the Judge being Hall, Taunton, on Tuesday, 2nd November, D r. H . Rosenberg. The indiyidual Oral Tests was well attended. Music was provided by were adjudicated b) Dr. ]. A. Richardson of the Four Aces Dance Orchestra, with Mr. H oye. The result of the compelltion was announced George Parsons as M.e. Refreshments, arranged by Mr. Wyatt, were supplied by a by Mr. A. Goddard, Disrrict .-1.mbulance local caterer who has kindly agreed to return Secretary, as under:1st Brigh ton \X' orks" \'" 2 [2 a generous proportion of his profits as a 2nd Lancing Works" \." 20+ donation to the funds of the Taunton 3td Lancing \\'orks " B" [98 Ambulance Division. 4th Lancing \\ 'orks"C" 175 West Riding of Yorkshire Western Region BRIGHOUSE CORPS BIRMI GHA:\I The '4 6th Annual Meeting of Corps was M r. A . V . R. Brown, Di\Tisi onal Superinheld on December 4th. Div. Surgeon G . 1\.. tendent, presented the class awards to the Collinson was in the chair, and was suppo rted Birmingham Snow Hill class and stated that by Asst. Commissioner H. Harrison, the this ambulance class, formed in 1892, was the Mayor and Mayoress of Brighouse, Corps oldes t in the '\ [jdlands; that from it in 1903 Surgeon R. 1. Smellie, Cadet Surgeon was formed the first Sr. John Ambulance Turner and Corps Supt. H . Hirst. Brigade D iyislOn and it was proud to be the Asst. Commissioner Harrison presented N o . I D ivision in the Count,·. Honours long service awards. gained by it included-twice champions of HARROGA TE DIVISION Great Britain (D ewar Shield), nine tllncs The Harrogate Division held the Annual winners of Birmingham and D istrict Challenge Inspection in St. Luke's Church Schoolroom Shield, and twice winners of the Boulton Shield . on Sunday, November 14th. Units represented ..\ir. H orace G. Fletcher, Secretary uf the were: St. John Ambulance Brigade (Harro- class for ten years, who holds forty years' gate Division), Harrogate Division Cadets and efficiency awards and who is an Hon. Sening the Harrogate" B " Nursing Div ision. Bro ther of the Order of Sr. John of After the inspection, which was taken by J erusalem; was the recipient of a presentaDr. E. H. Lodge (Asst. Commissioner), Mrs. tion in recognition of his work. Lodge (District Officer), and Dr. D o rothy Potter (Divisional Surgeon of" B" Nursing WOL VERIL:U fP T O i\ A presentation of awards to members of Division), Dr. Lodge complimented all ranks on their smartness, mentioned the urgent need three classes ar Wolverhampton (Oxley for recruits for all branches and thanked the Sidings, Stafford Road and \X'oh-erhampton) members for the work they had done during was held in the Stafford Road Institu te. 11r. R. H. N . Bryant, \\'orks ..\fanager, the past twelve months. Mrs. Lodge also thanked the members, Stafford Road, presided and was supported especially those who had assisted at the York by .Mr. V. ]. H. \'{'ebb (D ivisional Locomotive Superintendent), Mr. R . F. \x'ilson Royal Show. Mr. A. Ridsdale, Divisional Superintendent, (Divisio nal Engineer) ,' "'It. k V. R. Brown was in charge of the parade, and Mrs. 1. R. (Divisional Superintendent), I Ir. J . .-\. Hymas, S.R.N., S.C.M., was in charge of Warren-King (D istrict Goods Manager), Mr. S. H . ..\Iar tin (Station-master), 1Ir. E. J. " B " Nursing Division. Hancock (Divisional Secretary), '\Ir. G . Dl!'!I1 (G oods Depar tment), and . '\Ir. J. F. Sofie, BRITISH RAIL WAYS Engineering D epartment . . .\1r. IL F. \\'ilson London Midland Region presented a pen to D r. F. J. Lync In apprecIaLIVERPOOL The presentation of 3 I Long Service Medals, tion of his serv ices to the ambulance classes, 36 First Year First Aid Certificates and three and ,,\11'. Brmyn presented a pipe to :\[r. G . Medallions was made on Friday, November Hopkins, former Secretaty to the \\ olvel'26th, in the City of Liverpool Technical hampton class. (ContinNed on page I r) College> the l\wards being handed to the

