First Aid to the Injured 7th edition 1905 by Museum of the Order of St John

FIRsrr AID TO THE INJURED

:iJ1B ULAKCE .A SSOC IATI UN, BY .LDIE.· )[ A., )LD" F ]Le,s., LI o/lI)"ut'y 0:" the 0 ,1.,. of 't Juhn, lI l) " '''':1 Life JI"liIbet' o/. ai d L t: ;Urei' and Exami"." to, the As.oejalio •• '.V!tll a CHIPTFR on" tI'etcb"r Trail port," revisetl from thatoriginal!.r I,y 1(' FL'RLF.Y K" -jltt of of th e U,.deJ· of st. JoJ , lU :\"l"(JI"Il'UII'p With th " Anu\, l:>tretchel' Exercisei'. Also a OXAl'TEB. hl' l:ifth Let·ture, for Female., only), by E. }IA.CDOWEL COSGRA..E. F.It.:·.P.I.. KIII'lht 0./ oj thd of . JOIt/. Honorary ;)[t' a 0.', (Ill,' aild E.a.IlUler to, the dsooc."lioll.

SEVENTH EDITION, 230,000 to 280,000 THI' EDITIO.- I THE b , ME .AS THE IXTH. Prke 1 '. net; b) po t. 1'. 2d. TO BE OBTADiED "T .' T .11lHN'..... GATE, CLF.R.KE... '''\YELL, LO NDON, E.C• W. H. &: L. C. 5.), )0-2/05,

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\ RRAC'Cd:.D TQ THE REYI'iED YLLABUS 01<' T!f E AID COt:' R E OF THE ,,-'-I .

Wbe

8ranb of tbt @rber of tbc

of .$t. .3Jobn of .3Jl'ttH5all'm in .$.obtttign n11b l}utr.on .of ®rbtr.

His Most Gracious Majesty King Edward VII.

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His Royal Highness the Prince of Wales, K.O.

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V ACA N T .

£If ®f1I c.

His Royal Highness the Duke of Co n naught, K.O.

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Prelafe - Hi s G race t he A rchbish o p of Y OR K

Chancellor-Th e R igh t H on . E arl EGERTON OF Sir H ERBERT JEKYLL, K. C :\l G. , R .E

R ecliv er. Ge n e ra l-tOWIN FRESHFIELn, L L. D .

A l m oner- T h e R ev Canon DucKwolnH, C.\'.O., D D

Rcg z.rt yay- :'IIajor.Ge'1 e ral T h e Right H OIl. L ord

Gelle a logist-

Dir ector of tlt e A m bula nce Det fl> -tJlle nt-The J\J ost H on . t he ;\l arquess of K .G.

Libra r ian - Li eu t.. Colonel R ICHARD H OLBECHF.

S ecret ary- C olonel Sir H ERBERT C . PEI,ROTT, Bart. , c.n. .

Cha irman o/, the H ost ital , jerusalem-The R igh t H on Earl OF I ATTON .

CMe/ o/, th e A JIlbu irm a Depa l tment Colond Sir HERBERT C. 1::1r t., C .B .

S5 sid .mt ®x t.Cutibr (i)ffi.c ms.

AssistaJtf D irector o/, tile Amb u l a nce Dc/arflrt eJtt-I ielll.,C0l OI Si r R ICllAIW C LE , Bart., C. 1.E

Assist aJt t Receh'e r -Ell\\IN FRESHFIEI.D, :'I/. \ .rJ.lSlst fwt Libra ria 1l-CvRIL }_,q,

Assist an t TOCK\\' !!I I . .r_sq . R . ED\\'A,"WS. Esq., A.C..t\ lio n. Secretar), qr tlte BritlSlt Ul>lltlla!mic Hospit a l , jcru! a lcm:'Il aior ] T. W OOl R\,CII PEr,. '\\' , •

A sslst a llt H on orary SI'crefa'J' C/"'" tif tlu Britislz O/,Irlz a l".ic Hospi ta l, jerusalem- A.. .-\. Esq . [9£ (Ollll.ciI.

The C ouncil con,i'ls of lhe tI)·Prior. RS Presidenl lx,officio , lh e Exerllli", and lh" following fflcmlms :

Sir ]()H:--1 F UR/FY, C.B. DVCE DL'CKW')Rrll, :'ILD. C olonel]. C. DALT():O:, R .. \. Esq ., Highl H on . Y iscolllll ;\1. D . FORD, G .C.l\I. G :'IJ:.jor·(;eneral Sir 0\\ EN T BUR:--1E, The RighI H on . L ord :'I I OST\':--1. C;.C. I. E , Sir JA'''ES N VIC.K, K C.B., Sir CEllI"" HAnER CHUI1I1, Har t. R. )1. LH::UI.·COI. I..,lr RlcHMw C. TB!1 LE , Colvnel C. \V . BOWIJI.ER, C.B Barl., C. L E Ir.Tlt

The Chapler consiqs of lhe "- nit::hls of J"slice and Suh·Prelales de .lure ; lhe L.,eculive Officers; lit" ,dt led :'I I t: III L,,;rs of Council; lhe following @fli r lutlll g t1l]ap ',1I1l "

Sn,b.Dean. of l he CIIAI'LLS I The Rev. Sir BORRAOAILE AVOR V Ro \ Al., C. \ .0., D.D. , Barl , :'IJ. A ., A:O:D l:\rprrsrn taUiJc of !!1irar t,

GEClR(.E T. HIDIlLII' II , E"I. l\I ajor·General A STI F\' TFRR\, Colonel S ir E . T . TIIACh: 1 RAY, K.C B }T. Qi: ., R E. l n p.·Gen. B. )1 IN:>; IS, :'Ir. D., C olon el C. :'II. \\'ATSO:O:, C.B., C :'I1. G , R .E.

ir \ RTHLR J. R ThE"D ELL, C. ;\/. G.

Sir R ICHARD DOUl.LAS POWELL . Barl., K .C.V O., 1. D. Colonel C 1\1 ROYDS, C. H. , M .P. OWEN, E.sq , F.R.C.S Hight H on. The Earl of L A"lHOM.

F. H A ,.,ON FRESHFIELJ),EsQ.,M.A. l,eneral Sir F. \V. E . F(lJ.;E'>T1Ef,:. W ,\ Lh.ER, G C .B , G.C.l\1 G. n 2

Q:f]e fo lI ofui rtg ate tlje lIt ni ghts of justice :

H .R.H . Prince CIIRISTIAN OF Colonel The Right Hon. Lor 1 S CIlI,ESWlv.HOI.SlI::IN, K.G., CJ!;UL, l\I.V .O. G.C.H. FRc:sHFtELO, E,q., LL.!J.

H .R . H. Prince CHARLES OF DEN- (Honora}], CO/llJllrtnd.:".)

MARK, G . C.B., G.C.V.O. His Grace the Duke of Fin:, K.'l ,

H. H. Prince 'l. LBERT M' SCIILf';S- G.c. \ '.O. \\' tt, - H 0 L T I:: t 1\, G.C.I3., The Ri:2;ht lIun Lorl: BRASS: \', GJ'. \ -.O. K.C.n.

H.S.H.TheDukeofTEcK,C;.C.V O. The Right HUll . Viscount

H.S.H. Prince 01" T£CK, TO\\':\ K.C .\-.O., D ., .0. The Right Hon. Earl .btHERST. Captain H.S.H. Prince LOUIS OF The Right HOll. Vi'cuullt ' s BATTE:\BERv , G.C I3.,C.C.\'.O., FORD, G.C.:'Il.l;, (flom}) OJ. R K. BrtiliJI)·

CaPtain H.S. H. Prince .\1 EX \NOEl{ R . i-I.O\CLF;;\:\ :'II,\cLE \.', E'lj. ()I' TC:CK, K.C.Y.O., D.S.O, ARTHLR FR \:\ClS LE\,EThe Right Hon . Lord Lt':IGH. S, ):\-( t, H, 1-"". Lieut..Col. TRE\'E:\I:::\ HOL- Colond F. A . HLY(,.\TE LA:\D, C B Col. CH,\RLES iI[VIWAY, CHARLES Co\RTER, Esq. C. B., :'I[ P. • ir). FVRLE\', C.B. (lloIL. Bttiliff). The Rig-ht Hon the Earl oT R,\:\The Right Hon. Lord FLRLY, (;.C.:'Il.G. G.C.l\I.C;. The Right Hon, Lord SA1\UIILHST, FRA:\cIS ROBERT OA\ E,'1. G.C.S I., G.C.I.E.

Sir BROOK KAY, Bart. Sir HE:\R\ .\. BLAKE, C.C.ilI.G. ir T. NORTH DtCK·LAUlll::ll, Ba.rt. Captain X ,\TH'\:\IEt. GEO. PHtUI'S.

Major 'ir ARCHllli\LD LA\lB, Bart. The Right Hon. the Earl of l'IIL\1 H. Col. Sir HERBEwr C. PEt{ROTT, A. FI,ASI':R, Esq. Rart., c.B. The Right Hon. Lord

The Right HOll. LHI FFRREI'S. Colonel CHARLES H CGlII n- IX. Colonel Sir ].\5. l;lt.lJEA, C.Y.O., The Hon . the of C.B BREAUALII.\:\E, !Z G.

HE:\RY )OH:\ LOFTUS, f sq His Grace the Duke of PURTLA:-:D, Colonel BETHEL MARTIN [) ,\WES. K.G., G.C.Y.O.

The Right Hon. Lord 0.. Field·ilbr,hal the Ric:ht Hon. Earl HAcK:\EY . ROIl1:.RTS, K.G., K.P"

Gen. Sir CHARLES \VARIU,;N, ROBERT LCARTFH, 1<.,"1·, G.C.l\I.G . , K.C.R., R.E. F.R.C. '.

CoL'llel R.A. NORMA:\ HAY E'(j" Lieut.-Colonel AVDtER GOULl) F.R.C.S. (Edin.)

HL:\TER-\\'EsTo:-:,O.S.O ,R.E. Colonel }JH:\ At E'I(A:\PER MAN

The Right Hon. Earl EvERTON 01' S rUART, C. B., T';'TTQ:\. Colonel C. \\'. Ho\\ ULFR, C.H. ([ be foHofui ng em tlje

The Lord Bi,hop of ELY. I The in )r·.I<LsAt F:,t. The Lord Bi:;h0p of SAUSllL'RY. The Bishop of GtHRALTAR. The Bishop of BRITISH HO:\llt;t,.\S,

TIEJ:-\G THE Ar-mULANCE DEPART;\1EKT OF 19rior2 of tD c ®l'ber of tbe Jilos pl (al

of St . Jl cDn of ill Qtnglanb-.

HIS MOST GRA CIOUS MA JESTY KI NG EDWARD VII. (SO\'EREI(,:-/ ltEAU AXD ()F THE Ol?I>ER.)

:w r csillmt.

HIS ROYAL HIGHNESS T HE PRINCE OF WALES, K.G. (Gr,'\Nn I'Rlol, " THE ORDER.)

I"rnt rnl ISrr rut iIJc (!i'o mml tt rc.

Consisling exc.lusively of :'lIen l,ers and of the Order.

DIrector (>f tl:e A 7IIllflI11/((' I'''/,altmt!ltf and Cltaiulla71 of COllllIIlllL'!The illost H"n. the .\Iarque,s c f HRl'.AnAII1ANF, K.C.

Assistant Dit-reto>' alld j)'l'lIt)' Cilair1llQIl - Lieutenant Col o nel RtCHARD C TDII'LE, Ibn., C.I.L

rrjutr-CI;aI1111all -Sir }111); FVI't,E\, C.B., (Life :'IlelT'her of I!,e Committee IlolloJ'/'s Calfs.i).

,itL·"Il.r(,-S.

Colonel ). C. ]<.A.

Colonel C. \\'. llO"'Il!.I' R, C.13. The Rev. T. "T. WOOD. l\lajor-General ,\STLEY TERRY. \\'. l-.sq., :'ILl).

Colonel Sir ). W. Orn.EY. K.c. I. E. In<peclor-Gelleral H. :'II.D., R.N.

Sir HE:\RY FREDERICK 1 ORBURY, K C.B., '\1.D. , (Director·General, Medical D e partment, l{oyai ::\a\'y).

S. C. \\'AI:I)EI.L, Esq

Surgeon . .\lajor.Ct:lldal .. ir ) lIt'\ B\ COl.E READE, K.C.il.

G. S. ELLISTON, Esq., :'II. fCC S.

cmogn

QIentTiIl Qrommitfrr -ro u t l1lu ed.

CHRISTOPHER CHILDS, "Ln. ,

Surgeon-General. ir JOSEPH FAYJ{bR, Bart., K..C. .. 1 , :\J.O. J. TRDlflLE, r.:sq., C.:\I.G., L. R.C._P.

Surgeon-General Sir \\'1111.\'.1 R. HO llPF.f: , K .C.. 1. CLE;lIENT i\Ioi YNEL'" Royus, C.B., :\LP.

Captain J. W N01'T ,

Surgeo:1-General -ir WII L(,nI K C B., :\1. D., K P.

Director-General .\rm r :\[edlcal en Le).

Enm::-:o O\\,E:-:, r:sq, F.R.C.S.

The Ri o-h t H on. Lord CL,\wll HA \Ilt TOX.

The Hon. the Marquess of X ORTH.,\\IPTO·';.

Lieut.-Colonel A. C . \' .\1'1-:.

Sir WILLIA'I BE,wET1'. K.C.\'.O., F.R.C.-=;. RE,;l".'\LD H\ RRIS,)'i, r:"l, F.R.C , Lieut.-Colonel E. :\L WII su,. C.13., C.:\I.G D.S.O., R.,\ .1 C.

::,uro-eon-Genera\ A. KE1)(,H, C.H., M.D .

l.ieut.·Colonel W. B.\BIIE, 1).( ., R ..\.'\l.C . Colonel GE,)R(.E H . 0':\[ \1 '.FY, R.,\.

Sir EDWARD L . O?I.ULL,. r l\L C ,\1'['<;, :'LD., R.:-.l.

) L'n\( ASTLEY BLOX '\'t, E"l-> F H.C. -

Ex-Officiil ,1ft'lilbt!rs of COJJlJl(i/t,·,·.

Sir HE RBERT JEK\'LL, K..C.:'LG., R.E. (Secretary.Gener:>.l o f the Order). .

E u\\'(' FRESHFIELD, Es'l.., LL.D. o! the Order). ",

The Right H on. Earl E (. ERTU\( O. 1 ATT' ,\( (C hairman, Oph;:·h1.1miL Hospital).

IIhi rf : rmtJf,!!

CoL,nel Sir HERBERT C. PERROTT, Bart., C.B. (S{ -:re.tary of the Order).

an1l WI LLLUI R. EOW \.RD·, E-;q., ,\. C. A. (.-lc L· o:tttta"t flte Order).

®ffiC(s.

ST. G.'l.TE, U LOXOOX, E.C.

Tc'!.:g..-apltic Addrt!ss-·I Firstald, London." Tcl.-plwJte -Holhorn, S6r.

l3anlte;s.

A:-;O TER BA. K. Ll.\\lTED, (Lotllbury. E.C.)

REYISED 1901.

FIRST AID TO THE INJURED

SYLLABUS O F INSTRUCTION

Fm-;T LEeTC' R E.

A. Preliminary remn.rb, Ohjects of In struction, &c.

B. A brief descriptioll of the Humall ,'keieton, Bone., Joillt>;, and the cn lat· \..;y tern.

('. :O-;igll ", symptom" ami treatment of Fractnres, Dilocations, :O-;prains, and, trains.

n. The Triangular B<lndage and it. application.

A. The Heart and Blood Y c'seb. The 'ircu latioll of the Blood.

B. Th!? general direction of the Arteries, indieating tIl(' point-; where the ui r cnlatiotl may he arrest'd hy digital or hy tIte aPlJlil'ation of the tourniquet, or by othel m ean,.,.

C. the difference betw een Artcl'icll, Ycnons, and 'ap illary H lL'cllinl!;, and the "<'uion. extempurary means of arrr"tillg it.

1. The Trianguhl' Bandag anl its npplil'a tion.

5 REFERENCE1901

THIRD L crL'RE.

A . A brief de cription of the :Nervous, YRtem.

B . First Aill to persons suffering from shock or c011apse after in j ury, injury to the lll'ain, co11Il]1. e from drink, epil epsy, fainting, hysteria. SUlli<tl'l)ke, electric SIIUC\;:, dfect:-; of lightning, an(1 (;Ol1yulsinl1" in (hildl'en.

C. Fir. t .Aid in cases of fl'Ost·1Ii:e, or scalds, injl1ry hy v i trio l throwi11g, wound" l)iLe' of anil11ill'i, st:.]'S of inseet'S .

D . Wha.t to do ,yhen the dress catches nre.

E. The Triangular Bandage and its application .

FOURTH LECTURE.

A. A brief dccription of th· Organs and :'Iechanism of Respiration .

B. The immediate treatment of the apVll ·nU,\' c1r<l\\'l]c(l (r otherwise suffocated. Re"piration, Trcatment for Choking.

C. First Aiel to tho.;e p )iRonetl.

D. The immediate First .-\i d treatl11E'llt of injurics to the Internal Organs, and to tho.. e snjj'l!l'ing from Illtcll1al Hcemorrhage.

E. Foreign in the Eye , E .1', :.In(l ·osc.

FIFTII LECTURE (for :;\lal '; only).

A . I mprovised methods of lifting 1:lHl currying the sick or i nju r ed.

.8 . Met hods of lifting and carrying t.he .-;j(·k or injured on stretcher s.

C . The conveyance of such by rail or in country carts. 9

FfFTH LEC'Tl'RE (for Females only).

A . Pr p:lration for rec:ep1.,ion of Accident Cases.

1i :'Ieans of Lif1.,ing and '<wrying.

C. Prepara1.,ion of Bc(l. ]). l{emoyillcr the ClotheR.

B. for, ·urgcon.

XOTE I. - The suhject of should treate<l in (' ellera,! manner . The common pOl sons c1<18S1110(1. and nlll.'r Yheil' general anel.effects taught. '. .. To get rid of Lhe pOlson l' the treatmetl t ." 111( he . afely practi 'd hy P?rsons. thc ,ld· mini. Lra'tion of antidotes i the lltedu;((1 mew is duty.

, T II -Th h. 1., half hour of each lectul'e :<houltl lIe l' t' < 1 1 (le\'otec1lo practical \VOl k, as the app lea 1O.n 0, :ill.IC ilge. 1 Itl ,.;plints, lifting and carryll1g wounded on .

XOTF: III.-There shoulcll.e an a week (ach lecture. A Candidate for exammatlOn must attcI1l1 nt If' { t foul' out of lhe fh'e lectureR.

XOTE I\T. - ;'lnle da .. mU' t pa::?s in. tha.t . y.t 'm of l'tretchcl' exel'C'i"e mo. t <;uitallic for th locality.

X OTE '\ . -A littl time as po. sihle is to ' lpnt 0'1 in· --t l.l.uctiol1 in anatomival anel physiulogieal eletmL. Lecturel:." lInel Examinel'l-;al'e p:1.l'licularly l'cqueRtcd to rcmemherthatlt ic:; • First Aiel" t'lllt has to be taught al:d te :;lvl, 'm el not anatomy and physiolugy.

SU MMARY OF '. - of -

OHAPTER I.

Explanatory

The Skeletoz: .. ,pine, skull, rihs, hreasth?ne, extl'enlltws, peh-i anellower e_-tremiand JOInts ...

Muscles. Vol untary and involuntary

Fractures. Causes, Yarieties, sign anel symptom!'> ..

General Treatment of Fractures A t plints and ba,ndages. Gencral rule's for of Fractures . • pine, craniulIl fr,er Jaw, nbs. breast-bollc, collar-bmw, Shoulder: arm, forea r m, metacarpu-:, finuer pch'i" t 19h, knee-cap, leg, foot 0" ,

Dislocations, Sprai n s , and S trains

OHAPTER I I.

Circulati?n the Organs; general, l un and. cIrculatIOns; the heart, arteries g, c lpIllan es, b lood, course of circulation ' yein , or Arterial, ycnous, capil-

Arr.e s.t of Pre 'sure, direct and illIII tourniquet) , and digital; cXlOn, posItIOn of patIent, ele\-ation of limb

Course of t h e Main A rt eries and Arrest of A rterial H re morrbag e. The aorta, of the hen,d and neck, of the llPP l' exocemitie', within the and abl10men, of the lower extremities ...

Venous Hremorrhage . Varieo c \'ei11;;

Capillary H re m or rh ag e ...

ClIA PTER II I.

The Ne r vo us Sy ste m. Cerebro· 'pind, 'ympatheLic

Insensibi l it y. ({cllcr,ll treatmcnt, e:-amination of pattent, shock, COl1cu""ion and compre sion of the brain, llpoplcxy, collap ' c from drink, epilep ' y, fainting, hysterical fits, sunstroke, electri(; 'hoek, effect..; of lightlling, connll 'ion in children

CII.\.PTER IY.

Wound s an d I njuries to the Sk i ... Bruise,;, wound', fro,..t bit", hurn" aLH1 fcal(l. , what to (10 when the drc..;..; c.:n.tc.:lH'il lire, "itriol thro\\'ing, hite of animal..;, nakc bite', stings of in Get;;, &c.

l'EIAPTER Y.

The R .!s p ir ator y S ys t em

Artific i al R es pira ti on . . j hc , tcr's, Howanl' and Labonle "

Drown i n g Stra ng ulatio n, C hok ir g, Ha ng in g, Su fff' ca t ion

IIAPTER YI.

Poiso n s a n d P oisonin g . •'imple direction!': for treatment. Poi.·ons a.nd their treatment cla ified :- Tarcotics, ltlchl'iant , delirients, corI'o iYes (acid ' and alkalis), irritant · ...

:il 6-1 69 74 11

Page 7 99 101 LD-2 10-1 ]'2 1 133 13 ' 143 146

CITA-PIER YII .

In j uries of Special Or g a ns . hodics in the eye, ear-pas age and no. e. The chest (tlwrJx) and organs contained in it (hc1l't and lungs ). \\ ' oUlHls of the l ungs. The ahdomen an (1 the organ:-; contained in it (liYer, spleen, intestines kidIlC)'S , hladder), with treatment ()f injury t() tilPm. Rupture ...

CHAPTER YIII.

Bandaging, Application of the triangular Ilan(lagc to the scalp , foreheall &c., shoulder, hip, hana, foot, chest, back, knee, elbow

CnAPTER IX .

Carrying Patients. Four, two, amI three-handed seats, fireman ' i-; lift, temporary . t1"etche1's, to cros a ditch or wall, to 1():1cl amI unload a wagon

CIUPTER X.

Stretcher Transport . Intrn .lu l"tory . ,'tretchel's, stretcher exercise. . The Ashfonl'li ticr

CHAPTER XI.

The Fifth Lecture ( for Females onl y). Prep<.ll'atinn fo r reception of aC'citlent cases. 'boice and preparation of a room, anll carrying. Preparation of l)e(1. Removing thc clothes. P repar ation for fiurgeon

)')

L I 'T OF I LLU TH ATIO

...

,'kektoll, showlllg of main a1'terie:jronti.'piece

VerLelHu

,'kull and \'e1'to],1':11 column

BOlles of the left upper l'xtrl'lllity ri "ht lowel' extl'eillity

l lle Illp Jllllit ... ... .. ...

:-;11IJ\l'illg redu:-. Illu ,;ck of thigh, ,,-ith arttl Y, \ l·in aJ\(1 nl'l' Ve ..

Silliple fr,u;t un: of

Compound fl'<tdllre ()f leg

T ri'lllgn lar ]lamla ft', sp1'e HI I)lit

Triallgul ,l r handage, IIIH'e f·ddt·d. ... . ..

Tl'i ,l llgulnr f(,lrll',j a:.: hl'<I,ul hanclagc ...

Triallt,(111a l' hilll( l,lge, f()lded ,lS l1,ltT()\\- h:tnclage

Red kllot

lIotitCl ' mctho ,lof '-l'lint

Thinlllletiwcl (If securing splint, \\'ith knot incomplete

The same, with knut t:ulIlpletetl

Lal'ge arm-slill"

,'Illa,l

('(lilt uil tl1rnell lIJl tu fOl'm sling

SlIng form ecl froill slet'\'e sl it up ."

BlIlIllce for frat.:lUl 'e of Inwer j.t \\,

BallI fill' frelet \I re ()f I'i hs ...

,If flld nl'e ()f t: Illal'-hunc, "itll t\\'o 1lil!111ages

Alkl'lt'lti\'l' method of <Ii to TI'L'atml' ilt of fml:(lll'e of l: lllar-l)()ne \I ith Ollt: 11<l1ll1tlgi.!

Treatment ()f fradun: of a rill

splJllt

Treat 1lll' :lt of fn,dun' vf fUl'l' :lrlll

I GI lOG 179 z (

Pa;;e 2:? :2.) :27 2;) ....,)/ 3:-> 3!1 40 4 1 4 1 47 41) 50 51 51 5';

Treatmcnt of frat:lure of metan:al'pus

Treatment of fl'at:tlll'e of (high (lIlan)

Treatmcl1 t of fracture of thigh (woman)

Fracture of knee-cap

Treatment of fradure uf knee-cap

Treatment of fracture of leg

Ditto f.1ingle hanl1ed .,.

One form of dif.110cated . hOJl(ler

Principal lJlom1 ye .f;els and ol'ianf.1 of l'C'''pin1tHHl

Diagram of circulation of the lJJo() 1

Field tourniq uet

i)crew toumiq uet

Digital c-ompres 'ion uf caroti(1 anery

Arrest of hzemorrhage from temlJoral artel'Y

Arre. t of hzemonhaf;e from forehead ... of hzemonh 1ge from palmar archef.1

Digital compreR ion of ralIia,l ant1111nar artcries

Flexion of elbow

Digital com pre. sion of brat:hi,ll artery from helcJ\\'

The. ame from alovc

Compl'es iO:1 of axillary artery ...

Digital compres ion of. uhehlYian artery

Flexion of knee-joint

Digital pressure on femoral al'tery ...

Application of toul'l1iquet to felnoral artery

Brain and spinal oord, alll1nervefl l·rot:eelli .1g from it ...

The lung . and bronchial tub s

Artificia,l respiration: illf;pil'atioll _<\.rtificial respiration: e.>..piraLon

The organs of the chest all<1 aUlh nen

Bandage for head

Bandage for shoulder

Bandage for hip

Bandage for hand

Bandage for foot

};allllc1Uc for chc-·t (fl'Ont)

Bandage for chest (lat:k)

Bandagc fot' knce

Four-handed scat 15

Two-handed flcat .. , ... ...

Alternative grip for tIl n·hcllH1ecl scat

Another alternativc grip for samp

Three-handed Elcat ."

Fireman's lift (carrying) ...

Fireman's lift (lowering).. ...

Neat improvised with pole. allll ('oat

Ntretcher improyi . eel with polo ' H))(l coa ts

Nlrdcher improyi .'ed with pule, a1ll1l::i1ck

:Fnrlcv ordin lry ::;b'etcher (closc(l) .. ,

:Furle\' tele COI)ie.handb1 f;tn'tt:her (opcn)

Ntl'etcher eXel'CiRe TO. I., preparing to load

Ditto, placing on fltrctdlCl'

Ditto, placing on Rtrc:tcher

Ditto. carrying. trotch ,1' .. ,

Ntretc:her ex rcisc Xo. II., PI' paring to load

Ditto, preparing to loa<l... . ... . ...

Ntrett:her exercif.1e Xo. III., placmg patIent on Ntretcher ex rcise No. I\T., til'. t position pOHition

)hhfol'l11itter

lhlr st, three fOt'Ill!)

Parle 36 ;jll {itl GI Gl (j:2 li:j (j(i ,fl 7:2 'i(j I(j \0 ( ' 1 ,' ;) , 7 :--9 H) !II \,;j lIt; }11:3 1 l:iH ].ff) ] .j, ' lUi JUZ ]()2 l!i3 ] 6:i

P(I:le 164 164 ] 0,) ]G6 ]67 168 16 ]10 liZ 11:3 ] /.'5 1,.3 ] I,) ],9 Ilf) ]H2 IH3 1 6 I ) , ]gg tretcher 19:3 H)() 1f)7 I f),'; 20G

PREFACE.

- (:--

kr the request of the Contral Executiyo Committee, I ha\'o written tili::; manual as tho officinl handbook ot 'to John Aml)Lll<lnce L\..s'ocintion.

'1'he .' trides made in the teaching of "Fir ,t Aiel," anel the 1'e(1uircmen ts of the "-' t. J 01111 Am bUlal1Cl' Brigade, 11<.1,\ '0 neccs .. itc."ltccl an enlargemont of preYiou work. on the .. ubject published by tho A.:socintioll,

I h ;'"l'i'l' endefl.'i'Olll'ed to include onl,)' as UlILch atlatolltlCi1.l and physiological detail a.. i.' absoilltlly nece:) 'ary to enaLlo students to grasp intclligonUy the principle.' of treatment.

The greater part of the directions for the applicatioll of the triangular hnnclc1go and for lifting anel p:"ltienb:;, 1..':) adapted almo:::.t yerbatim froUl the" or 1.. of the late 'hepherd, a::; re-written 11,\' Dr. HolJert Bruce.

I wi 'h to exprc ',' m,\' th,mk to Colonel C. Bowdler, Drs. J, Brown, C. Child:..;, M. CoatcR, 'V. Collingridgl" J. H. Croa.'8, U. H, D.1t'\\'ill, and H . •\.. Latim er, wh f) ha;r e, [\,.' a suh-e mmittce of the A 80ciation, [\'8,i te d me in my \\'ork.

J AME. CANTLIE.

Jll lll:, 1901.

TO THE ,'lXTH EDITIOX.

TILE .John \ llllnllallce A " ociatioll ha pll'tec1 the t\\'cnty-.'ixth .\('ar of. it: exi.tcl1<.:e., tlte pl'l'io(1 .... in<.:l' tltl' ,\'''()l'lanOn 1Je!,!'clJ) It. \\01k, I 1l11(he<1' of thnu 'llll( l-; of loen lmel \\Olllen ha\l' l)ec11 itL the da , "l''' of the .\-,;sClciation how tf) hell ' heir in.illl'eel l1eighlHml'''' In eycry \\:hel'l: ('i , ilizatinll 11<1 ,' P l.·lll'tl'Htl'el do c the ot the. .\ ...."f)ciatio'] tine1 ,1. ready <llHjienc:L', All mnk" ot (lcidY tc-.;ti\'" to thl' n l'fnlIll'" ()' tIle ll\, trll:t,ion !.!'\\ Thl" \'0110\\ l'l" of no rL'ligiolls or t' rl'c ell'a"i] nt it., ailll and irll'il1-.. .ll'\\' nnrl

( 'h ristiall ,w<1 Jlal\()}ll' btl, BralllJlin hn<l Bllrldlll t,

accl' pt it. telld ', and al'pl'l'cia l' the l'l'lletib i , ("o llJ'l'h,

l -nr1cl' the ,In, pi<.:es IIi th e . t. John _,'-1111nll,1l1:1'

'- "fl ciatiol1, "Fir, t \ irl" lta, ll1,tu a lind 1n·<l1l<.:b of lll'ccssitatillg' a specl<l.l, tl'Cl.IllX l'ilhcl' in (IIII' 1I11'dic:l.l s<..:hools nor I1l.

ltu"llitaIs i .. "Fin,d, '- i<1 " ....llL,cia lly tangllt, and It .1"

tIl tIll' of till' ,-';t. .I(llm

L!()ll tlwt lJoth thc pnlllic .1ll<1 the Ill('chcal Pl'Ofls,lO.n arc illcll'htecl for hclyill!.! tll'\'el(lpl'( l and taught. tIll, i L.pu rtq,nt c1epartJlll'll t of llrgery.

The in.. trndioll h'gill. at1(1 l'nds \\-ith "Fin:;t Aid," aJl(1 tIll' :subjcct i thoroug'ltly Cllld. tin']\. 'rhe clut\, 0 the HlulnLlam:e pupil encL

\\ llel:L' the COlllmenCL'N, and there onght to he 11() oyerbpping 01' del 'hing of cluty or !\

11lOl'L' liLcl'..ll or n. cfni instruction hnH cYer hecn to thc pul)liL', anLl the ,\ ork of thc St. ,JOltil

Antlmlancc A , 'ociatiull 1t1ll:-.t clmtinnc "hiL·t charity

n'lll,Llll:-' to Ll. <lull • ympl h," for ::>ntfL'l'illg ltulllanity nl'c..,

FIHR'r AID 1'(\ TILE

l HArTEl I

E:"'l)f,.\ X .\ T() It) ' .

B\' " First Aid " h 1III'ant that fonll (If n:-;, i "tauce \\ hicb Pl'I"(llh traillcd ill 1l11lhlllalJ(:(' \\url, call aftord in talltalJ '(HI ly to tltl' . ick 0)' illjlll'cd.

" Fir::>L Aiel to the Jl1jul'e(l .. j" a 1))'<l11ch or practic;tl 1';1Irgcr,': dClllalHlillg' 'l)l'cial alld erlllcatiull.

TilL' prillcipal ailll and ol)jl'ct (If thl' .TuLI . \ lltlillLlIll' L ' .\:--I';ol'iatiol) to teach ill sil1lplt: bll!.!.lW!.!. l' ho\\ tu Ilclp <I si(·k 01' illjurcd pcr-';(lll \llltil till' .Tl'\ il'L'_'> or <I dud!)!' :ll'l' ol)lail1cd.

, \ fllrtllL'l' alld illljl()rtHl1t lnH1H:!t of auJlnIl,llI( 'P \\ol'k i.., tJll' ('l11'l'ia!.!.l' of :-.ick or i11jlll'cd }ll'l'-';Oll J." hy illlJllldHIll'l' \\<li!'(1I1. l)y rail. OJ' 1),\- illl1>]1)yixcd Illl';1I1 of trallsport.

Bd()rl' jll'Ol'ccdiug t() !.!'i'L' ill detail till' Yari(Jll:-- :-.tcp to be takcll ill til, l',-cut or accic1cllt OJ' .. uddell ilhIL''''", it i:-. lll'Cl'''<ln to ].;110\\ of the .tnwtul'c or' til ' l)ud,'" (L']L';llclILary ;ulHtolU,')' the fUllctions of ::imUL' of the 111(JJ'e illlpOltant Ol'!.!,tlll , alld Ny:-;telu .... (elL'ILlL'utary plty.iulogy' 1\ ..,llOl't dc cl'iptioll 0"' l1l'l'l'-'; illy 11llatollliml awl poillt of iwpOl'talll'l' i tllcl'dol'L' thl' ,'CYL'l'al nhjec:h nn' di . t'lh .... crl ill detail. I i.., l' '.... cutial to l'(.' lllembL'l' \\ hell . HlIntoUlY lwt th' hUltlll11 1 ()rl." i '

to be :'(tancling crC'ct, \'1ith the palm') of the hand::; cltrccted forward:;; C1nr1 thc thnmL. ' Otll\.\;lrcl .., or .from tbe Thc" l1lielc11e line ., of the uOEly J.' a. Illle clra\\'n \-el'ticl111y from the top of the heae1 to a. point hot\\'eell the feet.

THE

The human hody i:-; moulclul llpOll a h011\- fl':1l1le,rork which ,' eHO': (1) To ,>ha.pc 111111' til'l 11Ill'/'i. , to the hocly ; (:2) to afforel attachment to tilL' ; :llld (:3) to protect the morc yitnl ill tile III the ch&;t, a.nd ill the it1.XlOlllCll.

TH

E B ACK BOXE, SPIXE , on YEHTE13H.AL ('()IU'\[x.

The Vertebral Column .-Ench :-;eglllt'llt of which the :::;pine i,' compo, cel i, ' terllled n, Yerte hra. A Yertehrn, COll.'i, t., (l) of a, 'cntral hml\- or llla,s; (:2) of proce:::;e:::;, t\\·o of which join to {lIl'1ll a. canal for the "pinal <,:ol'cl-the Spinal Can a l · 1chind, bony projection, -tho spinc: of tile Hrtllln: -ca.n be felt beneath the kin for the \\ JHJIe Jelluth of the h1Ck (Fig. 1). r-

T he Yortehnc, :3:3 ill all, arc gronpcll illtu rcgion. ' :_ 1. Th e Neck or Cerv i ca l YCl'tchl'cC nrc 7 in llllllll1C}" t h e nl':->t or atlas f01'l11" <l iuint \\-ith the ha:-;e of the at which thc nodding mO\'cmont oj' the he,td place; the sE<':Ollcl 1)1' h,v the joint between It alld the atk, ctllo\\" of the 'ide to ..,ide

mo,'ement of the h ead. II. The Back 01' Dorsa l \-ertehne, 12 ill number haye the 1:2 pair.. of rih attarhecl on ei.thcl' side. 111. The Loin or Lumba r

OODY OF'Vl;nTEB:-lA FIr., 1. , I SURFACES

n:rtl'l,r,', 3 ill 11 II IItl IVl'. ill'" till' largl:'>t of all thl' n:rtl'I.r'L'. IY, The Itlllllp BllllL' or Sa c rum (:011 . ish uf ti.l,·c 'I l'J'tcl'l'a:, ullite!l in adult· n a "olill \\ hieh \\ itll till' t \\ 0 llitullch hone, form tlt · pelYi:--. Y. The Tail HOllL' or Coc cyx cOllsi ., t, (If fum "ertL,ln',' \\hiL:h U" juinccl togdh'r t() form ;l ,iu!.!,ll' L!;l'OllP, TIll: \ertL·l>ne i n each rcgioll are kllO\\lI by lllllldler CIl\l1l ill!.:!,' :2l1d , dL' .•

Bl't \\ l'l'll the hodie. of the \ L'rte l)l'Ce thid\. picL'e (, ' L!,'l'I/'itic (11' l'Hl'tilH!..!,'t' (t'lIful l,/,ttli/'o! <lre interposL":, \\ Ilidl, \\ Ilil .... t thc\ hind, the bone, ' tOL!,'L'the}', alltm (I

fn'l' 1lIll\'L'1I1 'l1t to'the (' Ollllllll a ' a \\ <lllcl . el'\'l' t o tllL' "hock {) ' (lilY lli l,l en fnrcL' ltpplil'(l to'

SUPPORTI NG H E A D S O F RIB S

C,7 0,12 C O.4

spinc. Th \\ hl'lt' ll'llgth of the ,'pinc il'; . tl'Hppcc1

ogcther l)y lig'Hlllcnts

l'cachiug frOJt1 cl1d to 1\C 1 of he C011111111

THE Thc 1)OIlC:-; of the , k1111

,}'e 1Il t\\ () tl!o:-,e flf tho

1Jj'aill t;,lo'C OJ' ('1'H l1iUI tl and thu 0 of tIll' facc, '

The lJOllllcla1'il''' 1Ij' t Ite Cranium al'C the y;u!lt or dOllll" tlte }otllHlcrl portioJl j'Ol'llllllP: the top of the honc1; the frOlJt or In'ow: tht' h(\('k of till h ead \\'J](:,1'C th<. atcst \ ten t of 1)]'ai11 e\ j , t...;, .11](1 \\ lll'ro. t jlL'J'ci'U]'(', FJ(:. :'KCLL AND VERTEH1UL CULU)fN, )':J'ho1l'W rJ {fjt 1'ib" (wrl llOI" lioJl of Tlte "/UlLt rill;; M'e 1'€lIwl'ed.

thc t'l'Hllilllll I, \\ (llId clt1 Cj):--t: th(' :--iclCS (ll' l' 1l1ph':-" \\ hc l' c tht' (IPl'llilll-!':-- ill 0 the eal' pa!" 'H gcJ-. al" .'l'L'U, ;ul<l to \\' hie b lhl' l'ar i att11l'lll'(1. Thl' I)t' llc c}';ulilllll i, Ilidd( ' 11 I'rolll \ ;'.'\\ l),\T thc lHJllt' of tllo

f:II'(' ;llId lito \'('rtt,j,J'al L'(lIl11lllJ: ill il an: JlIIIIJlj(IIl' plrf()l'i\tlOlIs I()l' tilt' pa":-:l!.!'l' of the 1,lo()c1 I!( ill!.! to HIlIl 1'1'11111 tlw 1,)'aI11 : tltl'(11 gh llie ...,t (l""l1l!..!'

tIlL' I'mill alld :'1 ill<l l t'(1J'(1 <ll'l' ('UJltill 11111",

Tltl' 1)(IIIl''' ()f tIll' F a c e, \\itlt till t:--c 'ptioll (,f 11'

]11\1 L'r .ia \I. HI'l' liJ'J,tI,\ juilltl' 1 ,() 1I1at 1111)\"-

IIll'Jlt l)d \It'<.'ll tltl'lIl i, iJII]lIN,ill)t"

The cil\'itil' ,' of tlte :llId (If tllo (,\'t' o..,(J('l\et ((I/'''it) <In' rlll'lllL'c1 1,,\' tIlL' lJ(11Il'" (Ii lilt: CI'a;lilllll "wi

CUI IJllj lit I y, TIll' 111Cllltli l'<I\ in' i" tOlllll<l l)l't\\'l'l'll tIll 1l]l}'Pl' : Jlc!' IO\\l' l' .in\\", tltl: l'"lalt' I,('illt! tile hOll,' roof IIi :!.L' lllOltth \\ hiI'll it fl'()111 h-..' lHl"al c< "ity aJ,o\,L'.

TilE H

Tht' RibS CUJI:-.i:-.lofl\\l'hl' pilir. of t:l1l'\'l'd llCllll ('xtell<liut! from thl' 'l'l'tl,l'l'ill col III I 11-' 1,L'hilld t o tl]l frollt li tlte l)u(ly, alld Hl'e kno\\,}) 11.1' 1I111 11 hll''': 1. l , lnc1, etl'" l'OU1Illl'lll'il1!,! fr()lJt ahoYL', They i ll] III joints \'. itll tlte' \' l'ttelll', ': and t1llil' lllllit l'l'sl'llllllcs tltat ()j till' handle (If a lHlckl'L Illl' l'ii, an' lIot, I]()\\ L'\L'I', IllIlIy llJ],Oll!..!.ltOl1t th'il' ':lltill: I'llt!tlt, 1\ t it , 11(1)'t di"tallL'l' fl'PIIl tht' In'c,\:t bOllt' tIll' lJllll." JllalL'l'ial l'IJ(I", alld gri lIe (cartilage) tnkL' Jl:-:.

r...

pbcc . The upper ".e, 'c l1 l:;lir", !l 't'ned thl' /1'/1 " nils, are atLa<.:ltccl lJ)' th r-' ll' t o .l il e jJ()!II: ; thl' JO Wl'l' the pn.ir:-:> are tl'l'lIll'd l h c .Iu/::;e )"] II'>, a:-. thl'lr ('arti : ,1:.!.'l':-:> fa ll " h o r t n[ [he middle l illC. (if [ill' iab c l'ilh thl' 11th and l:!th pail''' are tl'rmed till' or \\iu"wl rih,) a::; thcir l'wb ilrl' f'rl'C ill front. Til l' rih" che t, allll Cl'\"L' to proLcct the hl"trt, liYe!", . tUllmch, :-.plecu, etc . T llOl'cl.'\ ;[11 ' ] A LdulllL'll).

TUE BREA ,[,-RU:\E

The Breast -bone (3IPrlllllll) i , it hOlll' with t h c point below, ju.t O\'C l' stOluHch; it s ll pport:-; tltc iUllcr curl .' bOlll' , alluyc, allli lhe ,'l'\"l'll truc ril) , with it un eitilcridt,.

THE EXTUDllTrE:-..

c1a!.!'g'L' I' -:·i1IH pl'd thc pit ui' th L ' of the ('1>ll:trarc CU!llll' L·tVrl

Till' Shoulde r Il l ' 1l' '> ;ll" tit ... ('!)J!ll'- I)()jh ' (dUlliel / ) awl till' s it tHtldl'l'-IJi.l ('" 'JILIII) ,\lId tIlt,.'" tll,!.!L'til l'l" l',)lhtitllte itll '(lI '- tlll' ,S jHlIlldvl' . !.!lJ'(liL', T he Collar-bon e l'; 1!1 Il'-' t'l 'lt Ll' Il l' aLlI till' :-.kill .. till' Im\ el' aud i'r'llIt pilr t t:f tIll' lweI;: a :-; it \l'll'!'!l\" (;111'\"(.'(1 rucl of 1l011L" lh()llt thl' tllicklll'S:-' Ill' a rill!.!'l'l', It" inlll'l' j'l'''t" Illl till' Ilpper piln cli till' ill'va ' r 1)0 <ll' : the Olltl'l' l'llrl j()ill"; II itll Ill\. -: thl' top ()f thehlllll Iv)' ; ,,- l: t h ' r l'll.1 it joillt v.' :" t-; Thl' ('ollar-hHll' i'> l'ndl) II cd \\-ith l'stra l'laslll'lt,' " til it POS, l' :"'vd a douhle Clln l', tlt e P A I n 01, CULL ,\R BO\E

A R'1 _,.. tH U.llH.U ' )

( eL\ ,\ Forenxm I

\ R .HHf'S l.'_11, .:l,

25 1:,,\1'> OF 'l'ln: F T UI'?ER EXTIU, 'lITY,

inner l\w-thir(b of tilc lHl1l<' l;eilJ!.!; cun cd fOl'1I a r(h awl tile olltl'r tilinl

'lank 'l' hi" Is

l1l'l'C . <In" ill orcler to l'l' i .. t 'the train

tltl'OIl 11 Oll tllC l)()Uc 1)\" fall:- 011 thc hanel, Ill' il()ltldcl'.

The Shoulderblade lil's ill tlw hIck 01' tile Chl:"t, awl jonll'> j()illh \nth thl' ctll1nrl)(Jlll' and tL \., hUlle (If thc arw,

Tltl' bone of the cl r m (/dlllle) 1£ ,.. )

rl'tlehc frotu tlll' f>ltuul(kr ttl the clh)1I , J11 Ule Fore c:. rm

rtl 'L' til 0 hUiles, the Radius Oil t1 e ontc!', or tiic1c, -ide, , > ' ' little finger

1 tl ' Uln a Oil the llllll.:l, U1 Vb am I ' tl' el Lo\\ to t e Both Lo n e!::> retl..dl from It.:

20 .and they change th ir lelative po ition with e,-ery turn of the hal1cL

Tne Hand is composcd of: (l) the bone' of the wri.·t or cmpU8, ei<rht in nllmher, arrallgpd in h\"() row' of four; (2) the IIIPtal'a I'pu. (the fraluc \I c: palm). pre!;entin cr tiy.: bone', \"hiGh fOrlll the kl'l..!cldc:-.: upport the bUlle of thc finger. : ( 3) the plza/'tn.7es or fin(rer hones, three in eac.h and tlYO in the thulllb,

TIlE PELYIS La" En EXTREmTIE',

Thp. Pelvis .-The lar,re 1,a, in-like ma,,' of hone attaehed to the lowcr 1,;,l't (If the :-;pillC i:-; tOllJp0'>ccl of thrce bOlles, the two haullch l'one. alJ(! tile :-;al:llllll (or rump bone). The haUlll:b 1,u!H,',' mcet (at thl' [mile ...;) in the middle lillc ill frollt. only a. l-illlall pil'l:e uf gri. tIc iutencnillg. Imt, l'chillcl, the al:l'llm i , placcd het\\'ccn them. The l,cl\' i-, to l-illPl'OJ't the abdolllen and its C{)lltcllt:, to protect the organs within tr.e pehie c<L\'ity, to giye attachment Oil Ih outer surface to the 1I111, 'clc, of the hip and ;md prc::5ents the dcep 80cket for thc JJcad of the iJligh l)one -the hip joint.

The Thigh bone (feltluI') reache, from thc l1ip to the knee joint. The ,·haft ut the lJone i .. "tllul, rounded aud anllcd forward!'. Tbe upper 'lld pl'ea rounded Jlcac1, Oll a !leek \I llll.h inward::; at all ullglc £1'0111 tho shaft of the

'..-HE lIF THE }w t;T Lo\\ FR EXTHEM1TY.

PELU,', TJIWH TIl '\E (FE:lICH). CAP (PATELLA BROOCH) \ ,\E (FII:t:u.). • H1N (TIlI!A). TAR U"'.

h011e to fit into thc of the hip joillt. The lower cnd CXpall(l::; to form two projecLiOlli') fit the kuee join t.

ThL' Knee C a p vlatella) ilS a thick trinnglllar pieL'L' of 1)onc with ua:-;' upw<lldi') lying ill frollt 0' !hc kllcc joint and the luwer end of th thigh lHHH:. It can he felt 1wneath the .. kill.

Tlte Cone s of the ieg all' the ,'hin hone (fil,/'II) allel the Brool:h 11011e (Jill/LIft'. The S h in bo ne (till/a) i-.; triallg'lllar ill :-;h;lpe. It cxteud:--; from thl' kllL'e to the ankle, into huth of which joillLI'I it eutel''' ancl p1a:,:-; an impurtant pnrt. The .·harp edge 01' .-;Mn can be felt illllllciliatdy uelleath the Hkin of the frunt of the leg; at the inner Hide uf the allk Ie <l HtOut pic(;e of 1)une project.- clu\Qmarcl:; frol11 till' tillia. Tlte B r ooch bon e (ti/iIlZa) lie. pamlle1 to, and 011 the ()llter .. ide of, the tibia. ThilS luHle c1oe:--; 1l0t euter into the formatiull of tIlL' kuee joint, it. 1()\H'l' end form ' the ontcl' h011ndary of the ankle joint.

The Foot.-(I) Thc group uf ir'regnlnl' hOlle:-; at the ill tep (;olllStitl1tc.' thc There are HCYell hone . ill the tar:-;u:::i, of which the lnro'c:-;t i:--; the heel hone, anel the Hppel'lllo't (tbe all klc hone) i()],lll:::i the 10\\ er part of the ankle joint. (:2) The ti \ 'e IOllg hOllC.' ill frOllt of the tar 'H' cOlllStitHte the alHl each hilll' .'11pport· n. toe. (3) Ench toc, except thl' higtOl', pno.;.esse threc l)()uc:--;, llamed thL' 1:-;( 2lld, aUll 3n1 phalanges. The big tue ha hHl phalallgl' . ulll.'".