FIRST AID & NURSING, DECEMBER, 1948

oxygen can enter the lungs, and so enter the blood, whilst the carbonic acid gas is fast accumulating by the oxidation of the tissues, and soon saturates the blood, all of which soon becomes ven ous. This points out the necessity of ventilating liv;~g roo1J!s by allowing for the removal of the impure By expued aIr and for the access of pure fresh air from the J. WE LLS, M.R.C.S., L.R.C.P. outside atmosphere con taining oxygen to take its place. The walls of the chest are formed by the thoracic or dorsal spine behind, the breas t bone or sternum in front, RTE~IAL blood. becomes ,,:"en~:)Us blood in the cap!l- the ribs with their internal and external intercostal muscles larles of the tlssues. ThIS IS due to some of Its around the sides, and below by the membranous and musCIIlar , oxygen uniting with the carbon and hydrogen of the diaphragm, which separates the thoracic cavity from the waste matters, forming carbonic acid gas and water. The abdominal cavity. T h e heads of the ribs form m ovable joints with the oxygen is obtained from the air-cells of the lungs and is conveyed to all parts of the body by the blood. Life could twelve dorsal vertebne of the spine, and the anterior ends not be maintained even for a short time without this of the seven true ribs are connected by their flexible costal chemical combination, for not only does it produce the cartilages, in front, wi th the sternum . The lungs fill the heat by which the high temperature C98.4°F.) of the body greater part of the conical cavity of the thorax. The lungs are enclosed in a double m embran e called the is maintained, but is also the means by which waste organic matter is converted into simpler compounds (carbonic acid pleura, one layer of which is firmly attached to the outer gas, water and urea), previous to removal from the body. surface of th~ organs, whilst the other lines the cavity of When the dark venous blood reaches the capillaries, which the chest, beIng closely adherent to its w alls. It is thus surround the air-cells of the lungs, it is changed in colour, seen that. th~ ches~ is an air-tight cavity, having n o direct becoming bright scarlet, that is, it is changed into arterial commufollcat.lOn With the atmosphere, while the lungs may blood. Carbonic acid gas passes through the thin layer of be considered as bags filling this cavity, and being themmembranes which separates the air from the blood, and selves filled with air, which enters them thr oug h the oxygen gas passes from the air into the blood of the trachea. During. inspiration the diaphragm descends, making the capillaries. These changes can be demonstrated by a chest caVIty deeper, and the external intercostal muscles simple experiment. Fill a bladder with venous blood, and suspend it in a contract, thus raising the ribs and making the chest wider. jar of oxygen. The oxygen will be absorbed by the blood The. capacity of the chest being thus enlarged, the lungs and the blood will soon acquire the properties of arterial ~re ~nfl~ted as ?efore described. In quiet breathing the blood. A&"ain s,uspend a bladder of arterial blood in a jar lllSplratlO? o~ alI IS eff~cte~ c?iefly by the diaphragm in of carboruc aCId gas and the blood will soon become men, while In forced lllSpUatlon the intercostal m uscles play an ~mportant part. In women the diaphragm does n ot venous blood. The extent to which these changes take place in the body play so Important a part as the ribs. As the ribs are raised J?ay. be s.een by ~omparing expired with inspired air. The during inspiration, the sternum will rise with them. T his msptred aIr contaInS about 79 per cent. of nitrogen, 21 per movement may be noticed by laying the hand on the ce-?-t. of oxy~en and o,nly about .04 per cent. of carbonic front of the chest while taking a deep inspiration. A gain, aCI~ gas, wIth. a v~r1able proportion of water vapour, when t~e diaphragm moves, the organs of the abdomen whilst .the .exp,red au contains about 5 per cent. more follow itS movements, and this causes a visible movement carboru~ aCId gas, 5 per cent. less oxygen and an increased of the wal~s of the, abd?men. Hence respiration, which is proportlon of water vapour, the nitrogen remaining the affected chIefly by the dtaphragm, is often called abdominal same. If a person were to shut himself up in a room without respirati~n, while that produced chiefly by the movements any means of ventilat.ion, the air he breathed would of the SIde walls of the chest is called cGstai or thoracic gradually lose its oxygen, and aain a corresponding respiratiu n. After the lungs have been inflated by an inspiration, proportion of carbonic acid gas. When one or two per cent. of the oxygen had been removed from the air in the ~hey are. ther~by st.retched c<?nsiderably, and their elasticity room, a feeling of general uneasiness would arise accom- IS sufficI~nt In qUIet .breathmg to expel the air from the panied by headaches; ~s the loss of oxygen i~creased, lun~s ~Ithout. the ald. of any muscles . But in a forced there would not be sufficIent oxygen in the inspired air to explratlon the wternal mtercosttd muscles are broug ht into ch~nge the colour of the blood, that is, to oxygenate it. play, and also the muscles of the abdom en, which latter This would certainly.be the case when the loss of oxygen act on the organs of the abdomen, thus exerting indirectly and the correspo~ding amount of carbonic acid gas an upward pressure on the diaphragm. Although the respiratory movemen ts are g enerally amounted to IO per cent. The blood would now be venous ?lo.od thr~ughout the body. Carbonic acid gas, which is pur.ely involuntar,?, yet they are brought about by muscles In. ltself slightly. poisonous, would saturate the blood and which are under the control of the will and are sometimes thIS togeth~r WIth the oxygen starvation would, in three partially. or enti~ely: voluntary, as in speaking or singing. or four. mlm.~tes, caus.e death from asp~yxia caused by In speaking or SIngIng, the vocal cords are stretched across suffocatIon, WIth cessatlon of the pulse. t~e larynx, leaving only a narrow space for the p assage of ~hen an animal is strangled, choked, or drowned, or a~r. Under these circums tances, tht cords are made to buned under any weight, such as earth or sand, heavy VIbrate by the current of air forced between them thus enou~~ to preven~ movement of the chest, the same producing the voice. condlt.1on of asphyxIa is brought about. In these cases, no

The lu ngs & Respi ration

(tv be cuntinued.)

FIRST AID Be NURSING, DECEMBER, 1948

Topical Notes for First Aiders and Nurses First Aid F ire-fig hting Apparatus A committee convened by the Institu te of Mechanical Engineers has prepared a Code, in draft form, which deals with the design of fire-extinguishers. Comments are inv ited so that amendments may be considered before the Code is published in its final form . It is, at present, known as Code 402,401 " Chemical Extinguishers and other Hand Appliances ." Copies can be obtained from the British Standards Institution, 24-28, Victoria Street, London, S.W.I. The draft considers the design, manufacture, installation, testin g, inspection and maintenance of portable fueEghting equipment that can be used by one person or a very small team. The conten ts could well form the subject of a debate o r discussion by a branch of the B.R.C.S , or S.J.A.B.

tend to eliminate thc fibrous elements which, by their scouring action, keep the teeth clean and so prevent food stagnation. j\ n additio nal factor is the large proportion of fermcntable carbohydrate in the modern diet. Naturally produced foodstuffs that are not too refined should be chosen whenever possible. Biscuits, puddings and pastries which tend to cling to the teeth should be used sparingly in a child's diet. The value of fruit, such as an apple, at the end of a meal is that it acts as a kind of a toothbrush. O n the other hand, medicines such as malt preparations contain a large amount of very sticky, fermentable carbohydrate, and if a dose is gi\'en to a child at bedtime his teeth should be well brushed afterwards, T oOthbrushes must be properly looked after, being rinsed in water and dried between each usage. If there are several children in the household it must be seen that T he Lords D eb ate N u rsing Shortage thc brushes do not become mixed . This can The figures given in the House of Lo rds a few be achieved by choosing different colours. weeks ago with regard to nursing recruitment The lecturer stressed the reasons why periodical and shortage should be pondered by everyone inspections, at least twice a year, are advisable who has the health of the nation at heart, for from the age of two years. The child will they place the p resent problem in a right then have no [ear of the dental surgeon, as perspective. The whole report needs to be treatmen t w ill probably not be necessary on read, not merely the biassed and unrepresenta- the fi rst few occasions and the child will gain tive extracts published in the daily press, w hich confidence. T he deciduous teeth have a renders such dis-service to nursing and to larger pulp cavity and a correspondingly nurses. thinne r layer of dentine and enamel than the We have over 20,000 ",ore nurses than we permanent teeth. The deciduous molars are had ten years ago, and yet we need another not replaced by (hei r permanent successors 48,000 in order to make a 96-hour fortnight .a until the age of nine or ten years, so that the possibility in all nursing work, but even thIS early loss of deciduous teeth can be a serious increase will not enable all the hospital beds matter from the point of view of mastication in the country to be serviced. In (he light of and nut rition . these figures the shortage of nurses is seen to News from All Quarters (contd,) be due to the greater demand rather t han POLICE because the professio n is unp opular with the Hants