29 .1 ()l :\"'1':-:.

A Joint i .. fOlme(1 at the' jlllldioll of t\\"o ()l' IIl(JIC hOllC·S. III joi11ts :--l1ch :v the hip, knce, elllo\l, etc., tile sl1rf,l(;c.' of the h011l''l nre coycred 1»), f,:Tistle Ill' /'wti,layp a hard, dCll.e, sCllli-tral1.lucellt l'oyerillg \\ fricti()unlld he yi()lcl1cC amI 0.;11<)('].;; of a fnll. Lnbril'atillg' the j(iint i:-. <1 c]cm' rather Hticky or syrupy fi11ir1. tIll' "joillt ()jl," or "!ll/or ia, ellc111l:;cc1 \\'ithin a,'

Tying th hOl1l'.' fil'lllly together, 1mL yLt all()\\'ing of lll()yelllellt, a 1111lJ111l'1' of J a1)ch-; ( r ments. D llle.) cartilage, sYl1()\'ia, l:apuIL', and ligament::; are tbcrcfcrc

FIn. 5.-TIlE HIP the component parts of 2eclioll of n Ball and. ocl.tt Joint, the lim1) joillts.

T o explain the matiol1 of limh joints, 1hc fo]]o\\ing example.' an' glYl'l1 :-

1 The Shoulder , n 1 ocket joint, eOIl-ists of a :-;hallo\\- sl1rfac.e Oil the nut r al1(r1e of the amI of the' head uf the arID-bonc (humerus). <..h ing tu

:.I U CD \R Tb'US

TL:\lIO\ OR OF P_\Tl::LLA _---""=[11/\

FlU. 6.-DIA G RAM STlOWI"'0 R ECTU,' Ml ' ::.CLE OF THIGH, WITH ART&RY, VEIN ASV TERn:. :31

thl' of th ..: 'bou 1 kr-lJlade i>ui'fctl'l',

t he t'Olllld l' l H [ of thl.' 'lrlll-J,()lll' i, ' \'L' r y prOlle

() ft'Olll it;.; .'ocket (dis!ol'iltl'),

2. Till' Elbow <t h!l1g'u jl,illt, is ('lll)IP:h('d of the a1'lll-I'()lll' al)()Y8

<llH [ of t il L' t \\ 0 Ill'lol\ (til(' awl 11!1);I), Til l' Hppl'r

('w ! nt till' IIlun fOl'lllS

a stollt l'l'!ljeL'tioll hchilHl-thl' tip of thl' cll)(l\\'--\\ ' hich to ('llIlmll'l' thl' HI'lIl-!)()lll' 'Iud maintaill thL' l)lIlIl's of .t/.LL' dbu\\ joillt III po ItWIl.

'1' HE .\1 {' '('

The muscles of tIll' hudy II'L' clilified illtl

t\\ 0 th ,'nlllrdal'!/ aml the illl"uluntary IJlIl.·!'/P,-:.

The Voluntary muscles "()ll'lilute tbe lllClinlmlk ()f met with ill thl' lilll bs, the heacl Hncllleck, ;tllll the snrface of thl' trullk, Thee III w ,,d c. a r e att;lched to the hOlll' .... , alld ,l. they pas, frolll one hOlle to illl(lthl'l' el'IlS ;t joint, and 1,cillf!,' endowed "itll the pO\" l'r of cuutr,ll'tiol1 and relaxatioll, CnlhL' till' 11l0H'tlll'llh of till' hlHl\'. \ a muscle C1'OS.'(;S a joint it luse'i it. rl'cl, tll' .... appl'arance alld hu;o mc,.; il tendo1\ (Ie,tell'r). Blool 1 'es, ds tra Yel' 'e Hncl . npply til ,' llllhd..:s, amI till' lll'rn;s euterillg the lllll.'tk.., ]Il'ill!!,' tlll'lll uncleI' the direct {:olltl'Ol of the "min <lIlt! "'pillal curd, Till' Involuntary muscles are met with in the \\ ,db of the stcllllach ,1lHl llltl'stilles, in the nil' passag'c and ill 1l10 .... t of thl' internal organ:'> ill1d hl()()(l \ l' eh, al. II ill a . pe 'iill fol'lU iu the benrt Th l'\ an' ll()t lllHlL'r tltl' inH.IIl'lH;l' ()f thL' "ill 1111t l'II!! 'illllL' (heir work durillg' the hllllr ()f , leep; they arl' .... \lpplietl 1>y a ;';l'p'll';t l' .... d uf l1L'rn's ('ee :\ l'l'YOll' :-iyst'111).

FIL\ 'TCHE' \XD TH EIl{ TltL\T:\tE\,T. h: a Fra cture i .... llll'allt it In''1kl'l1 lH'l\l'.

'A[' E:.... 11\ FR \C1THE, A houL' lila \ ' 1,\., broken 1)\' '1. D ir ect' Vio ence .. \\'hl'll hll'l1 a blow,

impact of <l lmllet or ern ' h of a ",heel, etc ., a Lone hreak at the :-;pot \\ here the force i:-; applil'cl, the fracture it:> termed clirect.

1. Indirect Viole n ce. " Thcn the bUlll' hrl',l.kt:> at some distance from the, eat of injury, Lile fracture i:-; ter med indirect. Alightillg on the feet and fractlll'ing t h e thigh-l)one or the l)Ulle:-; of the leg, or on the haml and the mcliu:-; or the cul1ar-hollC, a r e hlllilial' eXclmple:-;.

3. Muscular Action. The knec cap and the arlll bone arc occn,'ionall.\T hy a yio]cnt co])tmctiOl1 of the 1lll.U5cle:s attachecl to thew.

YAR1ETIE, ' OF

1. Simple . The hone is hl'ukell ill tm), \\'it h Imt ,'light injury to :-;urroullclillg part:.;.

:2. Complicated. '!'hc hOlle' i:-; hroken and other important adjelcent structure, illjnrecl either 1).'T the yiolence which cnn,crl the fractllre, or by tIll' end, of the lJOl1c \HJ1l11clillg <l l)loocl ye:-;. el Jl'I'\'l', o r any of the orgalls \\ ithin the skull, Clll'-;t or abdomen.

:3. Compound. The l)()l1e i:-; Lrokel1 and the , kill and tis.. nes pnnctnrecl or tom al1o\\"ing the ail' to cowmnnicate with the eat of the fracture. The f ',u:tul'erl ends may protrude through thc "kill, or the \\ oll11d may leacl do\\ 11 to tile fradul'c. Thc ,ioleJl("(' that the bone, or the jaguecl cnc1:-; I)l' lIt' bUllo

tll(llloChe,', c,p"cially c1nriloj...' ll w':c lll cn t, it.;-; n fritctllJ'C t() 1lCc.:()] Ill C{))Jl]'( ' IIHI.

l)assillg referellce lllay ,.1 . I) 1,(., LD t.hree I j( ) lC

FIG. 7.

DJA(;RAM OF' DIPLE FRACTURE UF LEU

DI AI ,J{A \1 or CO;\IPOG.'H) Io'.l:UCrl ItS UF T Lt·, WITll BO);E l'ROTt{n ,I G D

1\""'",-;. -'

varieties. Comminuted :-The hone ' hed into s c ycral p ie 'l':). Green-stick : -In children, owing t.o tho t)oftcl' of the hOll Y ,1. hOlle may ll cnd and crack without toly aero '"

Impacted :- \rhcll, in:stcacl of oyerridil1O', the broken cllcb of it. l)Olll' arl' driyen the one into the other, the fm Gtul'c i .. to he imp<ltted. Seyentl of the II unl ,mel :::-,nnptulIlt> of fmttlll'c mentioned below are in greC1H.,tick and illlpacted fnwture·.

AXD :-inIPTC))[ ' OF }'RACTURE.

1. Loss of Power in the limb.

1. Pain at Ol' nCar the :-;C:tt of fl'actllrt!.

Defomrity. The injlll'edlimo liel:) ill ,Ul unwl.tmal "uc1 i:-; llli:s- 'hapcll itt thc l:)cat uf tlle inj my.

.-1:. Shorten ing. Owing to the contmdiull of tlll' 11 Hu-;deK, the l'lHb of the honc oyerriclc, calL ill" -;llOrtctlillg of the illjml'cllilllh. W

G. Swelling . The uYl'lTirlillg end .. of Lilt! brokelt 110110, tlw (;outmctioll of the lllU clcl:i ,wel cffll'lioll or blood, will the part::; aruund the :-imt ()f thl' fnwture to iu(;rca.'e ill bulk.

o. Irregularity , If the fmctured l)OI1l: i:-; (;10. e the Kkiu ;1::, ill. the (;c.L,·e uf the ja w, collar-bonC', shm-hone, etc., the gn.p .ill the l )one or the encb of the fmglllellt .. way l)c felt by tIll' finger.

7. Unnatu raL MObility. :\IoYement may 1)('

JIH-lCk 01lt at the, eat llf the break ill the 1JOlH.! a' \\'ell a .. ClL a joiut.

t:(. Crepitus ur holty i.!,TaLillg' lllH} he felt 01' heard

\\ 11L'1I tltl' In'okl'll end .. 1110\ l' ()1ll' llpOll the other.

Tlte la. t t \\ 0 :sio'l1:S ,' lwllIll ouly 1)(2.'ough t 1I) a .'urgeoll.

.\PPARATU:-< Fon OF FRACTURE . .

Splints and Bandages Hre tllt! npparatll.' 1:-

\\ hich lJl'okL'll llllllL'S ilre to lIt! treatcd. In ho:,pltaJ:..;, :-.pliuh (llltl J' lluclag'L's appropriate to cycry Yarid)" of fmctun: ,1.rl' at haud. lillt for "Fir.. t Aiel " treatment t Ill'.\- freq Ill'ntly kl \'l' t{) lie illlproyi.'ccl. . .

Splints 1IIa,\' l'L' ill1p\'(lYised from walkll1!!; l:itIck', 11Iltll1'l'lla, hillianl CllC:-', brooll1 or 111'11. h handles, n p()lilTlll;m" trullchl'OIl, a ,ll1ll. ket, a or s\lol'll ill its cahlHlrcl. a foldcd coat, allY piece of \\ ood, tinl1l\- folderl Ill'\I spa per or allY other paper, H rolled-lip u\ap, fir, ill faet, anutl,ing that firlll waf 107/1' tnOl/I/ll to "'1'1,)1 th e JOI'nt:; imlllediately au(,ce a7/11 the' t"radurerl bone at re:..:f. ,,"h ether any of the ahrlYL' appiimH.:c arc ,1.y<tibble or not, the uyper lila" lie tied to the trunk or the lo\\'er 111nh to It--. fL'lfow.

Bandages may ht' illlpnl\ iseel from handkerchief.... , belh, Ile 'ktiL' , or any 0' linen or cotton tlmt to hallct.

Esmarch 's Triangular Eandages (Fig. 9) arL' 111:l.clL' hy (;uttillg <l. piece of lillL'll or calico ahont forty . D

3(3

J'OI"T .

E N D •.:..--------.:=-.::. L'\]>

F lO . 10. LOWER BOR n ER. BANDAUE Oi\CE FOLDED.

L O RORDER .

FIG. 11. BROAD BANDAGE

LOWER BORDE R.

FIG. 12. N AR RO W BA N D AG E.

ill('llI':-' .""llare lllto t\\() piece' (TO:-" W,IY..,. '1'bl' b;1l](lt.10'e Ill"." hl' ll"ed either :h :t hrniH l or llarrow l'H!Il1a!4f', TIlL' broa d m a d e b preadillg' the hallda!.!,'C' out,

F IG. 13. FII" 14 ,

t1ll'11 the pOlll dlll\ 11 til thl' 11111 er 1,ordc: 11)), 'llllt tllt'll fl)ldill!.!. llltl) tIl II 11).

The n arrow i" IIIHdl' 11\, the broad l)ilmLwc H!..!'illli ill tllO (Vi!.!,'. I:.!), ' -=' \\ hell WIt ill llSC I till' trlall!.!,'lliar 1l<lllila!.!:c :-. houlr1 hL' fl)ldl' ,\ ;1 ;t lI;t IT() \\ hiIlHLI!!/'. t h l' tIl () cmb he tllt'lIL,d to thc C'c ll trc, allil till' inmtau'l' thcll folck-d into fottr, n'lhcitlg' it to ;1 pa,'kL' :lhoutGi illl: h c" lty ;31 illt:hl'''. \Y hCll tilL' ltaIH.hl!.!,l' I folded in tlli" mallner it j" 111111 lIL'Cl'..,salT tv l'xtend it lell"th ll' i:-.c tu fOrIn. <I

nalTol1 to nllf'old lla lTOlr baud Ige and ..,11 d (ln\,le it I\il:h Ut.J.k-: a Lroad Landage.

E"D

E'\D 37

The hUldage 'hould ilhmy' be h..,ll'l1ecl ( 'it her l)y n. pin or hy tying the end::; with a. ree1' knut (Fig. ]:)).

FIG. 15B.

FIG. 15A.

'Yhcn fn1' '-)l'CUl'the houl(l 1) 0 folded llHrrow, <ll1rlmay he applied ithl'l' (1) l)y P<l:-.t->illg it once, twiee, or III Cll'l 1'0111) (1 the lilJlll <llld splillt anel with a reef knot : or (:?) 1)), dOll1)1i ng it, }leL.ill!! it ronnel the lilld) and -'plin t, OM nrl

th r011gh the loop forlllC(l l)y (lo nl )ling the l)an(lage and tyi ng it tu the frcc cnd . 'with a ret! knot

Fig. 1-4-) : ()l' (:3) 1>)' a:- ,111 (2), l.l'lt pt.', ing hath enrh; through tlte wop .11 dir!'ctill11 ("P(, !llHl tyil ig i IH. 1ll wi h ., ] Pl'j kllO (, "e 1:11').

K 11 0:: '. . 11 0111 (1 ;,I\\(1.Y" \"here po:-;:--il ] < 1Ie -ieel over n. plillt. '0 that lIla), nCI 1 reo.; , lllHlIl '!lfr '- nl(·tllre,' de tltt 111 :<,.1'y.

Large sling 1G).-

".t a hal1/l1111 (11." ow1 o'-er the \1Il:1dcl' 0 11 he '()Hm1 ,jilt' . h,t the I,thel' JI ang' dm\ 11 il.l

Frc: . 16. 1']"(1) If j 1 ; the ]IO:ll t l,cthe clhmy of the injlll'ec1 ann, an(l hend the ann for\\ ard oyer the middle (If 1.e hl.lldnge; i hen ' ca rry the ,' ('con(1 cnd mer he "ho1l1c1cr of the injni'ec1 . ide, and tie to tho 0 he-r end;

tiic point f nra rtl , ;llld \ -!o pill to tIlL' frollt of Small armsling 17 ).

Fold tIle I),ll) 1-

aL(L' illto tbL' In'()(l(l

thCII place (jUL'

cw1 ()\ 1.'1' thL' ()n tlw :--irle : l'rlh

tlte fOl'enrlll on'!" the 1I1i(ldk (If til, hllldaL(L'

el()\\ 11 .... t h l' l" JIL'l"> t :

thcll 11l'illL( till ot hcr l't II 1 () \'l'l

thc .... h( lltldl'r Oll

t hc il\j mcLt iele.

aIHl liL' at the :-idc ()f til ' Ill'ck.

SEn....!. ..... 1l1,l\T h' l'\: eupori eel hy tllmiu:..!.· IIp tltc t ,.il of rlll.' 'emil' Iu(l pillnillL( it ()1I tIll' I'\h()llld'r (fj'l g. 1 '), Ul if ;jill' ,,',UJl or tltl' lw .... bN'.Q '11, Ity thL' artll III till' trip of c..l(>t:I1 ::;0 f' Il"lm'd, :.lit 1 pillllill.! ;l.... ....\to\\ II L FIg. 10. .

(, E \ E[UL Hl'LEi" TO BE OBSER\'RD IX THE THEADm;:.. r 01" FRAf'Tl 'RE-;.

Thc' o"ject of til':-:t :Ii(\ Lrmtllll'llt of fr;ldllrt':-' i:i t ;I!.!,·aiu:-.t fllrthe r lJlio..;chid. awl c.... pl'ciall., tu prc-

FI\.. 1 . FIr .. la.

\C11t '1 fl'adul'l' rl'OllL l"Olllplicilted (11' l·!lIII1>Ollllll. To itttaill tlll:-- '1111:-

1. Attend to the Fracture on the sp t whe re the a cident occurred. .\ () lIlatt '1" It)·

l'l'owded the thoronghfare', or hOiY hort the di , lance to a more c011Yenicnt or tOlnfor ahle plilec. n(l at tl'mpt lila, t he made to 1110ye tIlc paticnt nlltil the 1,onc ha' l)cen rendered as ill1J1)oYc'l.hle a:-; l'us:-;;l,ll' 11Y a "plint or othcr rcstraining apparatm;. ,\Yith l!r at principlc e.. tabli 'hc(l, the treatmcnt of ....pccial 'racturc, is a qllc .. tion of dctail.

2. Steady and support the i n j ure d limb <It <1 '1ce, ,0 that its further mOYL' Jl1cnt Oll thc ]Hlrt of t ' her the pclticnt or the hy, tall(ler:-; i. . :3. When a bone of the low e r extre m Ity IS br oken gently pun npon the foot llntil limh l'cvain.. a morc normal shape. , ' hen the posltll)}l of limb i, improyc(l, on 110 aCCou11t let /-!'O (If tllC limh nutil it i .' secured in position 1Iy ,plint:-;. otltl'l'\yisc the ll1wcle. wi1l hc n.llO\\·ccl to C(Illtl'cl(;t, <lllll tIl' rough Lllcl:-; of the hrokcl1 hone l1Hl:Y p llctmtc tht' "kin, pierce a or (10 furthcr damage. it i 11 lit \\' ell to attcmpt extcn,' ion (i.e., m ea 'e o f a fracturc of thc nppcr lililh. Thi' .... holllrl 1)(, left to the, Ul'geOll.

4-. When ' the fractu r e is c o m po und nnd further complicated 11,\' seYc1'C hcelllUl'l'hagl" arr est the hremorrhage lJefol'e fmtller tel's nrc tak '11. In all cases of compollnc1 fnlcturc apply clean rll'l'Sing,' to the wonnd,

5. Apply splints a n d bandages 0 the 11mb in position, a\)rl to preYel1 movement wbil..,t the

patient is bei n g carried to hi borne, to a h0pit al, 01' to t mporary shelter. The "plint,' :-;h0111d lIe long enongh to k(;l'U the joint:-; i}]JUJediatcly alane and l,elow the frnet11J'ecl lJOIl nt]':--t.

6. III eH']'V cns of fnH:tlll'e, it i ,' nCCi:N';,ll'Y to k eep the patien 'i: warm , so a ,' to the efr'eet of the :-;nO( ' K of the <l.tci.l l1t: thi: i!', d011c by plating' <l d(lak, , h'nY] 01' cOat oyer the patilllt llntil be reacheR :-;helter.

FR.ACTURE , .

F racture of the Spine. -Tlle yertehml column may he broken either by dil'ed or l,y indirect ,iolence. Falling n height OJ1 the h1.ck ,t{.: rOR.' a l'HT, or upon an unel('11 :--l1rf<lce, is an example. of yio]cncc. Falling on the ht'ncl, or a t'l'11.hlllg tmce :l]lplied to the head, are eX<lJllple.' of, indil:et't ')(llL'lh:e, uS11<111\' a In'()h('11 llPck. \\ hat C( Ullll()uly a:-; a'ln'oken l nl·k ('ol1l5i t .... of a fractllre qf Ill' processcs 'ol1nectillg the bone.' with (lil'>pJaCl'lllcnt (If til, Yel'tellnc, th reLy endangeri])g the 'pillal conI and the nenes i "'uing from it leading to compl tt, (1 1' partinl paralysis of th' part}' below the I., n of lllP1l·Y.

' Tr; 'ntlJlent. - Pl'ey nt all mOYE'mcnt Oil the la. t uf the patient. If cl doctor j , within cnll, keep the patient quiet llntil h arriy(' , . If th(' :-; niccf.' of " d octor cannot be obtained i ithin rea, onable time.

,l l)lankct, heet, lStont plaid, picce of Kail or C1ltl\-il, etc., hencath the p;ltiellt. I) () llot roll the patient o \-er ill cloillg hilt till' hhllkl't or dc., cilreflLlly fin-it bellt'ath the head, t11l'll lllllL'l" rite budy llllel lo\\'er he ()ll his 1,uck. P ull' . then tl be rt>llerl ill the I,]allket Olle Oil l'ilCh :-side. Till' p<1.tiellt 1111l,'- 1lC)\\- he lifted 11,'- fOllr p T'>lllH, two (Ill either :side, the pole.· (each persol1 n::>ing' hath 1,1.id on i.l trl'tcltel' or sh lltter, llllfl ci\.rric(l tu 'hcltel'. So Illrtlln treatllll'llt is callc'l f(lr Ilntil the doctor ani \-L'S, except t() gi \·c thl' patiCllt water, tea, etc., if hl' i. cI)llsciuu.'.

Fracture of the Skull. - Fmctlll'l's (If thl' craniulll are ill pruPOl'tiull lo lite e\ kilt (If thL' illjllly to the bmill cUlltailll,d IlitlLill its lHl1lllcIaric..... r.ll<llly there are ..1 Jllptolll-, of illjlll'.'- to the hrain (see l'ulllpre::;.'ioll and ('ol1clls:-.illll, pagcl':> 1 alld 1 Fl'<lctnl'e::; of the "<t!llt arc clangennL tltilll of the 1)(tl':>L' ()f till' cranilltll. 'YbL'll illl,'- p:lrt of, the "anlt i::; fractllrC(l and H scalp wOl1l1(l n'ymb the injured uone, the fnltrmc he ,'CCll or felt: thi ' tlla\- or Ulety uot be \I ith eyic1l'lll'l' (If hmin inJlll'Y, .

" rh"n tIll! ha 'e of thc cranium i:-- fnldun'd, bl(}(Hl or ell'i1.l' fluid lllay iSSllL' frm'l tlte ear: or the Itlt)od may from·the llt)Sl', ur pa:--" c!mnl to thl' tOBlet.c h whencc it 1ll:1 V Ill' \-olllitl'll. Tlte fmctlll'" may ill\'oh-e the orbit,· Will'H hlood will e ' CHI e illto

the socket. of one or Loti, (' '("-. tll(, frHCtltrc lS fn,r hack, there 11l<Ly uc j)Jd (alJOllS of it l.ntbc at the h<lek of the head.

Trratme,lt.- -. \ rrest alJY ],, "jJJlIlTlmge f),())ll a hlood· H ', ,e1 iu the :::,c.:alp (see pa 7" HI). PIHer tJI' IJ HI) PH, Y 111)sItIOll 'II J.]'c>atlil': lllHlo all ('ll1thillg': I'a ny ,III' l';tti('llt, illdoo)' or lllJdt·)' ,,111'1 tl')': apply,\. ,.J I':tll 11i1lidk(·]'I·hi(·i, , l of Illil Ill' lillCH dipped ill ('"ld \\ att:)', or, if HyuiJ;dtll', all icehag, to tJ1(; 11(';111. I )() llOt give 1,y the lllonth if tlJ('pHticllt i1l,ensihle, gLt a dod(,}' "peecLl.,.

Fracture of the Lowe r Jaw. - ,'IJel'e H) e thc sjglJ )f fractll1'l', \\ ith iwll,Jlity

Fl(;. 20. to speak or l1w' I' tile j;m freely,

()f tiH. tcct ll ;,))[1 J.](c' diLC' roll] the glllu . !'reatl/If nt. PJcI(" tbt palul of the balld he)olY the bone, 1t gelltly llpIYardlS th!J

upper .pw, llnd nl;tillbtin it in that po ition 1): a IHLlTU\\' h<t\.lCbge. To appl," the bandagc, place. the centre t.o one of the tbin, carry the Olld' Itp the ,ide of the Ilead, cros'ing them jll't ahove Olle 2ar, and p;t:-:i' the ell(b JOllnd the heacl, tying them Oll the of the head oppo,'ite to the ero (Fig. 20).

Another method i' to tie the ends 011 the top of the 1Ie:\(1, and pa," a ..econd l);\nda.g-e in front of the chin, fa '(L'lL the end,' at the hack of the neck <lucl tie all fOlll' enels on the (;)'0\\'11 of the head.

Fractured Ribs. - The uwalh' frac:tur ecl are tho:-;e oceupyill o a ccntral PO,'itiOll ill' the n;ullcl,\', the 6th, 7th, til, awl 9tll. The higher and the lower pair' are 'L'ldu lll fracillre(l, A rill lJIay lIe broken hy a direct blow or 11,\' a S'!II('('Zl' or Cl'U!')JI. It lImy he broken in any part of it.' COllr:-;e, but it i u .'ualh· fractnrerl halfway heb"een thc 1,r a t-bnlle and lmck-hoIH'. The dct11g'er of a In'okcll rill Yal'ie with the amount of il1jlll': to the lnng. Pmcticnll.", wlu'l'cYer n. rib i. to be f'lt there i:-; lLuw heneath . th erefore allY force \\'ltich tenc1.' to driyc titl' (;11c1::; of the broken l;one inwards may tear the IUllg.