Constabula ry F irst Aid modern girl. Preventive medicine of ~Il Competition kinds engages vast numbers of nurs~s, 10 The fourth annual First Aid Competition clinics, in schools, in industry and 111 all branches of Public Health, and the complexlry of the Hants Constabulan' was held of the numerous investigations and tests recently, at \,('inches{cr. Se,:en Di"isions carried out for the sick involves the work of a entered. The Lord Mottistone Cup was won good proportion of the nursing personnel of by the Isle of Wight D iyision. The runners-up a hospital. The daily press pounces upon were Eastleigh Diyision with \'\' inchester Christmas Seals to Help the Tuberculou s every allusion to conditions of training and Division and New Forest D iyision third and For many years past the Canadian Tub~r life in hospitals that, for the most part, ceased fourth respectivel.¥. T~e ~a?y Louis :'IIoumculosis Association has produced an attractlve when tyranny in the home, the school and batten Cup for thr best illdlndual performance Christmas seal for letters and parcels, with a the workshop gave place to a reasoned was won jointly by Inspr. . \. . L. Aymes of double-barred Red Cross and a small picture. discipline, and this increases the difficulties of E astleigh and P.e. "-1. . Large of the Isle of With characteristic generosity, each year the those who are straining every nerve to o ver- Wight. Pim Trophy Associatio n presents the National ~s sociati o,n come an impasse in the establishment of an In a letter to Chief Constables [he Home for the Preven tion of TuberculosIs (of thIS adequate nursing service. Admittedly, a few Secretary draws attention to, the following country) with sufficient seals to provide most parents, a few school maste~s and sch<;>ol:of the funds for its work. In the past ten years mistresses, a few people 111 responsIble points Rules I , 5 and 6: Police\v'?n:en . ha~e the sale of these seals has raised nearly a positions in business an~ in~ustry a~d a jell) hitherto been precluded from partlclpatl11g ill quarter of a million pounds. This year's seal people wielding auth?no/ 111 hospitals are the competition. It has now. been agreed bears the figure of a little boy rapturously tyrannical, but the malonty use theIr power that a « mixed" team, 111cludlllg not mo re gazing at a Christmas stocking hanging from wisely and considerately. than two Policewomen, may be entered. a mantelpiece above a fir~ of yule . l~gs, and Rule 5 : F orces with an authorised strength the Canadian Tuberculosls AssoclatlOn has Dental Defects in Children In an interesting lecture, given on November of between 501 and 1,000 may emer tWO sen t twenty-one million for sale in this country. teams for the District eliminating competition, They cost 4S. per 100, and can be o btained 24th by Miss Lilah M . Clinch, L.D,S., R .C.S., if desired. F orces with an authorised strength from the Duchess of Portland, N.A.P.T., at the Royal Institute of Public H~alth and of between 1,001 and 1,500 may enter three Tavistock House North, Tavistock Square, Hygiene, she stated t~at the l11creased teams, and so on. _ ., L ondon, W.c.!, and are intended for sale at a prevalence of dental carIe~ among modern It is hoped to hold the flnal competltlOn halfpenny each. Rally round, first-aiders, and communities may be expla111ed by the ~act towards the m idd le of March, 1949· that the modern methods of food preparatIon help a very good cause J