Siull s and J. .lllIIpt()ms. ,Yhen a ril) i .. brokell tIll' patient comphull' nf u .. eyere paill. on attelilpting to take a. deep breath; the i.. :-;ltort awl shallow, and crcpitu' be felt on placing: the halld o\'e1' the injurerl part. hould the rib pe1letrate th' l nll;; blood mol,,)' he coughed up and expectorated.

Rloocl ,coming from [\, torll lUllg coughed liP; it i: of it hnght reel colour, and prc 'eut' a frotit:' appemallce.

Treatment.- When the IU17[1 i ...; 710t i17juud apply bn) hrond bandage firmly ruund thc the t "itll the eentre of one baudillJlllediatel\- abOYe tbe of ,ccond llundage illllllediateh' belo\\' the cut of fracturc. The arc to h· placed '0 that the lower o\'crlap' the upper tu half it .. ext nt. They arc to be til'cl 011 thp 'uppo 'ite ,iele of the bod \- \\ ith the knOb rarl;er to the fron t of the l'OlLY, nnd tight enough to gi H' :hc patien t t'lnpport c.tnd cun.fort

Fl(: . 2 1. ill breathing (FiO'. \-\'l1c11 11U bal1cla lYc' arc

1) 'ocnl'a!,ll'. rio"htl'llillg tlte \Hli.. tcont hy pinning' the hl.l'k Ill' ('curing it otherwi.. e i, n good plan. lVh e71 th e I'Ib" an) /Ji'Oh-r:lI, fa7l:,Jrlfj 11(jU,'"!/ tu, al/ll it may be ]I 1'1 '(lrrha:le /j"om the lun;!, do no pi<lce it ktmbge

-t8

10Ulld the I)ody, hut la.y the patient do\\ 11, ilw1illL,1 a little towards the injured .·ide, in 0]'(1l'l' tt) gi \ ' more play to the 'Ol111d IUlIg; loosen the ('lothi1l;.!, give ice to :..;u<.;k, [\.11(1 pla.ce [\.11 ice-ba.g OIl the ov('r the h1'o1\:e11 rib. A balldi:l,ge rOllnd the cbe:-ct might tend to clri,"e the broken hone further into the lung. .\ large .: ling to :mpport the arm cf the injlll'crl ide i. ' 1ldyi.'able in either Cll,.·e.

Fracture of the "\Yh n thi. aGcic1ent is ,·u.'pected, or wh 'IJ l)y the finger.' 0\'(']' tlle hreast-bol1' the fmdl!rc call be ;-tctun1lY felt, the treatlllf' ni to be fo11owe(1 .. til IIlldo a11 tigl;t clothing, to p1ace the patient in a po.'ition pbs. 'ible ulltil a doctor arrives, and to :l\'oi d rough lJalldling 01' ' udden mo\'cmcnt.

FRAC'TURE OF TilE OF THE UPPER EXTRE'Il'lY.

Fracture of th e C oll ar - b on e (c1al'il'le).-The arm Oll the injured .'ide is p<1rtinlly lwlple.'s, and the patien ll'3nally supports it at the cd)'I\\ \\ ith hi . hand, 'mel incline.' hi , head toward .. the injlll'ed :-.id '. 'VhCll the finger i:-:; pa..'ed along the inj llren 1)ul)(, the fractured end.' can generally be felt to owrla}J. '..lle outer fragment dropped below the 1('\'e1 of til iuner onc. The oth er :-:;igns and f-iymptol11.' of trndlll'C are 1y }Jl'e.'l'llt.

Treatm en t.-Reuw ve tile coat with c:are begilllJillg with the .'oHud :;ide and be

4\)

illjurl'rl lim1) c1lll'illg the J'ellloyal of the thl'rcfroll; abo take orr luuch lIJUre of the clotilillg as i:-; expedient. Place a pad auullt the of a Bath 1)1ll1 ill nnllpit of the iujlll'ed l:)itie. llelld th e furearm \rell up, keeping-

the dhow <l. fur l);Lck ,L I ractlcall1e, aud support ill tl hl'g'e anll :-;lill!.,(. I Ll"jteafl of npplyill!.,( the large anll . ling ill the llllal LUetilOd, it is 'lch·i. abk to IH'" the L'nd, tklt ill th e unlinClry W<ly would gu UYer

thc fnu:turcd lHllll', 11 nc, th the armpit of tlH' illjl1l'L'(l bidc, and tic the (]1(1" hchiml (Fig. ::!:2). All altcrnatiYe for111 of preferr 'cl by BOHlC, i:-; pH t on <l :ol1G \\'S: -Rex the fo r '<11 ill H,:-; aboyc; plaeu UlJU cwl of FIt:. 2:3A. (n.? Ddltge round hod y, 1Il1litttl1 to cictr.,ils of "llug.)

the 1111 the ,llonl(1er of tl,e 11l1illj1.h'cc1 ;ch', keepmg the pnim tOwards the illjurl'cl :-.ldl" pa..:s the ha...,c lld\\ l'l.'11 the flexed +'o1'e,ln\1 alld ti,l' hoel,' 1 " L1en under the al1cl the :tllll til'

the t \\ 0 cud ' on t11e :-.llolll(lcr cJ the sonnel ,i(lc. The poim Hnel pH,l t oj till' of tile Lnuclage are 11U\\ to llc folc1l'll to ')llPPOl't tltt' ellJOw and fix('cl with (l11e or h\'o pil1l-; (Fig '. 2:3A and :2:31;); hy eithn 01 tbe.. o plans the bruke! 1 1 ,011C i:-; not Vl'l':-.;,wd npoll II)' tlte llHllctlgr. Fil1nlly, tightly .'ellIre tho limb to t!l :-;iclc' or tIle l)ody l)y :1, hi'OiHl hl11rln."'c a I)plild

eVI'!' Hnd 1l1)Oll the dhu\\' lit injnl'l'!l lilllh, <lS ,hn\\,ll in nmliiJl' (Fi!!'s. 22 and C.;ll)'y tho I) ud:-; 11111 izml1 ,11ly rOlllH I tIll) clll""L so [ l ' in Il'\l' l' onL the .H ill at tlt' :-;hOlllcll,t joillt, thc pncl fnl'lllill!.!: the fnlul'Illll. Fig, Wilen OllC 1"1.11c1.1 11 0 nnly ;t \';lil;1l1le p " , l' ,I pacl in t he flex thL' r()l'l'<ll'lll a.' ill diagra,lll (Fig', 2;3), apply llalTO\\ hmclil!.!.'l' illlll!l' ( illtl,ly n,l)(}\'c the elbow, uring (Ill' L'lHl thl 'rll llt of the ehest; can-v the <Jl l!l!.l' l'1)rl IIl'll illCl 1'111, aud then trillO" it o

bctwccn thc limb and the hody: pa '1) it a t o clllLn1lee the POttiOll of the bandage 011 the front of the dll::-;t, ;Iltd tin;llly it round thc b;LCk; pull tigllt ;llld til' ort' ill di<Lg'l'cLlll (Fig, F racture of th e Shoulder - blade (,-;r'almla) i to he tl'eate(l, ;Lfte r thL' c.:lothiug' }IY applying a llru;ul halllhge finulr ronnel thL' hody, uYcr the eat of ll1J lll','-, ,mel thC1'etnl'L' do"l' up to armpit:--.: the liml) is then snpportecl h3- a hi ge ;;:l'lll Hliug,

F racture o f th e A r m 1)one llI.,I \ 11l' 11rukell llP to the t:;hunlcll'1', ill LhL' llliddle of {tt-i or in tile illullL·diatc llL'igllh()urhoocl of the ellluw juiut. 'rhL' u.'ual nnd :--,:allptolll' <11'0 preSl'llt.

T((;'utllZ ent .- YVh en th e Hu,meru< /mrllll'ed at it.'"

Up/II!I' en d ('Iose to th e <ho llldu joint :-Apply a In'oad l ',1l1cia"'l' \\ itlt i " CL'ntrL' ahoyL' the middlc of the nrm, <lwl thL' L'nd, ronnd the arm and hody, tying th e' lOll' tLL' oppUKitL' ' jell' : :-:iUpport the forearm lly a : lIIal! "1'1ll :sling, Wh en th e ::;/w{t of the Ifill/l e l'US i.... 11l'ok <':Ll : Beuel the forcarm ilt rigllt allgl<.: .' to the a.nn; a,pply fum ;;plint· of ,\'ood or folded ue\\t:;paper::i, of books, etl'" to l'l'Heh from ::;houlcler to elbow, tr> the fmllt, lJal'k, uuter, Hnd inn l' 'ide.' of the arm (I'ig, :2 5). Thc :--pliut in fl'out (oycr the Litep" ulUbde) lllw-;t Oll no :ll'l'Oll ll t he '0 long a ' to pre , upon thc fold of the elbow joint, othl'l'\\ i 'c the hloocl-

yc, "d" ;ll'C ill Chll),!l'l' Id' Ilcing (' 1ll111I'C':-' ,d, Thc ktJ'<l\\ em l'l' Id' a "illl' lH lttll' Cllt to .1' proper lcnf?;th t()l'lllk all excL'llcnt "plillt for hc f)'ollt of. tlJ(\, .11'1.1, In cake (f c1itlicu1ty ill k}J 11lt:-:, It will , l,c ..;nttil'iellt t() pbcl' them Oll tIle' (·lllel' :/1111 l.l.Il'1 SI( c:-:i (ll]:Y :-1l'l' 11 1 , he

FIG, 25 . ,,} .Ill 1 :' b;o 0 II e ,.hwe :llJ( the other '.\ 1)(' .l'at of fl ilC nrC' , III <.;;.st' Il( ' ]Jlint.' an' :, illl,tlde, ::iCl'ln L' tile ,U'lll \vi ,j, t\,() 1)10. <1 to t1H' idl', t he fnn"n,.l i SI/ fIll arw 'ililJ!2-, } /'I{f'i:n/'/lII'III.'I til e dbo " jund ;,1 (' nt::l'l1<1l'd 1,\ '';(, IlIII Ll! "L'lIing,· "1}(1 it i·) so !Ii tnl', ill to «ce rtain the C'xact HatHI' of dIe lll.llil'y. th;,t whell the accident OCCII],,,, indoor" till' lilld, ....ll<mlll 1)l' Jaill Oil iI 11illo\\ 11l thl' lllost "(1lIlfl!)'t.l1)le pll it/fill po" ... ilill': ice or '(llll \\atel ures;:,mgt>

should bo applied t.o thL' ill,ill1'('(l part, lJllt 110 fllrther trua tment :-should he <Ittl'lllpte(l pL'lldiug' arri\'al,)t a lloutor, Wh en the .Iccicll'llt ucell]" ouL of it to be treilterl II}' tbe .tpplicatioll ()f all ,lU!2:1l1ar

( I"ig. 28) lll,tde .IS fllllo\\:-, '-1'akl' two pieC:L'" of thin :Hat \\" ooJ, 011e IO Ilg' 'llOtlgh to reach froll1 till' armpit to just below t hc' ,llJ()\\ . til' ot ll er IOllg' t l l re J.eh frolll a.boye t he \..'\I.\)\\ to thL' ringer tip": tiL' tltem tOg'ether so as

FIG. 26. to forlll it L angle, and apply the an C)'ular splin t fl>l'lllecl all either the oHter or inller (It tlll' Hexed lind,. In' nanow 'al10\c and l,do,,' the 'eat of fn1.ct ure, and, uppurt 1, \' a lan/I:' nl'lll 'ling', ()Il at remove the splint ;'llld :l if the illjm'," h'\ 1 out' LUTe r I indoor:-;.

F racture of the - S/',/71.": awl , " '!/IIIJ! toms.- When uoth /)0111'.' (fit" Rar/z'u." (/1/11 rillct) Cli"> b,'ul:e71 , the n.nal .:.iglls <It.,l of fraulure are pl'c.ent; one of the 1"'0 !,one;:: onll/ i, l'l'ol;Prl the signs are moclihed, 11ltt ::.hlJ limu \\ ill lllse po" er, a

c1!'\'t)l'I11ity will 1)(, rOlllld <It the eat of fracture, and a(;llte paill \\' hl'll 1ll0\'CIllCllt 1:-> attempted.

A fracture of the Ulna "\IIIIC 11 uall \, OCClll''1 a the npper elld lit till' LOlle, in thL' llL'ighi}()llrhf)l,d or till' e\bo\\'. The tip of the elhf)w Lehind i, iorllH.:rI 11,\' t hL' ullla, alld it fall upon that proc:e-;s of hon' i:'\ apt til })reak it ott.

The Radius i fre'[llt'lltly fractured ilUmeJiately <thU\ e tile \\'ri, 1., Lhe re ult o· ,t rall 011 the ha m!.

'J'hi::, frtlcture i usuc1.11y illlpaded and tilL' 'igu of fradJtI'l' ;1l'e moditieti, but the cldmullt,Y, the <.Lcutc paill Oil lll\)\ l'mel.t , 'mel tlte PI)\\ erlL''':-,lh:'·', ot' the hanr! are "utTIci 'nt h ' tnJll' DI' ,ot that thl' l'lllh.' IH'l)ken. • ..... -

l'r ea tw.ent. - Th L' rL'·I:::.. 1" the ..,all l:' Whl'tltL" tht;

il':i t?f Ulle or lldth of the bonc,'. ll( lld the furearm nt l'lght alll-!lL', ' t() the rtl'lJ1. kl'qJillg' tIte tlllllnl, IIp\\'arcb anel the palm of tile hand tU\\' anb till' 11<)(1),; npply b \ () broad ",hill' tllL' ronal'lll is maintaincu. ill the LL'nt 'll," ;tlnll!.!,' tl.L' illlle!' othc!' alollg thl'

Ollter (If Ii lld), TIll' inner "pjillt slwuld llL.' n))g

l' llol1g'll to rcach frolll tlJc' clho\\' tn thc and th)

onter fl'Oll1 the cIllO\\' to the h1Ck (If thc band.

t Ill' , plillt · l,y hlllclages, OllC al,(), l" al111 another 1'l'1m\ the ,'cat of fradlll'l', anel a third til fix t h e JlaJl(l in tiull (Fi!.!,'. :! I).

Fi g. 28. Fitlally :->nppOl't the liUlI,1,." it largc anI! ,'ling.

Metacarpus .-One II]' mnl'C of the lJ1 't;tc;l]'pal bone' may l)c ))l'oken 1)), uil'cct or iuc1il'l'd yio1clll' '.

"Thcn ;1 metacarpal hmw i frnctnrecI, placc a fLHl1l(l !" el, a:-> n tClll1i, halL ill tIll' palm of the ham}, ':'_'Ild the linger.' ronnel the l,n]], alld ScCllre the \\holL'

'j 'y a banc1agc, n,11(l nppl,\- 11 In,rgc Hnll (Fig. 2:-;).

Fracture of a Bone o f the Finger (plwl1f/u).

The natl1l'C of thc injnry j" l'c,ldily l'ecog'llizalJle H' Llcfol'mity can l)e l't'll am} felt. '

rrerftll/r>71t.'-1>m'" the injured fillgcr ).!l'ntly into l' apply a 11;11'1'0\\ the fWllt IIf tIll' +inger, ;mel it lly H picee of linen, tape, or ph tCI'.

'''he'll fingcrs arc injn1'ecI apply;t .. pIint Cllnngh to LUPPOl't the \\ hole JlmHl. 'npport the hawl Illc} forearm l,y n anll . lilllf.

Fractur e 'of the P e l vis.-=- 19l1,'; and /'.'ymptoms.

-\rhCl1, after SCYCl'C iujul'Y ill the llcighl)()lll'hIHHl nf hL' J,aullch hone therc i })() Si,!.!,'ll of injury to Lhe lo\H'l' cxtremity lnlt the paticnt i, Hua),IL t()

. tand Ol' wnlk, or eYL'1l to l1love the lo\\'c r lillll,,, withOut great (litticulty awl pain, a fmctlll'e (If thc peh'i 111;ll' llc to haYl' (lcclllTl'(l. Defo]'mity, de., ',1.ll11Ot 11.'ll<l11" lIe !llmlc Ollt. T(1C 11Ioo!l-ycssel.. and or).!·<lll'-', c.pcl'i,llIy the 1,larl(ler, Yitlllll thc peh-i.. , ttl" in great (bug-or of wunl1(led.

the l'ntil'llt jll \\ hatcH'r pn"itinll j", fUllW} to giye gl'l'atc ,t Bincl it l,road hand(-'.}Ie round thc hip, tight CllOIl!.!,'h to the I ,art, hut not ::'0 tight <l':> tu pre '::; the bruken bonc

fluther inwa.rds towClrd,' lIle ectyityof the pel\'iK, awl thereby cause morc damage to tlte internal Ul'gilU;-\, Flex 01' traighten the lowe r ac<':ol'clillg' (t, th" patient wi hes, anel lay him carefully on a hlHllket, , hutter, 01' 'tretcher before moving him to a pl.tl'e f shelter.

.b'RACT1:fiE OF THE BU\E:-' 01" TilE LOWER ,K,(TRE'trrTy.

F r acture of the T h i gh bone (.telJwr),-T!I' thigh bone may be hroken at the ncck (the nplK'l' encl) ; <.,l.l)ywhere in the length of it::; 'haft; or at tile lower end clo 'e to tbc knec. Fmctul'c of the ncek of the thigh bOllc i' ,'cry apt to occur in uld peopl " and from ycry .'light illjury, A 'c yere brui e of tilt: Ilip i apt to uc mi,takcn fur a fractlll'!, It may !"-' takell a::; n ::;afe guide 11OWeyC1', that \I !tL'Il. ;tttt'I' :l11 illjmy ill the llClg:hholll'ilood ()f thL' Ilip joint tilt illjltl'ed per::;oll <.:i1U, whibt lying un thL' l)Hck, rail' the hL'd off the !!"l'ound, the bUlW llot \)l'UkL'll : hut I' th(' heel cannot bc rai::;ecl it i:-, to as::;llllll' tlta the bonc is L1'oken FmctLlrc of tlte 10\\ l'j' l'llel ()f till' thigh bonc ir:; llpt to im'olyc the k11L'l' ill the i!ljun' \\ ith (letriment to the joint. , 'i{I7lS and Y}}lpfol71 s ,- The· lL.:'ual 'ig ll ' or fral'llll't. '111e ioot of till' iuj lll'eL! Illllb will lie ill'UlllL' ahllUl'llla! po,ition, nsn:tlly 011 it. outer 'iele, The :-,liortl'uill!!,' Oll the ,'ide lllay \"try from one-half to thl'ev iadles.

TI'('(lt'llH'1d.-(l) S't':u:h thl' ill.Jlll'ell liE:l) h.\· holrl" ill!:!, thc foot. (2) font :)f the illjlll'l'd :-.itle, Hnd lHlll..!, I lllt(J hue \\Ith fout tllc :-.ullllll limb. Vhl'll t\\ 0 or tllrl'e a;:,SI tclllh, ale at hawl; it i::. one P'1' II':" duty to to the, TOot, it ill poitlPlI llllt llot lInLll the :-plillt" awl \),lll Lu!L':- ,lI'L' apphL'd, (:3) ,_\ppl ,,, <.1 :-.plillt ull dl' Ol:tcl: :-'1<1e of thl' l,ll'okell 1,1l.11J), to reaeh trotH the arlllpit to thl: foo[. .A Ill'(HHll hUllClil" :, Hill kL't (lllltt end ill arlll

]lit), .t ,,,dill II 1ll.lp rollL'cl, 11]" :( couple of 1 <':1lL':-' tied or 'lll," PIl'Cl' of \\ (Joel cut ,to lCl1;-th llla\ Ilell,,,ed .1, n "plillt. Ct) ,\pply ,l , pllllt 011 till' ill .... idL. u' till' hrok"11 rhi!.dl, lOllg' to r.'i ','1. t'l'Olil thl' in'ide ot r ill' til)! of the tlllgh (tl,IL', fl]l ;"/ tv tlte kllel' (:»." lll'l' t11L' :-.plillh ill p 0:-. ltlOl 1 hy hllld:l!..!;L'''. P l. S !."Hllld th\" ,c11t.:t bd o,\\ rillc armpit .... : an ){;her rO'llHl the pehl:-': <t tllll'd. Hnd. fmntll hdHh!..!;l', l'lJ1hl'<leill!..!.' an' plaCL'ct 011 the Ulle ,Ibm"..! 1IIel lltlta 11elLl\\ thL' :-.e')t of

60 fracture; a fifth lnll cln,go ronnd the leg; <l . ixth j" to to he pas.'ed bohiIH1 hoth anl.... the encl:.; <':1"0.':-;0<1 m"or th; front of the feet, cmbracing the and tio(l off the feet, Finally, npply <l .'c\'cllth hUHlnge rounel hoth knoo.' (Fig, :Hl). Do not apply ,t htnc1ag'e over, the elhdomcn, it might l'eln.'c the patient to \'omlt, and, 11101'e()YcJ', ,,"on1(1 not keep the , plillt firlll, (6) shock by k eping the patient Warll1, H7z. P ll a pe)',:on is sin[!le-ltanrlprl, it io..; c:...pediont, aftcr extel1:->lOll of the limh, to tie ho feet t()gether to prc\'ent, the hOllO.' from again o\'el'Llppin!!; and llndor the . e cl.' W 11 as whell the patil' llt is a. womit,n, It \YQll to PelS ' all t h e liml) hnnr1ngeo..; round both limh.;, dispen.'i})l" '1\ it h the i1l...,ido ( Fig 30), I?

Fm. 30,

F r acture of the k n eec a p (prttdlrt),-The kIlcec,:p Ill;lY be hroken hy falling on the knee (dircr :JI <:l'c it iN hroken by mn.C'ular uvtlOn, an aCCIdent wInch may aril:>c ,Lf:! follows:

' ''hell thl i lut nml <til <lttCllipt i made to prl'\ elll H fall, the 1I11lKdeK ill the fl'(1I1t uf tlte th:gh act \I ith lldt ful'Cl' ill thl' attempt to lllailltaiu titt; IltLiallCe that the kUL'L' l'HP lll<l,Y l ll' ill t\\'U, 'ir;ru< a?lll '!lmpfum;.;.-Tb l illlll \\ ill Ill' quite hd]Jles, : a !!ap 111;(,\" hl' fl'lt between the Ilrokell ellll of tile kneecap: the kUl'e juint \\"illpeedilywdl.

Trf1dlill'ld,-Lay the patiellt (Ill hi ' Inlck : mi. e wcll an d FH., 31. :-'ltPpOl't the head and . buulrlel' , OF K'\Hl' \I ', and mi. e thc lim!,. .Appl.\" a plint alUll!! the !)(u.;k, uf the litu!1 hOlll the hip to !lL'yonel the Ite!'l; apply it llClmlage ,,"itl , it ccntre plncl',c l illlllll'diatd.,- al)u\'c thc In'oken kUl'l'cap, cro.. the l\mb jlchilld OYer thl' ::>plint, Hl1tl tie otf in front llc\o\\ tlte In'okcn lH>lll' (Fig , 3:? ). 'J\l nnlllll\;-;;-; it hallc1age lllHy be nppllt:cl ill it :-.illlilal' \\,H \ " to th l' hLtt (;OlllUll'lH;ed llel()\\", and til'c1 thl' !n'ukell bUlll'. The Kplint j:-. to b' flll'tlter :-'l'clll'l'(lll \" ll<lwtl!!l' ruunel the t b kh Hllllleg', Tlte foot i. tltl'll to hl' "1Ul')PUl'tI'tl well oft' the g-roullc1 h.Y a pillO\y, roll of cluthing'. ctl', ; or if nOll' of (':Ill hl' had, 1>.'" l' 'still!.!,' the f(lot of the injlll \.' d lill1h 1111 the lop of the fuut of It· :-'(Jl1ml lilllll, \ n il'l'-hag or

c1rc:-:;:-.ing :--lw1l1l1 11l:' apl> li 'd Oil the hUllt of tbe ll1Jured kneel:<tp <t::; :::'OOll <1.l::i pOBsible.

F racture of the Le g (fi l )/(( ,mel fiv7Ila\.-TInth

tIn".' lllay llc In'okCll at the tilll(' ;'nr eithll' lila\" be llroken alOlle. . -'1f;n8 an d 8ymptom;:; .-The 1 :::'1.;,:<.1 Big)}:::. tlll(1 :-yllIp-

A fnH.:tnre of the fllHlln. thnl or fom illl:he,' allOY \ its 10\\ 1.'1' l'11(1 j:-. fn.'<pll'ntly mi , take11 for cl Kprnin, a11l1 not lllfrcqnl'lltly for a cli:-;lu(;<ltio)) of the .wlde . 0\\ ing to dil"plact'llll'))t of til f(lot llcillg the lIlOKt pnllllillont "i!!ll. \r llen ()]lL' lJ()]le is hrol... cll there \\ ill Ill' no lllilr],cc1 ..,hurtenillg.