A Worth-w hile Job To the girl who is interested in making life endurable, and even financially profitable, for the disabled, the gaining of a qualification in occupational therapy opens up a very wide sphere of activity. The training takes three years for a girl holding the school certificate. A sense of vocation, a desire to help people, much patience and a sympathetic understanding of human difficulties are also essential to success. There are now seven recognised training schools in this country, details of which can be obtained from the Secretary, Association of O ccupational Therapists, 251, Brompton Road, London, S.W .3. The students spend some months learning different crafts and their application to various types of injury, illness or disablement. They study anatomy, physiology, psychology and first aid. Towards the end of the first year they take a preliminary examination; and then decide upon the broad lines of their specialisatio n. For example, are they more interested in the mental patient or the physically hand icapped? Would they like to work in remand ho mes, app~oved schools or even in prisons? Or do they aspire to become teachers of occupational therapy? The bias of the second and third year of training w ill depend upon the choice that is made. A n additional qualification in psychology and psycho path ology will take an extra six months to ob tain, but the h older of the dual qualification can eventually become the head of a large occupational therapy department in a general hosp ital with outpatient clinics and psychiatric wards. Students who have done Red Cross w ork start with the ad vantage of their nursing experience and their knowledge of hospital routine. Salaries range from £ 340 for newly qualified people to £ 450-[.550 fo r heads of departments. The suggested working week is 3 6 hours and holidays are usually four wee~s in the year, but at present much depends upon the particular jo b.

FIRST AID & NURSING , DECEMBER , 1948

The Tubercu lous Patient in the Home BY

FIRST AID & NURSING, DE CEMBER, 194B

Bland ye t pote nt iodine

AGNES E. PAVEY, S.R.N. Diploma Ul Nursing (University of L ondon) pRACTICALLY all patients in whom a diagnosis of pulmonary tuberculosis has been ma~e require an initial period of complete rest before s'p~clfic treatment can begin and, under the present conditIOn of extreme shortage of available sanatorium beds, the patient must often undergo this resting period in his own home. In making the necessary arrangements many important factors must be borne in mind. The Patient Himself Tuberculosis is a disease in ",-hich the personal factor is of extreme importance. The discovery of its presence always comes as a profound shock and it usually involves a complete re-organisation of the patient's life and of the household routine. The whole outlook on the future is altered and ambition receiYes a check. The patient is often a young person whase habits and character are still in the making, and the probable attitude of his friends to the infectious aspect of the condition constitutes a psychological as well as a physical problem. His treatment will be long and tedious and he may encounter many disappointments and set-backs. He must develor a greater degree of selfdiscipline than is essential in the completely healthy person, but he should realise that tuberculosis is not the only condition in which this is necessarY, for the diabetic ha's equal need of such self-discipline. 'It sometimes helps to discuss these problems with the patient, for 4e must arrive at an acceptance of the limitations imposed by his disease, and whether he can do this successfully will depend upon his temperament, his intelligence and his character, combined with the understanding help he receives from those around him. He can be told that tuberculosis is now a curable disease, that most of us are infected by it and that, without being a"ware of the fact, many people have suffered from it and have completely overcome it, for it is a condition to which human beings are peculiarly resistant. \'{'ith wise management there is no reason why he should not make a good recovery. Even moderately advanced cases should be encouraged in this way, for hope is a great healer and, fortunately, most patients with tuberculosis retain an optimistic outlook throughout the whole of their illness. Contacts

The statistical results of investigations show that home contacts with known cases of tuberculosis are the mOST fruitful sources of new cases. Therefore, no child should ever be brought into close contact with a patient suffering from tu berculosis, and yet, in innumerable homes there are patients waiting for beds in sanatoria, and others have returned to their family after sanatorium treatment but are n?t yet .free fro~ infection. In some of these people the dIsease IS too WIdespread to benefit from specialised treatment, and they have been discharged from hospital to make room for those in whom the disease might be arrested.