T,.eatment. -( 1) ,'tcnc1y the lilllh by the itHlt of thl' in.i1lrl'd ..,i.(ll'. Draw the f()ot of the iJl]llrcd ...ide level with the foot of the 'oHncllilJllJ, with

FIG. 33.

t0m!) R.re pl'c ,·ent. The tihi ;1, JR ,'0 f'!o:-.e T\) the .... kin that the fracture,l encl, call Le readily fvIt.

Fig. 34.

tll!' lIl' 1 iDLing up"'an1:--, , llH1 d0 llO t ld !!O ulltil thc . piint. haY(' lll'ell fixed. Apply to the \ Ill' (Ill thl' ont ... i<1(', another OJl the inKitll'. The "plillt ' :--holl1L11IC long enongh to rC<l l' h frolll n11()Yc the km'C' \) 1Il),()lHl the foot, that the k1lee and anklc joint:::. ;,],1.' kept at rCKt. J f o])ly 011 Kplillt iK Hyaihtllle. pl<tcl' it on tho OHLer Kidc. (--1) S(,C11rc the. plint,.; hy pbccd 011e nhlYc ,mel another belo" the -.;eat of fradnrc. A third hlllclnf!c is to he npphecl 11l1lI1ec1iatel ) ;,bo\ e the knee, and ; fonrth amI fifih l'vnnd

bOyl cUll.des and knee: ' a, in th.e cl:t..'e of t hr. thigh. TT hen 'mgle-handed, a.fter extclldlllg the Ii III b, tie til feet togethcr , dispcns 8 ",ith the im.,idc Hplint, awl (;ttrr,Y 1 round both limb. ' (Fig . .3+). 'YlWll the patlcl:t 1:::; a womau the in:::;icle :::;plillt limy l)c (li:-\pL'u:::;ed \nth,. and i:Lll the bandagc.· lllay lK' Citrril'ri. both oyer the clothing. ,rh cll no :-;pliut l <1.Yalbble, tylllg the legs, ank le' and knee' tu!,(cther is of great seHiee. '-

Fractures of the Metatarsal Bones a!1d Phalanges (C1'U 'hed foot).-FnH.:tlll'e' of theHC l)()!lC are commonly c<lu:::;ed hy the pa ' 'age of a heavy \\l'i !.(!l uYe1' the foot. <l(;cident i:::; r ecogni:::;ed hy· pain nn of the foot or toe', 'welling amI 10 'H of po\\"er.

. 1'1'cati,lent.-The (:ou:::;i t ill the application of a fiat 'pllllt of wood or other material a. <1 Look or piece of cardboard, to the 'ole of tit' foot mth a bandage to enelo 'e the whole foot.

DI

.A dislocation is the displacement of one or mo re of the entc ring into th \ formation of a jomt. Th e Jo mt mOiSt frequently d i ' located arc of the the the t humh, t h e fillgers, ",wI the 10\\"(, 1' J<l"-. Th· .lOlllt:::. of t h e lower extremity are but cli.' lo eute'l.

,'TGN,' A ' D ,'YMPTOMS OF DI SLOCATION.

(1) Unnatural position of th e limh.

(J) Pain of a ,'cvcre tiickcnin g charactcr.

(;3) Deformity in the neighbourhood of the i])j m ud joint.

Fixity of the joint. Unlike a fracture, the limh cannot 1>0 moved at tho j oint Ly either the pa,tient or ot11er:-;.

(5) Swelling and numbness of the part.· bclow the ::lcat of (li:-;loeatiol1.

(G) A bsen ce of the crepitus cl ml'itcteri. tic of ordinary fracture.

OF DISLOCATfO '.' .

No attempt hnlllcl he ma,dc I y anyone except ,L doctor to rC(lllCC iL dislocation. ' 1 he follo\\ iug ment, howcver, pending the ani vuJ of the doctur, !)hould be carried out :-

rNhen the Accident occurs out of doors .-

( 1) In the ea:::.e of di .·locatioll uf th e lwulder, Ht'tpport the upper extremity in whatever po ' itiOll gi H)1:) lllO:--t caHU by a large arm 'ling; pre\'ent all jolting' of tIle limb by tying <', bandage round the limh amI 1>(." ly or \ by pinning the tiling to thc clothing. Whcn 110 lUt'<lllH of appl ying a, 'li ng are at hanel, ftvtCll or pin liho eoat, ",lccyc to the cloth in!..!:. (2) When the elho\\ is clil->' , loealrd, til' or I'a'len Lh(' uppcr extrpmity to the . '

of the body in tL::: mo;:;!' Gomforta,l)lc po itioll pO:Hiblc. (3) When any joint of the lower extremity iH dislocat.cd, place the limb in the ea. po. ition posHible and cn.rry the patient on a ' tre tL:ilcr to hOllHe or home.

When the patient is indoors.

- ( 1) R rnove the clothing from th· injnrecl joint a,ncl lim!>. (2) Place the patient all a couch or b eel. (3) ReHt the liml) 011 ell or pillOWH in the position which afforc18 mo. ,t com fort. (4) \pply cold (ice, or towels wrung out of cold water) to the dislocatecl joint. (5)

FIG. 35. 'Vhen cold eeaHeH to ONE FORM OF DISLOCATED SrroULDER. give comfort appl.,warmth (flanncl::; OJ' towels. wrung out of hot water). (6) \Vhen the shock IS severe keep the patient warm by appropriate remedies. (See Shoak.)

67 rRAIN

When by a 'Sudden wrench or t" ist the ligament. · <tll(l the parts around the join t are stretch ed and torn the jo}nt is said LO be Hpmilled. "Goillg oyer » ;tnkle IS one of the commonc.-t example ' of an accident of this kind.

:-)T<;:i\ AND • D1PTmI OF '

severe pain and inability to II '0 th e joint

aft .' 1' ;l, tWI . tor wrcnch ma.rk the occtlrrcnce a .. a Hprain. the part 1:)W811 , and become.. eli 'colonred "hlack and blne " - owinO' to th e etfll 'i,)ll of hlood illto ttlld 'I.ronnd the jOhlt. Ther i. , ll()" eyer 110 i'l';l!'tnrc or of the bon e. . '

'l'RE.ATMENT 01<' rnAl ED

When at some distance from house or home. Do not remove the tockinO' or boot hIlL l,inu the foot and ankle tightly ronnd by a handage. The bandage is to he pil '.' e(l belo\\' the wai8t of the boot, crossed on the fron t of tlH' ankle, and thcn carricd rounel and round the auk]', where it is firmly tied. -WC't the hUHlaO' aftcr n,pplication; it is thereby tightened. A reaching shelter, Jay the paticnt <11.)\\1), ;emove, ltllollt dmggillg, the boot and tocking, cutting hoth Jr 11 ('l' i"SHl'Y ; pht.t:c the injllr c1 part in n.. t!omfol'ta 1 k

a a::; pOHsible, appl y ice or cold-water drl'sl-ling".·

to the .lOlllt as long as t h ey relieve pain, alld \\ hl'lt LIleY ccm;e to give relief, apply hot fomentation::> or a hrau poultice. I

'When other joints are pra.itled they l'Clltli:'c mucll tIle Hame immediate treatment a ' whcn tilev are dislucated. '

STRAINS.

\\ rhell, severe exertion, a lifting Hnd pulling Iway." wClgnts, mmi ·les or tendon::! are o\'e1'- 'trdcherl. LileY arc 'aiel to ue "stn1,ined."

AND OF THAIX '.

a p'l.rt i::; trained a sudden sharp pain OCCllrs • reud.cnng further exertion painful, dithunlt, or illl l!os,::ilhle. If the strain lw,::; ouuurred in the llHck, tlll' }l<LtleUt be to stand upright or take a deep hreath wIthout paUl When in <'\, limb, the 'trainceL llllvde may Hwell, causing ::;evere cramp-like

TREATMENT 0[<' TRAIN '.

I'l.<lce the patient in a.s comfortable ,1 pOHitiUll <t. ' poi:llHl>le, and apply hot-water Lottlc, ' or hot fomentation' when the pain I::; very severe.

. A strain in the groin ( rupture, or hernia).

]s all lllJury of a. totally different llCl.ture (,'ce P<1(TU lr,O) . C"

CHAPTER II.

THE ORGANS OF CIRCULATJOX.

{'rUE orga.l1,' concerncd in the circulation of tllf' h1oo(1 .nrc the Heart , the. Arteries , the Vein s, illHI the Capillaries .

The Heart is situated in the chest behillel the hI' 'a:t-hol1c and rib cartilage , between the and immediately above the dia.phragm; the heart lies ohliqne1y \\ ith a quarter of it::; lmlk to the right, ,and t h e remaining three-quarters to the left of the llliddle liuc of the body. 1'he beat of the heart lll,ly he felt jnHt helow and to the illllel' 'ide of thl' 10ft nipplc. The hea,rt has four cavities, two 011 either .ide of a centrn.l partition (septum). The two nppel' eel' itil':-l are n,lmed the right and left auri cles, thc t\\() lower the right and l e ft v entr i cle s. Thl' ,arterial rc(l or plll'e blood is driven from thl' left Yl'l1trielc' of the h tl.rt into the a.orta. (the maill c 'ntml artl'rv of the body). From the aorta hmuchl" (a,rtl';'iC'::! ) are given off to all part of the hody. 'I'll 'Sl"' <l.rterie:-; divide a.nd sub-divide, a,ncl HO H111<111 <Ill 1,11 'y bc 'orne that they c1,S::;ume micro 'copie dimcm;iollM, \\ hen they are termed capillaries. Jn the cnpilIaricH all interchange of gases takes place, wher '1,.\' thc llollrishmellt ann maintenance of thc tiH:-;ul's <ll:d

L. larynx (voice bo ). 'J' T h . RiO"ht LUll . L LX, . rac ea (wmd-pipe); R. L . r exAP<lSeLthe AareRd"gl'ahWllt tr> __ eft A . 1 J nne e . p ep Right Ventricle; L.V. L ft

S.V.C. )eri' .' IT U onary Artery; Ao. Ao. Aortn; from the or ena cava (the large vein carrying blood

I f · pper part of the body to the heart)· I ,T I • n erLOr vena cava (the la . . ' . .\.. lower p n't of the body t v:m carrymg blood from the veins C'1/1/10t be shown inothe The four pulmonary

of the hody are provided for, and tho red hlood a. purple (;010ur; the purple (venous) blood lIO\\' frOlH the capillaries to the veins, which COllV'Y it towards the heart, getting larger andlarge.r as they proceed, by bci12g jC?incd by neighbouring vein ulltil they finally as two large ves.''lels reach the right <wricl of the heart. The veins, !l:5\pecially in tIle lilllh.;, are provided with valves at frequent ir:terva.I:-" \\ hieh preyent the htekward flow of the blood A :-.pecinl sy.'telll of blood ve,' e1 , called the pullllonar;', j. cOllcernccl ill cClrryincr the blood through the lung''), Frolll tll' rif!ht auride the blood passes to the rIght n'lllriele, and i:-; thcllce carried tc the lungs, where It is pll1'ilil\(l by contact with air, and becom es red III l'olotl!': it i,' then tOl1ycyed to the left ,tuncle of thc heart and pas:-,es into the left vcntncl £', th l:OIl1pletiIH!.' the L.:irelllalion.

The heart contrncb ill anults at an average rate of eventy-two time' a minute, but the rate vane., iu('rea ing <l the po.-ition i' changed from the lyIng to tIl sitting or to the 'k'\llding position. About two ounce (<1. winegla 's ful) of blood are dl,·ch'l.l'g"rl into the aorta at eycl'Y contraction of the left ventriCle. and the blood ent into the arteries in jets

OJ' wa\ es, can 'iug thc pulse, which may be felt .l.Iong the L.:oure of <tll the rnain arteric wherever the tlllger ('an be placed on <til artery a it pal::! eR over a hone. J11 the YCill no .puhe is to be found, i1t1 tho

In the micldlc of the diagram i" the heart with its foul' Above t,he heart the lung (pnlmon!lry) cIrculatIOn. The lower part the g neml (:yRtcmic) Vessels containing Impure (venous) blood are shown bllck,. while those containing pure (artenal) blood are shown whitt,. The connecting yess Is represent the capillaries. '}'he arrows show the direction of the How of blood.

FIG. 37. DrAGRAM OF THE CIROULATION OF THE BLOOD.

heart wave is expended during the pa ,, 'age of the blood through the cj,pillaries and reduced to a re<Yular and even flow.

H.iEMORRHAGE.

Hoomorrhage. ?r bleeding signifie ' the e, eel-pe of blood from an mJured or dist'ased 73

Arterial Hremorrhage.

-Blood from ftl1 artery O} i ' scarlet in colou r j (2) escapes in spurts or jets to the pulsation of the heart j and (:3) flo\\' , from the side of the w01md nearest the heart. It is, however, chiefly when the wounded artery is dose below the skin, a in the baud, foot, temple, etc., that the blood ma.y be seen to escape in jets. '''h en the artery is deep eated, a. ' in the leg, the blood may well up from the bottom of tbe wonnd without marked signs of p.ul ation. Th . quantity of l)lood 10 t varies w:th the size of the a.rtery wOllnded. 'V hen the aorta, or one of the large arteries at the root of the neck is wounded, death is instantaneous; when the main arteries of the thigh, armpit, neck, etc., are wounded, death will occur in a fc\v moments unless the flow is l:Itopped. Pressure applied to medium sized arteries, as those of the leg or forearm, within a few minute of being wounded, will save life j luclDorrhage from smaller arteries may cause serioll. ]0:-4.' of strength unle s the flow is speedily arrested.

Venous Hremorrhage. - When a. vein i::; Cllt tne blood (1) is of a dark colour j it flows in a slow, 'Contin uous stream j (3) it issues from the side of the wound furthest from the heart. Wounds of veins of 1he limbs are somewhat less dangerous than in the l'a e of arteries of corresponding size.

Capillary H remorrhage. - Blood fl.o\\-ing from <:apil1arie.', as from a slight wound of the Skill: (1)

is liO'ht-red in colour; (:3) flows briskly in a (3) wells up fr om all points of the cnt surfane

GENERAL PRI TCIPLES OF THE ARRES'l' OF ARTERIAL

The pr i nciples of treatment to be followed in the event of bleeding from a large arterl are: . h;t, to apply d i rect pressur e o.n the bleeding and 2nd, if direct pressure IS unsucces,:ful or Imposible, to apply pressure o n the ma i n trunk o f the a rt ery between the wound and th e heart a s close to the wound as possible . The closer to the wound the artery is compressed, thl' 1es will be the damage to the limb.

rrhe mean employed in the temporary arrest of hlOClllorrhage are digital and instr.umemal pre ·ion and flexion of the limb. Laymg the down and elevating the limb will lessen the force wIth which the blood escapes.

1. Digital compression is the appli.cation. of the thumb or fingers either on the bleedmg pOll.lt itself-di?'ect compnssion-or on the trunk of the lllam artery leadinO' to the wound-indind comp?·ession.

IL v compression may also 1J applied by the direct and indirect _ (a) Di?'ecf instrumental CQ1lqJ7'eR sion may be earned out by applying a halldkl?tehicf, piece of lint or linen

foTclcd.into a small, hard pad, and placed on th L' bleeding poil1t, "hcre it is secured by a bandag' firmly tied rOl1l1d the part. To fold the handkerchief as a pad, proceed aH follows :-Lay the handkerchicf ont on a flat surfac..:e; bring the four corners to the centre of the handkerchief; again bring the to the cel1trc, and continue folding the corners toward , the c ntre until the handkerehief become a hard pad .

The ronllel, . mooth surf,we is placecl 011 the 'kin o,er th' artery, and to prevent the pad unfolding, the l)1lckerecl ,nrface may be fix d. by a ,mfety pin, or stitche(l with a needle and thread, if such are at hand. A hard substance such as a ::{tone, cork Illlt marble, etc., may, if ne 'e!:l!:lary, be enclo:)cc1 in the' centre of the pad. . Should occa ion permit, a graduated compres< may he made Hnd applied as follow ' : a folfled piece of linen or lint, or cotton, upon the bleeding poillt; over this place a ·ccond anel larger piece of the same material; a third and a fOllrth or more pad::;, ench htrger than it predpce 01", are Llperimpo.'ed, 1.l1ltil a regular cone i· formed, with it.. point or -apex resting on the wound, and it ba eprl'::;'ed down by a tightly applied handage. (b) Indit ed instrwnPntal com jJre<sion consi ott) ill ·topping" thc .flow" of blood through the main artery by a tourniquet. A t ourn iquet is , n in tl'ument wherehy presslll"e can be made on the trunk of ar artl'ry as to Htop the flow of blood t h rollgh it. A

tour niquet may consist of a pad to be pbcl'cl ()ll t h e trunk of an artery, a st?'ap or bandaqe applied .'0 as to encircle the limb and pad, and ::t budde, screw, or twisting apparotus (such as a stick) wh'l'eby to tighten the strap or bandage. The three principal tourniquets are the improvised, the field, awl the

38.

FIG . 39. FIELD TOURNIQUET. S CREW TOURNIQUET.

tou r niquets. 'rourniquets are seldom appliecl -except to the b r achial and femoral arterie · . An i mprovised tourniquet is made and applied as follows :-On the trunk of the main artery, say the femoral or t h e brachial, apply a firml y folded pad. ahont

the sizL' of a tenni ball cut in t,yO for the thigh, aud or a \\alnut for the arm; over this pad place the centre..' of a narrow triangular (or other) bandage, :md tie t he end on the side of the limb oppo ·ite to thf' pad. . \ fter the half-knot of the bandage i. made, place ;t sLwk J pcncil, walking-stick, poker, pOliCCIIlC.U1'S trullcheoll, or orne such instrument, upon it, anel theu complete the knot, adding yet another half-lmot ror sl·cmih·. The" stick" it) 1l0W to he twi:::;ted whcll the hallclage \\·,11 be tightened, and the pacl . '(1 finuly npoll the trunk of the artery with :::;ufficicllt furtc to arre.-t the flow of Hood. 'honld a 'uitable p,uluot 1)c at hand, a knot may be made ill the centl" or the handagc, and when avctilable, a stone, cork, et<:., '11 'cl in it to gi \'e it nl'lnlle s and bulk. co tlUlL the l)lllging, aud not the fiat, side of the knot is lle'\ L the .. kin. The" stick" is finally "locked" ill pO'4itioll hy the ends of the bandage used for thl' lo"nliq nt't, or by a.llother bandage pa 'sed l'ollud LItl' limb ttlld lUade 10 cnclose alld fix the 'tick. The field t ou r n iquet con ist& of ct pad and strap. ,/l'he pn.d is placcd on the cour:::;e of the a.rtery and Ih.ed there by the strap, which i' pulled ticrht aHd buckled off. The sc r ew tou rn i q uet (by COll:-;t(kl'cd ohsolcte) acts on the same principle, tlw ;--;Lmp, howcycr, being tightened by a screw appanl.tm;. All elastic bandage pa sed round the limb inlllll'uiall>ly al)oYe thc seat of an arterial

FIG.

'i8

uned tight will arrest bleeding. The . imple ..t form of this is a strip of twenty-five or thIrty Inches long and b\ 0 :nche.' \yide, with a piece of tape sewn at e;tc.;h end. An elCistic; brace or belt will, however, '1118\\C1' p m-po. c. It i.' not advi 'able to use a 00rd or elastIC unles ' no other apparatu, can. he as the pres 'ure of the cord cut oft all cIrc.;ulatlOn in the limb.

III. Flexion of the Limb. -The artcries of the bat.:k of the knee and the front of tho bend of the elbo\\ may be compressed by placing a prill upon the trunk of the main artery at the knee or c]ho"" and, after fully flexing the limb, securiu(y the Jimb in a flexed po. ition by a bandage.

Dress th v wmmd. After the hremorrhage 11a. hccn arreRted uy the indirect the .:m 11 11:1 mn..t be <..:oyered over by a. clean dressmg. (ee" ounds.) In all cases, especially when the patient has to be moved some distance, the injured limu or pH.rt shonld be raised, if possible, and maintained a.t re . t hy splints and bandages, if need be.

THE Coumm OF THRl MAIN ARTERIES THE ARREST OF H 1E:\IORRHAGE.

(See Fro'R-tisFi ce).

The Aorta i. the main artery of the bocly. CommeIll: iIlg at the Jeft ventricle, it forms an a1'<.:h behind

{.be upper part of the breast bone. From the arch Are given off the large trunks whidl carry the blood to either side of the head and neck and to tbe upper o( ·xtremities. The aork"\. passes do,,'n on the left of the spine to just below the navel, where it ends hy dividing into two large hranches (the ilines) "hi·h 'onvey the blood to the O1'O'ans in the p lvi. · , am1 to the lower extremities.

ARTERIES OF TUE HEAD AXD

K E K.

The Common Carotid Arteries run up the Iwd one on eith r side of the windpipe, and on a level wi th " Adam's Apple," ju, t below the angle of th lower iCL\\, divide into the iut mal and xternal cal'otids. 1'he Internal Carotid pa 'ses up deepJy in the neek, anu entering the cranium ju 't internal to the ear :->upplies the brain with bJood. The External Carotid artery gi \ ' OS off brallchc ' to the tonguc, the throat, the fa.ce, the 11o ' e, the temple and the TaJp.

WOUNDS OF THE CAROTID ARTERIE MiD TlJEIR Bn NellE.

When a Carotid artery is wounded, as ill th ·case of cut throat, apply digital compre ,ion the thumb on the artery lJ,Y' the ide of the wmdplpe, 4'ither on the wound or between it Hnd the hemt, PI' ssing hackwards again t the backbone, taking care to avoid the windpip e. Pres,' ure mu 't Lo maintained.

80 by the thwnb (by relays of assistant if neCC:-i aI'," J, until the doctor arrives; no other method ,\,pplicable in this situation. Bl eed ing from the Temple is readily arrested by the thuml, Oil thc' wound, or by placing a firm pad Oll the WOlllld, and ma.kmg press ure by a bandage ap pli ed m; foll0 \\-,. : -Apply a small pad on ·the bleedillO' point, thell place the contro of H narrow bandage ou the opposite 'iele of the h ead to the \\'Olllle!, carry the Imudage horizontally rOllnd the h ead j u.. t abovl' the level of the eyebrow", make a twi t over th\, pad, pass the rOll 11(1 the h ead again, or carr." one end oyer tho top of the h ead and the othl'r

F IG. 4 0_ und er the chill, amI tie firml y (Fig. tl). II, 111111'rhage from the Forehead. or from allI part of the Scalp C(:1,n be arrested on the same jmllcipl l'_ Hwmorrha,ge from the Tongue is usually . by sucking ice; should ice be nnsncces.. flll or 1111obtainable, and the wound far forward, the point may be grasped between the finger. ,l.lld r.hHlllh.

Hccmorrhageirom the Lips may be controlled hy ice, (Jr, if very by comprcs..illg the lJleeding point the fingcr ano. H , morrbage from the Cheek if:) uontrolled by pa si ng the forc-finger ill.. ide the c he ek amI the thumh ontidc. and compl'l'... ing finl'l.1Y eithcr on thl' 01' belo w it i.e ., hctwccn the wound and the heart. The trunk of the Facial Artery JJlay he t:ompl'e,t-ied on the edge of the 10" CJ' ja:\\', al)ont an inch and a-half in front of thc Hllgll'. ,\\' hell the lJ1el'clillg i from th e Tonsil, Palate , or the inside of the Throat nin' ice to 'lH.:k:' if °the

Fw. 41. hmmorrha("c i ' e,crc itm<ly be nece (;o mpl'c,' , the carotid artery in the neck. Hcemorrhag 1 from the N ose treated a follow ' :- eat the patient 011 a ehair with the he ad, lightly throwll back; undo

,tIl tight clothing round the chest a.nd neck; rai 'C the hand::; above the head, a.pply cold ICe, a cold sponge, or a bUllch of keys over the spine at leycl. of the collar; keep the patient in a cnrrent of fre .' h 111r, and

on no account allow him to hang his head forward oyer a basin; place the feet in hot water. Blood i ' 'uing from the Ear channel , which generally

indjcate' a fracturc of the base of the cranium nlust be wiped away as it issues; no attempt is to made pln.g the ear. When the external part of the ear Itself IS wounded and bleeds freely O'rasp the Lleeclllw 'b 0 pomt Letween the finger and thul1lL.

ARTERIES OF TilE rpPER EXTREmTIEF!.

. The Subclavian artery pas ' Ct:) from behind the lUnor end of the collar-bone across the first rih to the armpit (a,rilln,). In the armpit the AXIllary artery , which a continuation of the subclavian, keep clo. e to the shoulder joint, and can !)e felt pul 'atill(f when the finger' are deeply pre 'sed mto the armpit. The Brachial artery i' a continuation of the axillary, and run ' down the ann ou .tho inner 'ide of the bic p ' muscle, gradually pet· mg fOr\yarcl , until it gain the middle of the front of the elbow. The inner 'cam of the coat 'lee\'e aboyc the elbow roughly indicate' its cour 'e. Ju . t below the elbow the brachial artery divide into the radial and ulnar arteries, The Radial artery nms along the outer ide of the front of the forearm' it , COlli' 'e may be indicated bv a line drawn the middle of the bend of the elbo\\' in front to the root of the ball of thp thumb. A bout one inch above the. wrist: and one-half illch from the outer (thumb or Ide of the forearm, where the radial artery ltes upon the radiu ' , the pu] 'e to be felt. The

FIG. 42. ARREST OF HlEMORRHAGE FROM FOREHEAD

rad ial arte r y, at the wri.,t, turns backwar ds above t he r oot of t he t humb to the bade of the hand, and pn. es fo r ward t h e metacarpal bones of t h e thlllnb and forefinge r to r each t h e pal m of the hand . The Ulnar artery runs a long t h e front of the forearm, corre.'ponding to a line drawn from the centre of the front of tIll' elbo\\' to the root of the Lall of the little finae1'. In the hand the branche ' of the radia,l and arteries combine to form the supertiGial n.nd deep Palmar arch es . The superfic i al Palmar arch is neal' the surface of the pal m, and to the line that runs along the inne r side of the ball of the thu mb. The deep Palmar arch is lightly n ear er the wrist, but lies deeply on the bones. In t h e finger, the arteries run a long either l:iide of the fingers to the tip, where they unite.

ARREST OF ARTE RIAL HLEMORRIIAG E THE UPPER LDIBS.

When a D i gital (finger ) arter y is wounded place the thumb on the b leeding point and compress th8 par t fi r ml y; sub 'equently, appl y a small pad on t h e wound, and bandage wi th a piece of tape, strip of li nen, o r a trip of pIa. tel', round the finger and pad. When the Palmar Arch is wounded , place t h e left thumb firmly on the hleed ing point, leaving t he r ight hand f r ee to ap ply a pad and bandage. Apply a firm pad (a fo lded handk er ch ief), or better

i:ltil l .a graduated compre s on the bleedina poi n t 1 I . b , mHo t Ie patIent the pad firmly, and apply a l nmclage as followl:) :-Spl'ead out a triangular bandage, tum up the lower Lorder about four inches, lay the hack of the hand on the centre of tao hand age, fold the point oyer the knuckle,- amI wriHt, pas ' the two end .. r oulld the \\Ti ·t, nmke till' patient

pull Oll the point of the bandage, eros' the end, over the filH!,'e r' twice and tie them a ' firmly as poosible. I Bring the point do\\'n to th' knuckles and farteu with a pin a:' B Fig. 4-3). J"inally, hcnd the forearm well np and 'upport with a large arlll ·ling.

Flc.43

The Radial and Ulnar arteries may be compressed by placing the thumbs on the arlcries one inch above the wri t (Fig. 44). This may be neccsary when the wound in the palm is too large to be covered by the thumb; instead of the thumb., the cork of a pint or quart bottle may be cut in two FT(;. 44. lengthwise, and one half laid on t,he radial, and the other on the ulnar artery a little above the wrist; place the rounded sides of the cut cork next the skin and secure them by a tight bandage. See al 'o next paragraph.

Hcemorrhage from a wound of the Radial or Ulnar artery in the front of the forearm may b arrc:-;tcd by n. pad placeCl in front of the middle of FIn. -t5.

the Ibow, the forearm being firmly flexed on the arm, and maintained in the flexed po ition by a bandage.

T he pad may be made of a folded h andkerchief with ct small tone or cor k wrapped up in it; but when no pad i ' available t h e coat sl eeve rolled or gathered up aK far .\, ' the elbow will serve a a pad. Bend the forearm upon the arm and tie n, nalTOW bandc\,ge round the wrist and then round the upper part of the arm, ing the end' bet",'een thc forearm c\'nd arm so a to better prevent the bandage lipping off. Finctlly) tic the limb to the 'ide by a bandage lhl; limb n,lld the tnmk.

F IG. 46.

Hremorrhage from the hand , forear m, ben d of elbow, or lower part of the arm , may he arre .. ted by compre 'sing the brachial ltl'tcry hy digital -ion or hy c\' tourniquet . , YhCll appl)'ing an lmprOY1Sed tourniquet to the brachin,} artery, it not al ways necessary to usc the stick; the best plan is to tie a half-knot and pull the bandage tight; if the hleeding stops, compl ete the reef knot, but if it doe'1()t top the stick as descriherl on pag e 77 .

To apply digital compression to th e Brachial artery .-Ext nd the arm at right anglef.;, to lhe body, palm of the hand upwards. 'tH.nd 1)chind the l;mh, gnvp the ,trill, the thumb Oll til' AIlLide of the 1imb, and pn 's the fingers under the li.lck of the arm until the 'cmll of the coat, or the gl'()(J\'l' 011 the inside of the urn 'd e (hicep') i. rca ·hed.

11 l'c:-'''' the pulp. (uot the tip ' ) of the tiug'1'.' firmly on the <.:ourf' ,· of thl' artery (:-,ee Fig. 46). 'ome prefer to·

FIn. 47.

gra.. p the anTI from ah()H' the nm 'cle, but if thi . cour e is c.tdoptecl, great <.:are lllU ·t be taken to pres: the ,trtcry agailJ ,t the hone, and not agaiu , t the bicep.. mu .. de (Fif,;. -!-7). A 'light turn of the hand outward:-; a:-, it grasps the arlll will hetter en 'lue COlllpl'e' ion of the artery. In pmcti<.:c fcci the puh:;e \yith the freel1<l1lcl clnl'ing attempt.. at compre'sion of the hr<1.chial, to H"l'l'riniu if the tiO\\ of 1)looc1 along the artery . . topp'·(l. '

Hremorrhage from the armpit or arm may he a rrest ed by compre. sion of the axillary artery . Hollnp a hard pad t h e size of u. bill iard ball in a triangular . FIG . !H

hmdage; place the pad in the arnJP.it·, oro., hn.ndage on the shoulder, pull the end.. tIght, nn(;l be off under t he opposite armpit, taking care that neIther the pad nor ·lipped. the injured arm to t h e patIent's sIde, as shown 111 }11g. 4-

Fl•.. 4-9 .

Digital comp re ss i on of the a rtery may be made when the. wound III llla:ll artery is high up in the arm or 111 the armpIt. PlOC'eed as follows :-Barc the neck to b low the collar hone. place the injured limh cl0 e again -t the ide of he patient's body 0 :l to rlepre the -houlder J and

take your stand oppo ·ite the shoulder, Ul:le the left h and for the rig h t arter y, and vice versa; gnt ·p the neck low down, placing the fingers behind and the thumh immedintely above the centre of the colla,ruone in the hollow between the muscle' H,ttach (1 to the bone (the bird' ne t) . compresl:l firmly prc.... il1l-! tho thllmll deeply dowllwarch and backwards the fin.;t rib, which i beneath the clavicle at thi ' spot. (Fig. -4-9.) In pnLctice the pulse may be fe l t at the samc time to asce rtain if the flow i' stopped.

OF'l' HE LARGE ARTERIES WITHlN THE ClIE 'l' OR ABDOMEN.

(IXTERK AL H.LEMORRHAGE.)

,Yound of the large arterie. within the trunk callso luclllorrhage into the cavity of the cho,t or of till' ahdolllcn, and giye rise to signl:l and symptom. of internal hremorrhage.

and '.l/11/,/)IOm8 o f I lItn'naT Hwmorrha[/e flr e :-

A rapId 10 s of strength; pallor of the face ,Lud lips: coldnc... of. the extremities gic1c1ine's and more espccmlly when the upright position is it:-; lllllCll : the 1!l'en becomes 11 urried and laboured, and i ::tccompalllec1 by ya,wning and sighing; the pnl 'c fail .. gradually and way altogether di"appear at th e "Ti .. t ; the patient tln'o,,- hi · arm' nbout, tugs at the clothing' round the neck and calls for air. Fina.lly, the patil'ltt may become totally ull conscious.

93 '.J of I l/ternaT Hcpmo1'?'hage.-Keep the pHtient fiat ; ullClo all tight clothing ronnel the 11 'ck ; l,royiae for frce circulatioJl of ail' ; fa.n the patient; sprinkle cold waLer 0)) the face; apply .·mellillg salt.' to the llO ·trils; give ice t.o .'uck or cold water to chink. Ra,i. ·o the feet a foot or two from the ground, ,mel bandage the limb' firlIlly from the feet to the hip., and from the ba,ud ' to the :-;hould n, . Avoid in all eel ' et-) of JI( 'lllol'l'bage, at all y nts until l)leedillg ha ' been eOllLrollcd.

THE OURf:)E OF THE AEt'fER1ES 11' THE LOWER EXTHEM J'l'IES.

The Femoral artery , a continuation of the iliac, enter ' the thigh in t11e centre of the fold of the groin, wher it may be felt immediately below the skin. The eour.. of th ) artery may he indicated by a. line drawn from th centre of th ' groin to the back part of the inner ide of the knee. The ilrt ' ry occnpie ' only the llPT)(' l' t\\ o-third of thi .. line, a ' at the lo\\er part, of Llle thigh the femoral art ry pa:-;:-;es to thc 1>n.c1- of the knee joillt nnder t he mUlle of Lhe popliteal.

The Popliteal artery - th e artery of thl ' hamoecllpie t h e centre or the pace at the back of the lmee (the }Iam). It it:; placed deeply hetween th> projection of bone nt the lower end of the femur, and i. further protected hy the ron 'c1 .' and tendon '

around the ham. J II t helow and behind the kno joint the popliteal artery divides into t h e anterior (frout) and posterior (back) til>ial arterie '.

The Posterior Tibial artery passes down the centre of the back of the leg to the inner side of the ankle, where, hetween the heel and the lower end of the til)ia, it enter:.; the sole of the foot a the Plantar arteries. In the upper part of the leg the posterior tibial artery i.' deeply placed beneath the muscle ' of the calf, but toward, the n,nklc it comes nearer the .'urface, l-tud can be felt pulsating iu the hollow on the iuner 'ide of the ankle. In the sole of the foot the plantar arteries run forward amongRt the muscle to the foot and the toes.

The Anterior Tibial arte r y come from the popliteal and at once pal:! es forwards between the leg hon e.' . The artery runs dowll the front of the leg, deeply plcu;ed amongst the muscles, to the front of the ankle. A line drawn from the frout of the npper end (head) of the fibula to the centre of the front of the ankle indicate.' the coun;e of the artery.

The Dorsal arte :- y of the foot iH the continuation of the anterior tibial artery: it passes along a liue drawn from the middle of the front of the ankle to the illten'al between the metatarsal bones of the big toe and the next, ,yhere it pas 'os downwards to t lw sole of the foot, to form an arch with the arteries of the ROle. 95

A RREST or ARTEHIAL liS" THg LOWER

1. When the arteries in the Sole or Back of the Foot are wounded , r emove the boot and stocking; apply the left thumb firmly on the bleeding point; and, with the right hand, and place a pad on the wound and bandage tIghtly. An experienced per on mio'ht be able to further 'ecure thea r re':>t of hrcmorrtage lly mean ' of pads, tightly lnl.lldagcd, plaecc1 on the auld\] at the point. indicated ill llw . FlU. 50.

? When the arteries of the Ham Or o f Leg are wounded, or when a pad i s insufficient to arre s t hcemorrhage f r om the foot or ankle, place a pad the size of an orange

the of the injured limb' Hex the lop: upon the tlllgh untIl t h e h eel almost tonche,' the hntloek . the limb in the flexed position hy pet banda,ge (or a. str ap) round t h e leg' il11111e(hettely aboye the a.nkle; cro 's the end , Let \\ cell the leg and thigh, and, carrying them rOllnd the limb duo e t o the top of the thigh, tie them ott' firmlY. :Yhen no pa,d is to be had, roll up the lq.( ;v !eU' as th e knee, and flex the leg on that nH n. pnd . It IS not to ta.ke off the clothing to 'Oll!})}, S,' tIw poplIteal .artery by a pad and flexion . Except at lower thu'd of the leg it is eldom pO:-;Hil)1e hy dIrect pressure on the bleeding point to <1lTC,·t luemorrhage fr om the artcries of the leg.

:3. When the femoral artery in the lower half of its course is wounded and whe n a pad and flexion fail to control ' hremorrhage the or tibial arteries , apply COl?preS,' lOl1 to the femoral artery at the grOll, untIl a ea.n be applied.

To apply DIgltal Compression to the artery at the Groin. - nppo,' ing it iH the nght femoral that j , to be compre'secl, proeeed as follows :-L ay the patient down flat on the hn,ck ; -tand or kneel as convenient on the left :ide of the patient's body; to fi nd the groin, raise the foot b io'h o a::;. to flex the thigh on the body (the fole1 in the c10tbmg at t h e top of the thigh will inditaie the

97 '

groin): p a. \' the fiugers of the right hand. oyer the outer side of the right hip just helow the edge of the front part of tbe haullch bOlle, and lay the fle ,' hy part of the thumb fiat on the (; litre of the groin. Pas. ' the tingen; of the left haml to the inner ide of the right thigh cIo 'e up to the fork, and by the left thumb all the top of the right thulllb

FI (:. 51.

all'cndy ill.positioll oycr the artery. Pres:-; fil'mly l)ackwanl", 1lf.'alll'it th' brim of the pelyi.s, \\ hell tlte tlmy of \\ 111 complet ely nrr e,'Lec1 (Fig. 5l) . • (leath III h, 'lllOrrltage from "0 largc nIl artery, it it:! no to \\'a.te tillle rClllOyillg th e dothing; th c t(,lllont] art ery at thc groin can ill mell be COlll; t · a. tClllpnr:tl',Y mea nrc oycr the clothing'.

To apply a Tourniquet to the Femoral art e ry .--In practice it is a good plan to m;.l,l'k the course of the artery by drawing a chalk line from the centre of the groin to th' baek part of the inner .-ide of the knee' the artery can 11e COlllpres ed by a tourniquet C\,t <lny point on the middle third of the line thus inclieatcu or a little highci·. improyi:::;ed, <1, field, or a 'crew tourniqu t may l)e n sed. The pad of the improvit)ed toul'lli(luet should b aK 1arge u::; half an omnge' a llanow ba.ndage i to be placed with it:-; centre over the pad, and the knot tied on the {mt'ide of the thigh; the " sti 'k" i.. to 1)e plaecd between the "hal\':::; " of the knot, so as to ,woid FIG. 52. injuring the skin when it i:::; twisted. Finally, the (( Ktick " is to be "locked," and the limb put in a splint or tied to its fellow (l"ig. 52).

4. When the artery is wounded in the upper third of the thigh the femoral artery DlU:-;t be compres ed by the thumbs at the groin, instead of applying a tourniquet. Relays of assistants must

1)e eillplo,n:cl to kecp up the pn.!::;::,nre until the cloctOl' the fre -h a:::;.. i:::;hmt applying hi:::; thumb:::; on lhose of the prc\iou.. as .. i .. tant, who carefully slips hi:::; thllmh:::; from heneath, so at) to prevent gm;hcs of bluud dlll'ing the changc'H. 'When n..... i:::;tants are few, or ;l doetor not to ))c bad, an attempt lllay be mnde to a1 re:::;t the htDlllOrrhag-c oy placing a pad 011 the <.:entrc of the groin and maintaining pre hy H.ll elalStic conI pa sed fl'OIll the back of the thigh, cro.... ed oyer tilC pad and till! ellclK fat)tenccl hehil1d over the loill.'.

YE::\OU.' ILE:'>lORRIIAGE.

The eUlTcut of blood in the YeillS is ill a dil'eeliol1 the heart t] 10 ref ore, when a vein is euL the 1)looc1 \\ ill i.. 'ne from the ellCl of the wounded Yf'il1 rell10yccl from the heart. The rea 'on wI]"\' the end ne<1rer the hea.rt docs not hleed partly by the direetioll of the flo\\ of the blood, awl partly hy the yahe. ill the Yeim:" which are ,0 pIcu-cII to prevent a backwnrcl flow. The BU}Jerneial yelll more apt to lJe wonnde(l than nre the deep \ 'rREAT:.\lEX'l' OF YEXOU' H.EMORRllAGE.

(1) Lay the patient down, th' head :reKting 1111 a low ....npport or piJ10\\.

(2) it be n \ 'in ill une of the extn'lllitil's that iK l)]ecding, elevate the limb.

(3) UI'ldo the clothing and expo e the blecding 11nrt.

100

(+) Apply direct pressure on the wound b y t he thumb, and main Lain t h e p r u::.;::mre i:>nh..eq llclltl y n, pad a n d bandage.

(5) Shoul d di.red pre::';f.;un:- prove ill::;ufikiellt, apply a pad and bandage on the trunk of the vein , , on t h e. ide of \yound furthe ,t fr om t b e henl't. Varicose Veins. -The Ycin ' of the legH arc 'p ecia ll j apt to het:ollle vnrico:-ie . "\\' hen a yariveill i::.; examiued, it will he not only to he dilated etnd tort nOlL", lmt hend -like (l:ariCU8e)projl'ctiollH occur along it , t:OUl"1:>C. A vein l)ct:oUle YHricoKc frOllL YariOlU; such aK lOllg ::;tanding, tight ga,rtel'8, etc., etc. The fir.. t cffed i::.; to throw e'\.tm \\ ark upon thc YalYes, and the head-like p r ojedi.oll. are c,m8ed lly t h e blood accmlluhting in thc pocket::; hehind the yahel:l. In time, the t:halluel of the yein het:oHle::; HO ,,·ide that the YHhe t:,lll no longer ::;pan the vCH, 'Cl. vVhcu 011e of the:e dilated Yein .', ::;ay, in the leg, or bur ts, blood flow ' from the lower end of th e cut Ycin, but from the end nearer the h eart it fl.O\\':-; in nmc:h larger a.mount, o\yillg to the imperfect, tate of t h c yalveH in the yein:".

T' reatment.- \ Yhc'll ]uclllOl'rhage ot:cn l'K from a v arico. e veill in the leg, the treatment i, to -

( 1) Lay the patient fiat , the heacl restillg Oll a l ow support 01' pillow.

(2) Elevate the limb, mi illg it high, at a right angle to Lody if nccl',' 'ary.

101

Remove the clothing ,() ;t to the part..

(1) Apply direct pressure on the wound l)y the thuml ), Hon(l t->u l 'KC'lIWlItl)' l)y a pacl and ba ndage.

(5) Apply bandages , til':->t, on the Hide of the \\ Illlllcl further from the he ,lrt ; ,t:Oll(llY" the :-;i.c1' lleal'l'l' the heart hott]el th' direct Pl'c. "U1'L' pro\"l' jll , ' U tticil'nt.

TUEAT M EXT OF C .\PILLARY H E)[QRRTIM";E. . 'ee also Treatment of \ Vounds.

To ,UTC t from enpillal'ic.', <t H l ight .degrec of pre:-;,'ul" ,'lltiit'L'. . Pre .. 111<1y be appliecl illKtalltall 11Y tIl(' tIllllllh, anclwaintcLined 81111:",cquently hy a p,ul Ol' p] l(h.!:et of linen or PreHS11l'U lllHy HIKo l)e CWl'ci:-;ed 1,y appl.'"ill!:-( it pic<..:' of (p1cu..;ter) to thc woull(l oyer ,t pall. ..\n)' llleclit:alllent \\ hich Hi(b ill t.he arre::-.L or i.' termee] it Styptic. 'old, <..:ul(l nil' or ie , ctrre:-;t,.; h,cmol'J'hage 11, the 11]ood \ e.", cb. '\'-ntcr as h ot a::.; c;m he horne, by ',m:-;illg the hlollc1 to d()t, may ch eck 11< 'll1o lThng ;-;Ilch a. fin' stnmcl.. of \\oul, o r \\00], l'OarKe l)]ottillg pap '1', etc . ctc., ha\ c, if ·1 <1.11, ..,olJlething to ]'L'<..:tllIlll1C1HI tht'111. Coll()(hon appl iet l Oll ;1, finl' \\ ell of cuttOll \Y()ol i nil etlieiel1t . t.yptic aw l Hll artiticial ..,kill, helping to cxclude nil' from t h e wound .

('HAP'1'ER III.

T HE N ERYOl SY'T E :\L

Two system of nene' the l'erelll'o·spinal and t h eSympathetic, oyer the mOYOlllent,' and of the body.

The Cerebro - Spinal system made np of the· Brain, the pinal Cord, and the X

The Brain is situated ,yithin the craniulll and i,' (liyided in the middle Ene, 0 thcLt, with the exception of a fe"T connecting hand " the right and left are

The Spinal C o rd i' the long cord of lleryOUf', lilatter lying within the callal ill the bony are11 fOl'lllecl by the vertehrc.e ( eo Y ertebral'olnnlll). It ]ea\'e the brain ca 'C through the l)'1.'e of the 'kull,. and reache . a' Iowa' the npper lnmbar vert bne.

The Ner ve s proceed from tllL' uraill all (1 ::;piual conl in pairs; the former arc tcrmed tbc l.:nmial, and the latter the spinal no)'y(; , . A pail' of 'pinal nene emerge;' hetween each of the YCl'tebne. The nen' c, ', the brain about hase, and in tile Hpilln.l cord, so that the right hal f of the braiu pl'eHideH over the· left haH of the body and limb1), amI the left hall' over the right side of the hody and In thc lilnbs and trunk the nen e, are met with as large pearly white trunks, and CUll be tmce(l to tbe lUll t'le' and Hkill , 'Yhen the l1prn"', ;ln' t()rll through there'

103

pctra.ly sis of motion and in the regioll.' in which they arc di tribnted.

The Sympa t hetic System of neryes tf:> of cL dQuble chain of nerves and 'ma]l lICl'YOll'-, ll1H es termed qa77(flia ) 011 either , ide of fn'Hl t of the . pinal column. The t:hain frol1l the llCl,e or the skull to the (;Gec}'x. The nerye:-; of the :-;ympathetie send branch,s to all tht organti of the chc:-;t alld ahdOlllen. J t iH thi ' "stCll! tha.t control' tbe ta.ry mu:-;cle of th l)ody it regulate' all om Yital function' a::, ""ell a adjl.l.'t , the 'upply of blood to th 'ccrctiug and excreting 01'-

FIG. 53.

I>rAGRA \l ;';HOWI G TIlE BR.UK \ 'D THE SPIKAL CORD, WITH TIlE "'ERVES OF THE LEFT OF THE BODY.

gal), ' . The "YlllP<Ltbctie i":·stC'Il1 ·' (litfers from the -cercho-::;pinal tem, it aet, ' during leep, .and kno ws no prolollged 1'e::;t.

IN:,EX IBIL ITY.

Unconsciousness or Insensibility

\"ben the fundiol1l-l of the lmun are ill a1)eyallec, either diredly frolll injury or di 'case of the h1'(1,in ih.;clf, or indirt,etly from eli, tnrhance of the adioll of the ()r heart.

THEAT.JIEJ. T OF EX, ' lBT LITY.

,YHEX A PER::iON IS FOU 1- O A c'i'ATE OF IN, EN lBILlTY :

1. Arrest hremorrhage: if present.

2. Lay the person on the back , or III the po ition in which hreathing is mo ·t eelT

3. Undo all tight clothing l'onnd th e neek, ehe t, and \rai ' t, unfastenin o the brace, and top hutton of the tr01l.'ers in men, and the COl', et. ill women.

4. Provide for a ufficiency of fresh air by keeping the crowd away if in the tl-eet, or l)y opelJing the doors and ",indo\",' if the aecident hal-> occlllTed indoorI->.

5. Obtain a doctor ' s help at once; itS n gcneral rule, until he arrivmi, keep the head low if the face is pale, and mise it somewhat if the face il-; flushed.

6 Never leave the patient until you haye plaL!ccl him in charge of n, responsible per, on.

N .B. Giy{' no food or fluids (neither timulan t ' , tea,

Jv5

wa.ter, nor medicin e .) by the moutD. while the patient j,. ill en-ible .

THEN PROCEED TO EXAMINE TIlE PERSON AS JXDICATE))

BELOW, TO THE NATURE OF 'j'HE IN EN IBILJTY ;--

1. Feel if the pnhH> beat. · at the wri 't (r<l(linl <lrt ry ), at the tClllplc (tcmporal artery), or ill the neek artery). The pul 'e may be ab or it lllay he llnnatnmlly H1ow, quick, or feehle; It llHl y III iH ,t heat oeeaHIOl1al1y (intennitter t pulse); or, the pulse mCl,y heat quickly ,\,uel .'lo\\'ly altcJ'llately (irregular pnh;c). All eOllclitiollS inclieateol1lc ,' erion ' mi 'chief whell w.;soein,tccl \\' ith in ' cl) , il)ility. reebl' puh;c that th ' llse of stimnlautH (:::;ctl volatile, 10 clroIJH ill water, or a tea poonful ()f brandy in a winet!,'lrtHsi'ul of water) is adyiaule, pro\'id ,d' that the patit'llt iH able to ' wallo\\. ,rith a plllHe "itllliolc1 Htilllubnt.'.