One develops immunity to tuberculosis by repeated small doses of the infection, from which one recovers without being conscious of symptoms; so that adults are not very vulnerable to infection from contacts. The great danger of massive infect.ion is, therefore, to the child, who has not yet been able to build up a resistance for himself; so that his segregation from close or continuous contact with a tuberculous member of his household is of paramount importance. Either the patient or the child should be removed, but that is not always possible. The shortage of available sanatorium beds is a very well recognised problem at the present time, many thousands being closed for want of staff. The taking of children away from their homes is a clifEcult and perhaps undesirable practice in many cases, although, in France, a method, known as the Grancher system, of boarding out child contacts from tuberculous households has been in operation for many years, an infant being removed from a tuberculous mother immediately after birth. In this country the general feeling is that, unless segregation can be accomplished in the home, it is much more satisfactory to remove and treat the patient, and to allow the normal home life of the children to continue with as little alteration as possible. Tuberculosis Dispensaries The first of these dispensaries was established in Edinburgh in I887 as an observation centre for patients who had been discharged from sanatorium and for all his home contacts. Such dispensaries have now been established in all districts of Britain, but it is felt that the term" tuber-::ulosis dispensary" is not a happy one, for there is a stigma attached to the word "tuberculosis" that sometimes discourages people from attending, and the dispensing of medicines is now only a very minor part of its activity. The suggestion that such dispensaries should be called " Chest Clinics" is meeting with approval, and the term is being used for practically all the newly established centres. These clinics arrange consultations, give advice regarding treatment, supervise patients after their return from sanatoria and examine contacts from time to time. They keep the record for each patient as prescribed by the Ministry of Health and deal with many matters arising in Ministry of Pensions cases. A great number of chest clinics include a voluntary organisation known as a "Care Committee," which assists tuberculous patients in many ways. It collects money by voluntary means and receives a grant from the Ministry of Health. The assistance given includes the supply of beds, bedding and outdoor shelters to enable patients to sleep alone, and the family is helped to find better housing accommodation. Extra nourishment and clothing may be provided for the patient, and suitable employment may be found for those who, although fit for light work, are not well enough to return to their previous employment. Hitherto, the Care Committees provided nursing requisites and helped to defray the cost of dressings

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and appliances for surgical cases, but these are now supplied under the new Health Services. The domiciliary treatment of tuberculous patients with supervision from a chest clinic is considered suitable for those awaiting a vacancy in a sanatorium and for those who have recently returned from a sanatorium. The patient remains under the care of his own doctor, whilst the Tuberculosis Officer acts as the consultant. Periodic X-ray examination and frequent examination of the sputum should be arranged for at the clinic, and so also should repeated examination of all contacts, particularly children and young adults. This should include X-ray films of the chest. For all children under 5 years of age the routine use of the tuberculin test is advisable and immunization with B.C.G. vaccine should be considered. This method of immunization, although first introduced in France and

SAFE CYCLING FOR CHILDREN 2>387 PASS PROFICIENCy TEST SINCE the Royal Society for the Prevention of Accidents inaugurated its Cycling Safety League and Cycling Proficiency Test a year ago over 37,000 children have joined the League and 2,387 young cyclists have passed the tes t. This is announced in a report of the first year's working. The scheme was formulated by the Society in conjunction with the Cycling Organisations to combat the heavy road casualty rate among child cyclists. Every year nearly 200 child cyclists are killed on the road and about 7,000 are injured. The scheme has the support of the Ministries of Education and Transport and the Education Authorities, the Teachers and the Police.

Germany in I924, fell into disrepute owing to a disaster that occurred in Lubeck in I930, when a number of children who had been vaccinated with B.C.G. died from acute tuberculosis. It was afterwards found that, during its preparation, the vaccine had been contaQ1inated with a virulent strain of tubercle bacillus. In recent years the method has been widely used in Scandinavia from whence has received excellent reports and its use in this country is extending. Advanced cases of tuberculosis who cannot expect to reap much further benefit from sanatorium treatment must often, perforce, be nursed in their own homes, but in any discussion regarding the management of the tuberculous patient in the home the help that is available through the Care Committees must be borne in mind. (to be continued.)

"FIRST AID IN CHILDBIRTH" As a result of our single announcement last autumn about this film Dr. Brian Stanford lectured with it to over forty first aid groups last winter, and has already received more than twenty requests to show it during the coming season. These invitations he has regretfully refused, for he has decided that he cannot devote any more time to presenting this film himself. This decision has led to so much disappointment that Dr. Stanford is having a colour copy made of the second part-" An Unaided Delivery"-which will be available for hire early in the New Year. The first p;u.t-" Preparation for an Emergency D elivery "-will not be available, for Dr. Stanford feels that it is too much out of context with present-day circumstances to merit printing. Requests for hiring" An Unaided D elivery" should, in every case, be accompanied by a declaration from a registered medical practitioner that he will personally introduce the film and answer questions arising at the end. Further particulars are available from Dr. Brian Stanford, 54, Upper Montagu Street, London, W.I.

The Ministry of Education recognises such school activities for grant purposes, while out of school activities rank for the Ministry of Transport grant to Local Authorities under the National Road Safety INSTITUTE OF CERTIFIED AMBULANCE Campaign. Launched at the Society's Silver Jubilee Congress at PERSONNEL Brighton in October, 1947, the scheme quickly attracted widespread PROFESSIONAL EXAMINATIONS RESULTS attention and in a few months about 200 Local Authorities showed THE following candidates passed Examinations. Preliminary, 16th interest. October, 1948 : Howard D. Weston, John Aspa, D. Kenworthy, Branches of the League have been set up all over Great Britain, and Sidney Dore, Charles Ford, Alan ]. Stewart, Harald C. Dagg, ] ohn the tests haye particularly strong support in the counties of Yorkshire, Kitchen, Cyril Mays, Thomas Finch, Edward Kimber, Edward Sykes, Lancashire, Cheshire, Staffordshire, London, Kent, Surrey and Frank Rose. Sussex. Final, 30 th October, 1948.-George Stott, F.l.C.A.P., Stanley The inaugural test was also held at Brighton, when seven young Braiden, F.r.C.A.P. cyclists passed with over 95 marks each out of a possible hundred. By the end of October this year, 14,000 entry forms had been issued to Local Accident Prevention Committees and 18r tests had been held in CHRISTMAS, 1948 60 places from Cumberland to Cornwall and Anglesey to Suffolk. The Editor joins with his staff in sending a cordial The 2,3 87 young cyclists who passed the test did so with over 75 per Christmas greeting to all readers, together with cent. marks. To qualify a cyclist has to show knowledge of the every good wish for the coming year. accepted principles of Road Safety and Courtsey, his master over the May 1949 see this great country ever farther on machine, his riding proficiency and his ability to adjust the machine to the road to complete recovery, and may we be obtain a good riding position and maintain the bicycle in good order. given the fortitude and cheerfulness to meet the Under the scheme the Society is 'able to provide a volunteer examiner in most areas. Each volunteer is a qualified cyclist with many years of experience and has been recommended to the Society by the Cyclists' Touring Club or the National Cyclists' Union. To the end of October this year 550 examiners had been enrolled.

obstacles that block our way to full prosperity! To all members of the ambulance organisations we wish every success in their splendid work. ~ay their activities flourish! Good Luck for 1949.

FIRST AID & NURSING, DECEMBER, 1948

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Queries and Answers to Correspondents I. -All Queries must be accompanied by a cc Query Coupon" cut f rom the current issue of ' he Journal, or, in case ofQueries from abroad, from a recent issue. 2.-The T extbook to which reference mcry be made in this column IS the 3'}lh (I 937) E dition of the S.J.A.A. 1vfanualof First Aid to the Injured.

to RJtle 12. Quite an argument then arose. The Oflicer and_ one or two more members stated that the " Principles" had been unaltered. I stated that according tr- the Supplement Rule 12 1vas to be deleted. I contend that the 1vilrd " delete" means to leave out of the Principles altogether and thac Rule 12 regarding stimulants now becomes Rule 7 under the new heading of" Shuck." It would seem that your Ambulance Officer and you have been looking at this question from diiferent standpoints, the result being that both are right. When considering the treatment of a patient the old Rule 12 is certainly a principle which must be borne in mind even though it has been transferred from the Chapter on Principles of First Aid in the Textbook to that in the Supplement which deals with the treatment of Shock. On the other hand, if you are answering questions in a competition, one of which relates to the Principles of First Aid, you would not lose marks by omitting the old Rule 12 because the examiner would not (and should not) have its several points on his detailed marking sheet.-N.C.P.