If the pnbc call1Iot llc felt pbee th e 11<111(1 oy?r tIle heart, or apply th e Cal to the che 't, to ,bCl'l'tam d' the henrt

:3. Okel'Ye if t1ll' p erson h)'eathcH, and note the ()(lolU' of the hrcath. Thc brcllthillg lllny he blnw, lah mred , ,mel ;t <.:e oIJlpdlllc<l b loud .'IHlring and puffing of tll } (·l1 l't'k , dming cxpinttion (st ertorous u}'cathinq).

4. Ex',tJlline tIll' (' (lIp, temple.' nll(1 lHlck of the head for injury j t.l! ' and the llo ' e for . ign , of

lucllIorrhage; and the mouth for blood, froth, .'tainH'. h,' acicb, etc., and for foreign bodies.

'5. H.aiHc the eyelids, and examine the 'tate of the· pnpil,·. "

The pupil' arc the dark round i::ipoti::i in the ceutr" of thc hlue, brown, or grey iris. Indcr condition,' in ,'haded light the pupils dilate; in hright light they contra.ct to 'mall dimen iom;. In HC'\'cral (liKl'lt.'cd condition::; the pupils are altcred, they mH," he uoth widely dilated, ::>1' botk minutely ('()niractf'd, 01',011 the other hanel, they may be unequal or irregnlarthat iK, one may be large and the otker small. }> ryom> of :mdt altered conditions denote a seriuLl ' 'tate. Tbe pllpil,' are said to be fixed when in either a 'haded or a bright light no alteration takes placc in their 'izc.

6. Examine the body and extremitic. for Hign.' of fmcturct:;, di::;location , wounds-the neck for Higm; of Htrallgnlation or hanging- and compare the two 'idl',' of the hody a' to limpness or helples 'ne '13.

7. the tempera.ture of the kill, whether it hc natural, hot, or cold. The quickcHt way of doing thiH is to ph-we the back of the hand on the nakcd che!:lt of the patient.

(So)fETIMES LEADING TO COLLAP:-lE FRO\( I 'JURY).

After eycr,}' accident of any 1:le\rerity thL' patient 'utf8rl-. from shock. Jt is not so much 11, llH'lltal (,()tl107

diLioll that rc, ults, as one depcndent upon the pl,.";-;ieal cOtL 'cqllCnces of injury.

Sign,' and Sympto1ns,-Thc patient complains of fcl'lilll-( ('old and may etc-tnal1)' shi vcr with cold. The fate i;-; palc. the ;-;kill cold and clammy the pulse j,' wcak_ the 111'eHtllillg iH Kcarcc]y perccptihle' and the telllpemtlll'l' ()f the l)()(h', if takcn by a thc'rmometcr, \\ill be fOlllld to be he1;)\\, the llol'l1l<;l (9 '4), In ,' eycre ill,illric.... sllcll al-. cxtc' I1Hi\'e lnll'lh, l)l'oli:Cll l)ulJe ,', laccnl ted \I or Kl'YCre ern,'ll "ith elcE.'lHleateel illjurict;, the telllpcmtul' mny fall to 9-1 dcgreeK or \' 'n lower: ill :-om·ll CaKc,' rel'OYOry is rendered dOlllJtflll. Thc palil'llt, ml'nntimc, mny remain cOllseiowi, hut HP]W,U·.... clnzC'c1. In some cnHOS of shock the patient 111<1,' kl'cp quite quiet, hut ill other ea 'eH a markcd, lllll'l'''l-.()Ilahll' r'Htle " lle '::; prenl.iJ:.... The paticllt llla \ 1 dclirious owing to ,' cyerc pain 10, l". or 'l)l()()d, or mcntal eli turuuncc, o r may culJap. e t'n)lIl l'\trelllC JOSH of hlood, or thc of th ' , IIU('k.

TI' (, II/l17 ent.-Pr '\'cut t.he tClllperatlll" falling 1):" l'm { ' rillg the patlcnt np with a coat, blanket, or ,llIytlli11g aL hauc.1. A. soon as pOH 'ible gct the p:l ticll t uucll'!' coycr in n, wn,rl1l room, cr in hed, and prmnutL' \\arlllth 1>,\ hot ilanlleb, hot lJottlc,' to tIlL' fl'ct awl ahdomcn, and, if the patient i,' not 1l11COnscioll,', !.!:i\'L' \\ann drinks, tea, hot milk, cte. \\'hen hot huttle-; ,'ee hat the:' nrc \\ rappe(l up

106

10 '

in a piece of flannel 01: dot.h of 80111.(' kincl to preyeut p08.'ible injury to the :-;kin.

OF TilE BRA TN.

' Vhen the craniulll i: .. tnwk ,I, Hcycrc l,low, or injured during a fall, the brain lllay he concn '(1that i:-;, the person ))1<lY he Htnnllcc1. There may he no wound of the J'\ealp or injury to hc hone, hut the 1mtin is .'0 :.;haken that for th' time heing it is [unetionle s or paralysccl.1igns and ymploll/s.-In cnsihihty, a foclllc pul.·c, breathil1l!, the pupil::> fixed, :mr1 gcnerally .equa] in :-;ize. Hi:-;tory of ct fall or n, He\'01'e hlow may he ohtn,illcd; 01' injm'Y to the head mny ho cvidcllcerl by wounds, hruisos, etc.

Treafmpnt.- eo .\poplcxy (pagc 1m)).

CmrPHE ':--lOi{ 01" TIlE BR.\ IN.

'Yhen from ;1 fet1l or hlo\\' the cranium IS fr:1t'tured, and a pieco of ho])e driYe)) im\<ucl:-;, the lm:tin lllay he ,·umpre:-;:-;ecl. On the oth r hand tlll' hl'oken hVolle may ilJjure a \\ ithill' the eranium, and comp1'cf)Hion may rcsult from of blood 011 the ·lm·lill. 111 the fortu \] (';tHe the ill"Cl1, ' ihility \\'ill CUnle Oil illllllc<liately' in the laUer after ,'ome minute .. , 15 OJ' that is, \\ hl:n the hloocl has accllll11l1ate<l ill l-3llftit,;icnt quantity to cxcr · <;i, e pres8ure on the hJ'ain.

I ign' and , rn.'cl1"jhility; yiLlence of ;1,

",ollnd of thc sl'alp; Lhl' fractlll'L of n cntuial bone may be felL: :t HIm,", full pul.e; :-.tertoroH, breathing', lllH?<tllal pllpilH, Iixec1 \\ hOll the prc:-;. ure iH Heyere. In in,lll1'i01'; to the hrain ::;YlllptOlllS of COl1CUHHiou first pl'eYnil, by of com pre, ' 'ion. ec ...\ popll'''.'' .

Al'Ol'LEXL

\Yhl'1l a diHC;tHCcl blood \ e :-.d (!iye..... \raY \\ ithin the 'ranilllll tho hrnill i.. and its 'ti.. llL' partly clestroyoLl ll\' the 1,loocl \\ hich C, caPCl'i. WhCH the quantity of 'blo()d i\-3 lnrge the . Yll1ptOIll" cleyelop :-;0 r'lpid.ly that tIle c(Jl1clitiOll i. tl'l'llle<1 all apopll'dic tit or ..... elznrc.

,..... il/riS olld '/lIIlJdnms.-lllsL'llo..;iI1ilit:·, a fllll, :-,low pn] e, .tertorom; ul'caLhilll!, lluequal (olle larl!e and Olll .....wall) awl h\ec1 pupil, 1l 1i.n..... l1L'cl face, 1l hot .. kin (tltl' temperatll1'e till' InKl,)' i:-. ll:-ilwll:' mark dly 1'ai e(1). nnel th' lilllh' of olleicle ot the hody lilllP, \\ hilL' Oll the ()ther the llOI'llHll lllaY l)e 1'0tlw of n '-He\ e'rc nr:oplectic attack. The <t!..';e of the patient io..; it hdp in recogni 'illg tIll' condition, aH it i:-; INHllly eWerly Ill'ople \\ 110 axe HClzec1.

'i'I'ef({ment fo), A pop/C',1'//, and COlli pression of the Bwin.-(l) trentlllent for iU:-iL'll-;ihi1ity (100.'ell the clothing rOllml neck, l'lte t, <mel abd0 4

109

mel? provide for a free draught of air). Ll) the patlCnt on the hack with the head :lightly mit-; '(1. (3) Get a doctor at once. (4) Apply cold 1,0 the head, <Dither by an ice-bag or by cloths wrung ont of col(l water. (5) Keep the reet warm by hot water lUl.u,tard lecwe', or a mustard plaster. 'vent anything being given by the mouth. Take ('arc that the 'kin i: not injured by the hot-wnter hottle:-; ; they ought to be tested by feeling thcm "ith the back of the hand, <"\,nd then wl'Cl,pped ill HalllJel, ·te., hefore phH;ing them agaimit the skin.

COLLAr.·E FROM DRINK.

Physical eollap 'e from drink is genel'<1.11y witJl(,'). e< l in very poor per::;on ', upon whom, 1'J'0111 "ant of llOuri, hment, in::;ntn cie nt clothing, etc., ell'illk (it may be even a l:>mall quantity) hal:> an undue cffect. It is eldom that drunkards become phy ienlly coJlap:-,ecltheir mental powers may be paraly ed, hnt the uirclllation of the blood retains its pow er.

Signs ana Symptoms .-lnl:>ensibiJity lllil)' llc UUlllor partial, the patient being either uapahle of belllg roused, or totally nnconscions. The pulse i· feeble or completely absent at the wri.. t; the breathing is slow, and perhaps lightly .'iertorOlll:> ; the breath smells of drink; the pnpils are dilated, equal, and re pond to light; the face i' pille, emu the surface of the. kin col d and clanuny.

.J.. T.R-It mnst noL be ClHHllIlleut.]Hlt a per:o;oll has collapsed f r om drink merely becnll:e tlw lJ!uttJl of el1'ink; frequently, when people arc feeling ill, they ta,ke or arc giYell sLimulant .., after which theT may llecom im;cJlt-;ilJle, not from the drillk lmt from the cause which induced them to take it, e.g., apoplexy coming on, of poiHoning, etc., etc.

:P·reatmeut.-(l) G noral treatment for in.-ell ihilily (loosen clothing, proyide free circulation of air, and pt\ee in position in which hreathing i:s possible).

(:3) Keep the p,l,Lient "warm IJY coyering him oyer or takillg him indoors, and applying hnt-\\ ate)' l)uUleK friction to the surftl.ue, lUore C'Kpeeially to t.he limlm. (3) ,\'h en the p;ttiCllt can hu l'O\l:-i ed give \\ llrm ten. or coffee. '\ W hen the puI. ·e i. l'l'. tOl'c(l gi ye an emetl . of a de:scl't-"pOOll fnl of 11m. tard ill a tumhlerful of luke-wn.rrn watcr. (;» Wh en the emetic ha. effected it, purpo 'e, support the paticnt's strength hy givillg tea, Led tea, lll'<llHly ill 'mall quantity, or hy any of the prepared fuod., or os 'e nces.

The apoplectic. tate and uollap'c from clrink <1.r \ not Hl1freqnently mistaken the one for tlll! other. The more prominent of di 'tingni 'hillg them n.re at'; follow' :-

1. In apoplexy the patient i ' u ually gotting 011 in years; collapse from drink may occur in a per on of any age.

110

111

The ab 'ence of the :onnell of (lrink would indicate.. apoplexy. l

3. Pupil: genernlly lllleqllal and hxed III apoplexy;. c'lual and responc1ing to light in collap 'C from drink.

-to The pul e at the wriHt ill apo!?lexy i ' mmally t:ltrong aurl full; in collap.' e from drink it il:l feehle or altogether aL 'ent,

The features ill apoplexy arc ll:->ually l:onge:stecl <l,nd t:lllffu. ed; in collap:e from (lriLlk they a.rc petIe and pinched.

G. meau::; of ai:il:crt<1inillf! the telllpcmtl1l'e he at hand, it will be founc1 ill <l"poplexy c.;oll.. itleral)ly aboyc, and in collapHe froUl drink con 'ideml)ly l>elow the normal (9 '4).

EPILEPSY

Thi" di ea e iH freqnentl} term ed the cc fallill;! .. ic.;kneti." It occnr:-; i.ll pcnlO11. of almm;t any age, lmt mo ·t frequently i.t IS scen in young adult::.>. It i .. a COlllmon form of cc fit," aucl as it oc.:CLlr with 1Hlt little if ,my warning, the 'eizure lllar take place by night or clay, at home, in the street · , at puhlic meetings, in :t pllhlie COllYeyallc.:e-in fact, any\\ here. Owing to itH lleIden den'lopmen the patient may incur HcrioH::; clauger, e.. pec.;ia.lly \\ h '11 the attack come' on near a fire, m 'tl'hinery, a . teep lmnk or precipice, or where tl'atti t' 1

) IYlVH.tnllSYIJI}Jir;m.-.: .-, 'olllcLilllC. WIth, 1lilt gonerally vithont, (\, Hl:rC,Ull the patient falls to the gl'Ollllf1. inHcn:-;ihle. Th' lllUHclel:l of the body a.re in a. sta.te of ';-lpn,Km, HO thilt the fea.tures ;\,1'0 distorted, and the hauch; nrc tiu'htly deuc.;hed with Lhe thumb::; inward,'. Yery 1,-.111' rigid "pa.'m l)y whieh alJ tho.c l)(ut'l h(\,ye 1)een tixed i.' cxchanged for a. sta.te of eon vllbio)), dmilll-( \\ hiL:h the face, limh; anel borly are violently <:olltortctl. The eyes m:\'{ Hqllint, the pttpil:-; arc e(Lllal, dihtecl ,mcl fi'i:l,d. 'I'll<' fncc }l,t firHt pede, hecOIllc:; ky, HllIl froth fl'eq l1l' ntly n,t 1he month ancl ()cta .. inunlly at the 1l0Htl'il... The Longlle H}Jt to 11' l)ittCIl, it i .. the froth from the 1l10l1th In;w he tillged with 1>100(1. 'l'hc of,lll pilcptic fit i::; ul1l:crtain; iL l11<'ty (!ontinllo for hut ,l lLlinute or two, or for fhe to tift cn lllil111t.. \\'hell the fiL cea 'C::) the patIent lllC'l)' rccOY r .('nmpldclYI Ill<ty rall into a deep sleep, or lllay hctye .tllcl:e:'l-iio)) of l-iimilal' fit ... 1'uutm P llt.-(l) (;Cll ral treC'ltment for in. on. i1lility (Io()l-icn 'l()thil1ll', <lll()\\ fret' circn1n.tioll of ail', attl')Hl to pt):-;ition). (2) 11re\' cnt the patient from hurting llilll:-;l'H aH he awl nftcl' he has fa1len. (3) During tho tit c1mg him <t\\ay from ,l wa1l, heavy picl:c of fnl'llitlll'c, nl' othor sonrl:C of cbnger not 1110\ c(l ; pn .. h lighter fn1'llitnl'e ant of the way. (+) Kncel tlo\\ 11 hCKillc the patient and support hi:-; hea(l. C) \rrap it piece of wooel or any hard material (handle

of pocket knife, indiarubber, pencil, etc.} ',11 a handkerchief, and hold it between the teeth to prevent the tongue heing bitten. N.B. 'rhe movement of the limbs mnst be r e hut not altogether prevented or compl etely ch ecked, n, ' during the 'lXU:illlS the mu. cle might be t orn. GiYe nothing b.r the mouth. (6)

After the fit see th:tt the patient i· cared for 1»), friends, 'W cOllYeyecl to and allowed to re.'t and , leep.

F AINTISG

Cau. es. - A clo '0 or crowded room, tight clothin cr , \right, f; udd ell had ne\\, ' , fatigue, 'rant of food, los. bf blood, heart fail me, etc.

Signs and Sy mptom,.<I-Pallor, a feeling of gidcline' " It feehle hallow hreathing', blurred yision, followed by ill 'en 'jbility more or complete.

T ?'eatment.-(l) General treatment of ill 'en 'iLility (100 '011 clothing, provide circulation of nil', nttcncl to po 'ition). (2) Lay the patient down fiat 011 the floor, Oll a cOHch, or on the ground, or, if po. ,' illle, H,' wh '11 the patient on a form, let the head drop oyer th L' edge of tho form a little helow the leyel of the lHxly. (3) Rai 'e the feet a little. Uet a.' much nil' to play on the patient as possible by creating a c1mught, Ly hUlling, etc. 4) Smelling 'altfS held the will aid recovery. (5) 'Yh en Ren ibility i re:-)torc(l remove the patient into thc open ail', hut :-)bould recovery be delayed for ::;oyeral minute' 'lfter the fiat

115

po , iLion bas been a 'l:>lUlled, the patient lllU t lIe carried whibt jct in , nHibl to the open air. ....rote:-If llleedinf?,' i.' Lhe callse of the faint, Ul're t t11e ltwlllorr1mge hefore treaLiug' the in.' ensi1)i.lity. If tlte p,ttient is :-)nfi'erillg' from want of nouri 'bment,. gin' food .·pnringly at tir. t.

Hy TERICAL FITS (HY;' 'l'ERIA).

• 'i[/IIi' and, ymptollls.-The patient, 11 uallya younggirl, in eon:eqn nce of , olllC mental excitement 'udclenh- 10 'e' cOlllmnncl of her feelingf; and action.', .. be :-i\lh-:iides on a COlH.: h or in some comfortal)le po:-)itioll r ;mel C01llmences throwing' ahout, grindi.ng teet h, c1enehillg her fish, Khaking her hail' loo.. e, now clutching ,tt anything or anyone ncar h'r, crying, k ieki.l1!.(, or htughillg. The eyc1><tlls m,ty he turned IIp\\ilrd, and the opened and hut rapidly.

tilllL' , a froth may appcar nL the lidl:> and . eyeml other i lleyelop. The pa tiCll t i, not l'Illllplctcly i1l.'c11.' i1)1o in hysteria.

TJ' t afm ent. • 'peak firmly to the patient: threat ' 11 lILT \\ ith a cold watcr cl()llehe, ancl, if .. ho per 'i t in he)' "fit, " , prinkle hcr with culd \\ater. ledieal treatment

l1L'CCK 'aI'.\' to cnre the pati en t of the conditioll of mill!l nnel hod" whi 'h 1'i:-;c to the tendcllcy tu hy.' terical atta·<.:k·,

•'U:\. 'l'ROKE.

Heat Stroke an d Heat Apoplexy are term& T 2

114

."tho applied to conditio-no ".

a.pplied to that form of the ailmellt which 'COlll']S on ::mddenly whil t cxpo 'ed to great hent ; n,nd "heat stroke" is the term u ed when appear after the sun has set, in tle11(:0 of exp ' ure to severe heat during the da,)'.

Signs and Symptoms. - \Vhil , t expo 'cd to grea t heat, a ' in the engine-room or stoke-hole on l)()(lrcl ,'teamer', e in the tropics, or during it march whilst heayily lmrdened in ycry hot wCc-tther, pen:lon 0 ituatcd lllay (levelop a sndden sickne.. , .1. feeling of fc.tinlne 'H, giddines, and ditti c.; ltlty in hreathing. The patient complctins of thir,1., til e -;kin hecome. dry and burning, the face cougc, 'lcd, the pulse quick and hOllnding. Finall,)', lllay result, with broathing, ful1o\\ccl Ily '''0 11 apse.

zr,reatment. - Unelo aU tight clothing; l'CI1WYl' the patlent to a cool, shctdy spot-if on boarrl ship, lle1,\\ eon .decks· if in the opeD, to the shade; jf llear a 1)(1\1:-;0. <.:<trry him indoor ' and darken the 1'00])1. Strip tilL' patient to the waist, procure a' free n, cir<.:llbtion of <lir as possible by fa.nning vigorou 'ly, lly openiug the door and windows if in thc bonse, or placing in a draughty pla,ce if on hoard .·hip. Keep t hc patient lying down, but with the hea.d, neck and well rai, ed. on a. pillow or folderl coat. Ponl' -cold water on the head, neck and body, j ngfnl :lttel'

jugful, until conl:\ciou ness returns . An icc-bag to thel1Cctd and spine or cold water applicatious should be continued for some houn;. The patient may have cold "water to clrillk when con cious, but no stimnlcmt.

*ELECTRIC HOCK.

Tllr ugh contact with ttll electric cable, wire, or other electric medium the shock may be '0 scyere a:' to tau'c in en 'jb ility, and the sufferer will be unaul e to C'xtricate him ·elf. Immediate step' must be taken to re1110ye him from contact, but an attempt to do thi:-:; i. attended with risk, a anyone touching the sufi'm'cr without prop :; r prccautions is liable him 'elf to receive a ·lwck. The ri ·k can howeyer be materially if n It entirely obviated, by availing oneself of the. ntcs'nard which are apparent to anyone possessing an elelllentary knowledge of tho laws which govern <.tIl eledric C1UTent. ome bodi s, known a' "condnctor ," Hre particularly suited for the transmi ion of electricity and arc in tantly seized, when po ' ible, b} it cnrrent a its path. A' in tance' of uch bodie may he mentioned, iron, bra ,wator or moi ture, and one '" 0"\\'11 hody. Other bodies, call cd "non-conductors or "immlaton;," re ist the current, and amongst are lucliarnbber, gla ,dry silk, dry cloth, dry wood and dry hay or ·traw.. An electric Clll'rent always ehoo es the "'" Thi article has been kindly revised by Mr. •'. B. CoLtrell, Engineer and Generd.l Ma.nager of the Liverpoo.!l 0, erhead Railway.

116

117

118

be ' t comluctol' and the ::;hortest WHy to the earth, bnt it will not pas::; into a hody, no ma.tter how good a conductor that body may he, if it.s egl'c::;s is prc\'entl'el by an insulator through whil:h the CUlTl'llt Ccl.llll0t pa ,'.

.N 0 doubt the way to free a nffcrcl' fr()lll contact with an electric current would lJe to . \\·itch oft the current but this course would often bo 'I uite impo sible, and even if po.' 'ible, so much ineonyenienel' and perhaps danger to the lives of others might arise that some other method u nally to be ado}ltcc1.

"When liberating the uffercr from contactrememl)cl'-

1st. Do not touch with naked hands the utferer or his clothing if it i.. damp. 2nd. Keep your 'elf in nlated from the e(11)le or apparatus, from the sufferer, and from the earth a .. \yell. 3rd. Although indiaruhber i. prohalJly the be. t in 'ulator do not \Ya .. te time in runnillg for inc1ictruuher o'love or mats, hnt use dry article::; of clothil1t! : an india rubber tobacco ponch or ponche , or C,l.P, wunld . erve to protect the hands in an emergel)(·Y.

To cUvut the cu?'renl from, the sujfel'er.-Ha,ying in .. uIated your own hands and hody, get un iro11 roel or any other form of cond nctol' that may be at hand, and connecting one end to the earth and the other end \yith the cable or whatever may be the III dilllJl of the current; or if the sufferer j .. obtaining thc shock f r om two cables or COndu.ctors neither of \lllieh is

119

piac:e the rod in conncction witl) both. and the l:HlTent will th n be diverted from hUll .. If the :-mfferer i not rele;1, ed by the auoye lflcans lllsulate your own hy on a dry hoard,. dry a llUndle of dry hay 01' .' traw, . hnck ' l .'late or a.n indiarnbher mat or 'h ctlIlg. your hanel. ' hy plnl:illg <.1..' many as po ,'11)le -of dry dothilW hetween them and th sufferer, a.nel to e ,md insulate him from wJt.h the earth anel the conductor. ,\'ben the I,' in 'ulateel the ClUTcnt cea 'elS to pas. ' through hlln. rrhe ca111e lllny then he withdrawn, lmt ('arc lllUst be taken in withdrawing the cable that Lb . person ,. 0 doing, him 'elf remain,' in ulated, ot? nn 'e he .W111 a . hock. \Yhen the sufferer} , remoycd from contact :- 'bT

1. Apply th e !.!enera,l trcatm.ent 1 Ity (100 ' en dothillt!l procure frce cll'culatHlll or mr amI plncc in a rcclining

2. Dip a towcl in (;old water and attewpt to a1'0use him hy .. ha1'ply fiicking thc .

3 On11nen(;e artificial 1'c pInt tlOn If other meth ds fail' to re,'tore animation. 'Laborde's" method, (see paCTe 1-:1-2) h,l.' been found to be "cry .ucc8s ·fu1.

4. llUrn ' , if there are any ( e page 1 :?t:\).

EFFECTS OF LIGHTNING.

A per, on f';tl'lH'k hy lig·htning i .. more' or le. s

d epri ved of The treatment is t h e .'ameas that for electric s\lOek, except, f cour 'e, that t he in st rn ctions for removing the patient from conta.ct with the el ectric m ed ium do not npply.

CONVULsrON' IN CHlLDRE;:\.