Treatment of Wounds E. H . (Harrogate).- I would like y our help, please, tv decide a controversy 1vhich has arisen amu11g our members. In the Supplement, under General Rules for the T reatment of Wounds (pa<.~e 25, etc), fu,de 7 reads-" Bandage the pads firmlY in positiun and if blood soaks through the dressings and pads, applY further dressin<.~s and pads on top with a fresh bandage bu; do not remove the original ones." Does this JlIean that lvhen the 1vound p ad has been applied and fixed Jvith the bandage which is affixed to it and secured in position by a triangular bandag e, and that, if the blood still soaks through other dressings another bandage should be applied over the triangular bandage? Further, should the triangular bandage be remol1ed, leaving thE, wound Methods of Tying Reef Knots dressing in position, fresh dressings be applied over P. K. (Wellington, New Zealand).-The demonstrator of our · the original one and the triangular bandage re-affixed more Ambulance Class tells us that we must tie' reef knotsfirmlY or shilllld all the dressing p lus triangular bandage " left over right.. and then right over left." S6me of us find be I~ft in position and other f resh dt'essings and another it difficult to understand these instructions and so 1ve ask bandage be applied on ' top ? It seems to make too bulky a your k ind help for which we thank YOtt in advance. dressing if this is done . The method of tying a reef knot, which you describe, is Although the word " bandage " is not mentioned in the I!lecharucal and always irritates me if I happen to overhear second part of Rule 7, you are ,told to use ::I fresh bandage the words of command which you quote. Truth to tell, and" not to remove the original ones." You can therefore all first-aiders should be able to tie reef knots by the safely assume that the last word" ones" includes dressing, senses of sight and touch. Consequently, in lectures pad and bandage. I always start with a definition, pointing out that a knot T he bandage applied in the first instance is doing some is formed by two loops and four strands; that a reef good in the partial arrest of bleeding, and nothing will be knot has two strands above one loop and two strands gained by its removal. On the contrary, removal of the below the other; and that a granny knot has one strand first bandage would considerably reduce the direct pressure above and one strand below each loop. Next, picking up a already applied, thereby causing increased bleeding. piece of cord, I tie one loop in haphazard fashion. After .Should the second attempt at applying direct pressure this, I double back one of the strands so that both portions fall, the correct procedure, in my opinion, would be to thereof lie alongside each other. Then holding the ends apply the first bandage round the arm as laid down in of this doubled-up strand, I slip the other strand through the Rule g.-N. Corbet Fletcher. loop so formed and pull on the strands ; and thus I cannot do other than tie a reef knot. Next, I -repeat this process E xamination Howler M. R . (Cannon Street).-In a ncent examination I asked one blindfold, in this instance using my fingers to feel the candidate t{) explain the part which is plcryed by the spinal strands and to bring them together in a reef knot and co~d. I cou,ld nO.t help smiling when she replied-" The deD?-0nstrating how reef knots can be tied by the sense of touch. Incidentally, I find that tying together two pieces spmal cord IS a kind of tail to the brain I " of cord of different colours makes the reef knot more Good I Next please! !- N.C.P. easily understood and tied.-N.C.P. No. 12 Principle of First Aid W. H. (D oncaster).-I have read with interest your answers to .. FIRST AID & NURSING" queries in P IRST A ID f or maf!Y _years and I have learned maf!Y interesting points fro m them. QUERIES and ANSWERS COUPON I ~ow wish to submit a question which, to my mind, reallY reqUtres .n? ~:Jswer, but I ask it on behalf ~f thff members oj our Dzv1S1on. ,At a Divisional Practise recentlY our To be cut out and enclosed with all Queries. Ambulance Officer asked the members to tell him the Decem ber, 1948. " Principles of F irst Aid." All 1vent well until we came

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