'l'ecthing or stomac lt trouble are thc commone ' t ca.U8C::) of COllYul ·iolls in

Si gns and 'ymptoms .-Spa .. m of tho lllm<cle . or tlte li.mbs and liyidity of the face, in.'eni'{ihility, OUCH.SlOU LIly squmtmg, .. rl' ·pil'c"\.tioll, and heq uently froth at the mouth.

tp(eatment.-Put tLle chi ld in a \\'l:l nn oatil about the normal temperature of the body (98 clegl'cc:-, Fahr.), so that the water r eac hes high ;l:,.; the middle of tile trunk; and place a sponge dipped in cold water 011 the top of the head 121

CHAPTER T\"'". AND IN.J URIE THE SKIN. BRUISmt

A 13LOW anywherc on the surface of the body may e;Luse exton'i \'c lucmorrhage helow th' skin, ,yithout the .. kin l)eing wounded. A" black eye" i' an injury of this lJatUl'e.

i.rlllS and A.1/1/J1ploJIIs.-The injured part is at fir ·t l'L'ddened by the h10'#, hut the colour quickly a ·sumel:). a. hue and then beeome' purple, and aftenntrds allllo ·t black. In a few days the colour appears of a lightr·], tiut, ,md arLer gradually paf:l ing through pm'pIc and yiolet shades, it change to a greclli. h eolollr and then to a y llow ting uefore the normal colom of the skin is attained.

TI" J atl/lent.-Beyoud the immediate application of ice or eold-water dressings, no" fir·t aiel" treatment is rey' aired. Th e yirtue populnrly a cribecl to nt w meat applied 11) a black eye ha ' no foundation beJond the fact that the piece of meat cold.

\\ 'ourm .

A "urfac(: wound may te defined a an mjury illYolvillg an opellin o in the skin.

OF W OUXD: ' IX GEXERAL.

Be sure that your Hands are quite Clean . 1. Arrest Hrernorrhage at once when the

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'ource can be a ·ccrtained. Vnlcn internal l'hage is ::mspected the mea. 'ures to h? arc :,Re t, free circulation of air, 100senll1g clothlllg, a.nd free use of ice to \' uck; an ice-bag may al. 'o he applied externally in the neighbourhood of the \\'Ol;ud.

2. Cleanse and Dre s s the Wound-(A .) 11 hen Old-of-doors it is but ' Idom tha.t appropriate meH.l:s of cleanino' <:1, wound are at hanc1. (a) If no water l ' n.t 11and, but one clean handkerchief is to he had, the wounrl, if it i' dirty, with a corner of the hamlkcr<chief then fold the handkerchief and tic it oyer the If the hcl.lldkerchier is soiled apply a piece of clean (unprinted) aH the in ide .of, an el1y?lope, on the wound, and tIe a handkerclllef, neGktle, or brace over it. (lJ) If dpan water is ncar by, a.nd the wound i ' dirty, hut not otherwise, wash the wound freely, dip (or v \Yl.\.i5h if ncce ' sary) the handkerchief in the water and apply over the wound.

( B .) Wllen in-doo}'.-; I'leanso, the wound with water that been hoiled a.nd allo\\Ted to cool. To the water might be added, in the following proportions, if at hand, a fcw crystals of permanganate of potash to a half-tumbler of water; boracic-acid (a tea poonful of the powder to a half-tumblerfnl of water) ; 01' any of the disinfectant lotions in common The parts aJ'O'I.md the wound are to be deR.n, eel by washing with soap and water. When the part ha heen (lried, absolute cleanline., will he ell,'nrccl 1>y

mopping the kin around the wound with pirits of \\ inL' or with \\-hisky. Dress the 'Wound.-Thc woulld 1I1a), nuw uc dre,,, ed by one of the following methuds : - (a) .\ piece of dry lint, linen, or calico of sevcrnl thiekll and bandage(l. (b) The dre, ing lJl,lY he in \\ ater: uuilcc1 and cooled, or in allY of the lotion', OJ' in .Fl·iars (c) Cotton \\'001, lint, or gau:6e (medicated) may be applied "et or dry, next the \\ ouml, ill tead of the ahoye dre ' , inO', or applied over the dre.. sing. (II) ..(\llti. eptic powder, .. neh a' boracic acid, ma)' he du . teel .)\"er the wound, and then covered with lint or <:otton wool and l),,-ndn.ged. N.B.-Carbolic a.cid, although valuable a' an allti 'eptic, on account of mall,V <weidcnt having OC(;Ul'l'ctl ill recent year thrOllO'h i lllisa ppli(;ation it; not a t;"l.fe lotion to be kept in the home a a dre ino' for wounds. Ve, e1 containing carbolic acid lotion . hould not be left about.

The cleanline s of (he.. ings of lint, cotton \\'001, or trn,uze can be O'uarn,nteed only after they ha\'e he 11 'uhjected to great hcat. 'l'his can he aecompli. bcd by placing the quantity to be used in a clo.. ed tin in <t hot o\'en for half an hour. It is ad vi able not to touch clean dre sing with the hand, but with clean forceps, pincer, , sugar tongs, &c.

'Yhcn the blood bas cl'nsted over a wound do not di turb it unlet:>s the wound is kno\\"l1 to be 'lirty.

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3. Rest. The woul'lded pH,rt, when dre sed hould be kcpt quiet by splints, slings, or by re t in bed.

,VOUNDS A 0 THEIR SPECIAL TREATMENT.

The treatment of wounds in general applies tothese wounds :-

Incised Wounds. -",Yhen the skin i ' cut by a knife, a picce of glass, or other sharp in trument. the· ,,"olmd i - termed incised. The edges are clean cut and the wound gapes.

The edge of a large incised wound may b held tao'ether, after it has been cleansed, by narrow trip of badhesive pIa tel' laid across the wound with n slight iliterval between each Rtrip.

Punctured Wounds. -The wound cansed by the stab of a knife, dagger, bayonet, etc., i termed punctured. The wound is usually smaJl, rounded, or jagged, and the edges driven inward by the weapoll. The danger arising from the injury depends upon the situn.tion of the wound, or the depth to which the instrument has penetrated.

Punctured wounds must not be proued. Foreign bodies in wounds, when hidden from view, are not to be searched for by probing, they are to be left till the doctor arrives. (See also Internal Ha") morrhage.)

Lacerated Wounds. -When a part of the body is torn off by machinory, by the bite ()l' claw of an \\.1\in'l al, 11y an artillery shell. etc., a lacerated wounei

re ults. The parts are torn unequally, so that the :surface of the wound presents :it very UnOye11 and ragged appearance.

Lacorated wounds HeIdorn bleed much, but when part of a limb has been torn off, say by machinery, a tourniquet is to be applied loo.oly round the limb a,boyo the wound, ready to be twisted tight should come 011.

Contused Wounds. -When from the hlow of a blunt instrument, sl1ch as a stick, trnn 'hoon, e Le., the kin is broken and the parts around se' bruised, the wound is said to be contu ·cel. Th e edges -of the wound are uneven and dTiven ilnnnd,,; the ]1< ' Illorrhage is usually insignificant, a few drop ' of blood merely trickling from the wound. Treat a ' a. wound and a brui ·C.

Gunshot Wounds .-vVhen a p er on L "peppered" at some distance with small hot f rom a. o;-;porting glll, so that the shot has time to pread, th e ma.y be wide apart. Every shot CclUM ' ::; a "l)mall painful wound, from which a little bl ood oozes, and ,peedily gcts hardencd into a scab. 1 the " .. hot" has penetrated the chest or abdomen, or woundod the eye or a joint, there i::; little elano'or .from the injury- Tho wound from a rifle hullet 'how one or two wound, accordinO' as the bullet remains in or leavos the body, the apert ures ()f entrance and exit.

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Gunshot \\'OlUl d, a r e to be cove red ove r by lint O'auze, or cotton wool (medicated), if either is to be had, or if not, by some other clean dre'sing. 'W hen the slll'bce of the body has been "peppered" by a. number of small sh ots, do not :1.ttempt to remove them, bnt wrap the parts wounded (a. whole limb it may be) in a .'heet or towel wrung out of hot or cold "'H.ter, whicheycr i ' the rnore comfortable.

Poisoned Wounds. -Wouncl ' may be poisoned at the time of the injur,Y, or may become so aftennud:-; by the naturc of the discharges. 'C nder this might be included the bites of animal::;, the of in 'ects, the poisoned woundl-:! cau 'c d l)y natiy' wea.pon::; purposely poi oned by some drng, etc. ; these will 1Je com;idered in detail later. 'Vhen wound:-; become poi 'oned by dirt, neglect, in, anitary surrounding', etc., they are said to be" scptic," The word septic mean/:, putrid, and antiseptic material' and .'uo'tallCeti are that prevellt a wound hecoming putrid or .'cptic: with the treatment of these "fin;t aid" has little to do, but all that po ible to preyent a wound becoming septic \\ hCll it it-) fir -t CCll should be attempted. For treatment, see BiteH, . tings, etc.

When a join t i s wound e d , .'ay by a bullet or other foreign bo(ly, or by a ·tah, thc part is to he wrapped up in cotton wool and the limh put in a splint. The liUl I) l:lhould uo maintained in the

po, 'ition best calculated to pl'CYellt gaping of the wonnel.

a break s o ff n ftcr pelletratingthe Sklll and (hsappears, takc tl'c patient to a doctor ctt once. If. the wound is Ilear a joint keep the joint at 1'e.t on a plmt. "When a fish - hook i · eluhcdclecl in the' km, do not attempt to withdraw it I", retmctiontl,at is, by the \\'a' it went in-hut Cllt oft· the " dl'c,".ing" of the hook, so that only the metal is 1 ft,. and then force the point throllg'h tbe . kill, the hook to trayel omntrd::; until it can lJe wlthdrawn.

FnoST BITE.

During exposure to 'eyere cold, part ' of the hoc1y,. ll:-illHlly the feet, finger" no 'C, or cars, lo.'e 'e n and 1)CClHlle fir -t waxy w hi te, and then cong'e ted and of It appearance, en:-;ation l)eilH!,' lo::;t in the p,art It If:; by the by,tander. dril\\ ing nttentUll1 to the aL,eratlOn 111 tolour of the car nose etc.; the frost-bitten per::;on i mane a,,";u:e of fact: 1 ),pafm(,lIt,-Do not bring the patient into a \"arm until b)' friction by the hand, or hy 1'1ll>1)inQ' with sno\\', the sensation and circulation ill the' lnttell parts are re tored, Net!,lect of this precaution n.la}' deatll of the ti ues affected. Wllcn 1011 I rcstol'cn the patient ought to be kept 111 a room at a temperature at 60 deg , Fahr.

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BURKS AND SCALD .

A burn is cau.'cd hy clry heat, ::;11ch as fhullCS, hot -metals, etc. ; a ::;calcl caui'led by moist hC<.Lt, .. uch as boiling water, hot oil, tar, etc. "YirJns and ,'!Jlllptom effect of hody may be a mere rcddenmg ?! If e . evere it may b l ebs or blIstm. 101J1l, \iVhen the burn is very ::;ever e, the tl. '::;no:'> f t h e limbs or trunk may be charred an(l 'rh e clothing may adher e to the burned ing it impo '::;ible to separate them. llnme(hatc, .<1an O'er to life 'nocK, can 'od by the extent of to the 'kin.i remote, exhau:-:;tion, i'evere reartlOnal'Y mfiamma.tlOll, drhnmlty from ::;car ., etc. . '

Treatm,ent .-(l) The clothIng ove r the Injured part must be carefully ,removed . If to the skin, the adherent cloth lll; mlt.t ho cut ,Lround with sci ''01':'; and left to como (-LWelY l->llh:equently. 1£ the foot is scald e(l , the hoot he <.;arefully I'emoved, uudoing the lace and UH: hack ' eam of the boot, so that the boot IIIH,)' Inll 011 illstead of being pulled off; the stocking }Jl11'.;t ah\() he cut all along, so that it falls away from Lhe cal (led part. It is the duty of the bYl:'tandel'l:) to Pl'l' P;ll'l' tlH' <fIres ina while the clothin g is being ren1oYl'd, (2) Immediately cover up the wound from ,/j/ \jU'HM e-.

air. ,(a) When the skin is merely reddened the all' may be ' excluded by dusting it with flour, whiting, powdered chalk, &c. The part is then to be covered by .a of cotton wool, lightly bandaged and maIntaIned the most comfortable position possible. (b) When blisters are formed, 01' when the slU'face is charred, soak or smear pieces of lint or linen with linseed" almond, or cod-liver ods, or 'wlth vaseline, lanolIne, or cold cream. Carron oil, a rem.edy, is made by mixing equal parts of lmseed 011 and lime water' oli've oil may be used instead of the lin eed )oil. When the surface is extensive, do not cover the part WIth one large sheet of lint, but with strips abc.'llt the breadth of the hand; this is advisable during subse.quent dres ing, one strip can be lemoved at a tIme and a fresh dressinrr applied before the adjacent strip is taken off. sho<.;k to the system is thereby less than would be the case the whole of the burnt surface laid bare to the aIr by removal of all the dressing at one time. " Then covered by the ?ily dressing, envelop the part in " '001, or If that cannot be obtained) with a pIece of flannel. \"hen the face is burnt cut a "mask)) for the face cut of lint or linen,' leaving holes for the the and the mouth. Dip t.he mask in the, oil or vaseline, apply it to the face'; ana ' cover over WIth cotton wool, leaving apertures for the K

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J30

eyes, no e and mouth. , Yhcn the hand or foot i . burnt or sca lded, and warm ,rater -t hat is, \\ ate!" at the temperature of the body (9 . i) j at hand, pIn.ee the iujured limo in the water until suitn11le eire.', inn's can be got· and if a de..sert-.. poonful of hak iug f:lodn, (bicarbonate of soda) be added tu a hasinflll of the warm water, a 'oo thing' alkaline lution i, prcpared. Do llot prick the blek or bli tel" ; that tu the doctor to do if he think, it rig'ht.

(:3) Tre at Shock. -The.... evere shock, which accompanies eyery burn of nny size, ll1l1 ' t he dealt with 11." applying warmth to the ::)Ilrfa(;c of the 110dy generull:r, and by giying \\ ctl'm drink. (. eo Shock.) Be \'cry apprehcllsi \'(.! of the danger uf evell "light bums of the ncd".

W hen a Wo m an ' s Dress c a tc hes fire, p ro.;:: eed as f o llows : - Lay the flat on the floor at once. Place her "0 that the flames are uppermost; th,Lt to a)', if the front of the drc' is on fire, lay her 011 ller back, ancI if the back of the dre ' . i on fire, place her face clown wards. The reason for this positiun is readily under 'tood 'when it i remembered that flames a cend vertically; '0 that if the upright po, itiOll is as 'tuned, the flames will quickly a.cend and e1l\'clup th e body neck, and face: or if the per.. on is thl'o\rn down with the flames undermost, they will, if unextingui::,hed, pa " oYer and 1mI'll the limb' and set nre to the re L of the dress. A. a the per-

son i placed fiat, smother the flames with anything at hand, ..uch as a rug, coat, blanket, table coyer, etc. If made wet so much the better. A " 'oman rendering a' 'istancc, shoul d hold a rug or blanket in front of her.. elf when approaching the flames. If a woman',' dre.. cakh fire when no one is by, she should lie flat, flame' uppermost, smother the flames with anything handy, a. a table-cover, mat, &c., and call for a si. 'tance; on no account should she rush in to the open air.

YITRIOTJ TIIROWING.

Yitriol i, freCJuently used as a for injury. If it is dash d in the face. It IS a yery senOUi::l matter. If it touches the eye It would generally mean 10 s of ight; whatever part of the skin is touched by the acid is furrowed and burnt.. .

Treatmenf.-Carefully wash all the vItr.lOl sihle from the .. kin, by squeezing sponge m tepid water, to which some washmg or bakmgoda has he en added, allowing the water run gently oyer the injured part, then treat as an ordmary burn.

BITES OF ANIMALS.

Hydrophobia is caused by the bit? of 9.n animal suffering from rabies. Several amma:Ls, such .a' dog...;, cat, foxes, wolves. deer, &c., becon:e rabId. The poi 'on i ' contained in the animal's allva, and mlty l Ie con-.;'eyed on the teeth beneath the skin and g '2

131

thus into the blood of human beings. 'Vhen the bite is through the clothing there is Jess danger of hydrophobia, as the saliva is wiped off the teeth by the clothing. It is therefore by way of the exposed parts (the hands and face) that the poison usually enters the body.

Treatment.-In case of a bite by a dog or other an imal, do not lose time in the attempt to ascertain whether the animal has or has not rabie, but proceed immediately as follows :--(1) Prevent the venous blood from can-ying the poison through the body by imm diately placing a constriction between the wound anr the heart. Suppose, for example, a finger is bitten .t should be encircled above the seat of the bite (that i , on the side of the wound nearest the heart) with the fore-finger and thumb. .As soon as possible place a ligature (that is, a string, a piece of tape, a strip of handkerchief, etc.) tightly round the root of the fino-er' do not cease to compress with the finger aOnd thumb until the ligature has been applied. (2) Suck the wound vigorously, provided that lips are sound, spitting out the saliva; or (3) wash 111 water (warm water by preference, as it encoura.ges bleeding). (4) As soon as possible the wound should be burned by a fluid caustic, such as caustic potash, puril carbolic acid, nitric acid, or if these are not at hand, by a red-hot wire, fusee, e.tc. It is not sufficient to apply a solid canstic, such a lunar

caustic, to the \round; it doc.' not reach any deeper than the skill, and the poi. 'o n i.' at thelJOttom of the wound. rro en ' urc the ca1..l.'tic reaching the 1,otiom of the wound apply it on a :-;harpened piec e of wood, such as a wood en match cnt to a point. (5) Dre 's the "wound, and when it i' in the upper extremity, ling the arm. (6) Treat shock, if it occur '.

XAKE BrTE.

The POi 'Oll of the .'llak e is conveyed from the poi:on gland along a channel in the ::ierpent" fangs, so that when It snake bites the 'ecretion i.' cOlweyed beneath the .. kin along the h ollo,\' in the fang, and thl.l' gain dircet entnuH.:O to the blood.

Signs and "1!1mp fom c.- "Within a. f \\' minute ' after being hitten the part will swell and feel ,tiff j the patient become' palo and faint; and if the .'erpent i::-: one of the hil1-"hly YCUUlllOll.' .pecie the train of symp' tom' will be ,v fullo\\:: hurried urec1.thing, quick pule, mental excitement, cOllyuh;ion , and in 'en 'ihility.

Tr ea tm ent.-Tie a ligature (u. string, leather strap, strip of handker chief, llmcc, etc.) at once between the wound and the heart, 0 as to ob truct the veins leading from the ent of the bite. Two or three llch ligature ' may he applied at interval up the limb and tightly twi. 'ted (tourniquet). Apply a fluid caustic, uch a ' cau.' tic pota h, pure carbolic acid, or any strong acid 011 a pointed piece of wood, burning

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134

deeply 0 as to de, troy the poison at the bottom of the wound . When the caustic has been thorouO'hly applied, but not till then, the liga,tul'es mayb he removed . Su cking the wound i,' not without danvcr but if no caustic is at hand 'ueking must 0 employed, the aliva being immediately :pa.t out, and the mouth "a 'hed out 'with water 01' spirit.. and. water, and the ,Y01llld may be lJul'l1ecl with a fu:ee or in any other available manner. Shock is to lJe treated in the u ual way, and spirit of 'al volatile (a. teaspoonful in a wineglass of water). 01' 'pirit, (whisky or b r andy), are to be freely ac1minilStcred.

Bees , Wasps , Centipede s, Scorpions , Tarantulas , Spiders , Jelly-F i sh , HarvestBugs , etc., may each give l'ise to evere symptom, attended by actual dangel' to life in some in:tal1l:es. Remove the "tiug by squeezing the part, or by pre' 'lue ,vith the barrel of a key "hen that ilS po ,.. ible ; mop the part freely with liquid ammonia, ,pirit. · of wine, or brandy, whisky, etc. ; if these are not at hand, the application of the blue-bag, or .. trong solutions of carbonate of soda or pota h, will relieve pain; a paste of bicarbonate of soda and spirit .. of .al volatile is an efficient application. The patient's strength must be supported by the free of alcohol or al yolatile. As the harve ' t-bug buries it 'elf beneath the ,kin, it is neeebary to have the insect removed l)y a doctor.

135

CUAPTEU V, THE HE.'PllL \ r!,oB,Y Y.'TEM.

THE nil' re,u:he:-5 the 11111'" hv \\eW of the l1obtril:-5 (or the l!)()nth), the pharynx, the lcU',p;x, the tmch a, and the 1n'ol1<.:hiaI t1l1) .. .

The Phar y n x i ' the , pacc at the hack of the throat and ])o:--e, partly .. e 11 hchiIHl the tOll.'il when the llHHlth opellcd \\ ielel)'; the phar) us gi\' s pa. . nge to food imel air.

T he Lar y n x (tl!' \'Cliec-hox, Adam:':! appl .) is situated on llll' top of the \\ inc1-pipe ill the middle line of the llcck; it is 01 cartilage (gri-;tIe) amI contnim; the yocal corell-> illld the mu Tle:-5 C011cerncel in thl' productiull of the ynice.

T he Tr achea, or \\ inclpipe i. COlllPOi-;l<l of 'trips or ctlrtiln.t(c l)Ulll1d tOt(cth ' 1' 1)\- ela.tic <tlleI fi1m)1ls ti..." ne..., o.;() it' tn form <1.11 op "ll tn l )!'; it cxtcnd .. frulll the bryn:'\: tu t \\ () illches 1Jelow thc top of the hrl'llst-l)one, where it c1iyic1t'.' into the rig-ilL n.llel It' ft lll'lJllchial Ench In·onchu.. \\'h(;ll it cnter,' tll' IU1lg di\'idcl-> illto Slllilll nncl still sllln]]er blbc8, until the ultimHte l'l'CC";:SC" or the lUllt( - th ' ail' cell.., or ;lir . paccs -are rCiu: hell.

T he Lu ngs, Hight and Left, nC C' l1p Y he gTI' atl'l' p.art of the thol'(n: ; they lie \\ ithin the 1 ik, and practically \\ hercYL'J' a rib i" felt, \\' hetht'j' front, lmck or thcre i .. it l)ortioll of the ln1l!! bencath.

A. Trachea, or Wind-pipe. B. Left Bronchus. C. Right Bronchus. D . ma ll er Bronchial Tubes. 137

Each lung iH enveloped in a nno mcmhrane (the 'rhich allo\\'B it to moyo within the che·t during brectthing without fric.;tion.

Tho Air cnter' thc chc·t during Inspiration , and IO<lye:-:; it during Expiration. Tho lllOYClllcntH of l)reathing nre catl.'ecl partly l)y the 11111 'cle' of re,'pira.tiOll atLa<.:becl to the che.. t, hut chiofly 1»), the Diaphra gm, Ute large moya1Jle lllu .. cnlal' partition ,dlidl ,c}>amte:-; the thomx from tho ahdolllcn.

Hespimtioll COllHit:-:; of two act, inspiratlOn cmel e x pira ti o n . The pro(;e '.. of ill 'pimtioll i::> chiefly a lllllH<.:ubr ad; expirati()n i ' nlmo.. t " 'holly mechanical. II I in"piratioll the rib.- nrc rni:-:;cd j)y lllllbde . attached to thew; and al .. o the di<lphmgm, which in a, quicHcent ,Latei::> conYex (or eUl'yeel) upward .., llccollle ' fiatt neel, tlml-> ill(;rCcl1-,ing the capacity of tho thon1.x, and tho ail' flo\\, ' ill. In cxpiratioll tho rih , fall, and the diaphragm tlg'aill l11'COlllC" <.:onY()x upward .. ; thi .. Ie ', en' the <.:apiH;ity of the thorn .' amI the air onto The mec!umi,'m of l'c:-;piration i' 'o mewhat liko that of ordinary It )w:,cholcl l)ello,r. but without a yahe. The riuB may he comparcd to thc hoard ' of tho ue11O\\" ' , whi le the din.phragm corre 'pond.. to tho leathcr, tho air pa. . 'i tgC:-:; heing oquiyulcnt to the llozzle . Fiftecll to eighteen hrea.th::> are taken pe r minute in health . 0]) -truction to breathing, ,,,hen complete, Ci:tll osa phyxia., examples of whi<.:h are afforded in ca8es of drowning, ' uffocation, chokiug, etc.

136

FIG. 54. TilE LUNGS f.ND BRONCHIAL TUBES.

ART[FICLAL Ra: 'PIRATIOX.

Dr. ylueste,·'s lV eth od,

RULE I.-Adjust the patient's posilion,-Placc the patient on hi ba(;k on a, flat surfal!c, If po sible from t h e feet np,,'ard .', RCl1lo\ e all tIght

clothing from about the nc!.;k a.nc1 che::;t, awl hare the front of the l)ody ,v far a ,' the pit of the t0l1laeh; unfasten the bra!.;c,, and the top but.tOll of trou:-;crs in men, and the cor. et. ' in womcn. and ,'llpport the 'houlder.· on ;t •'lllctll firm cu:-;hioll or foiderl aTticle of dre . .. placed undcr the .'honhler-hlade . .

RULE II.-Jfrli,tfain a ( ree-entrance of air into the

139

windpipe .• -Clean ' C thc lip" and nostril:-:;; open and wipc thc mouth; c1ra\\" forward. the tongue ai:l far as pmll:lilJlc, n.nd keep It fOl"wH.rd eIth er by getting some onc to it with a or picee of cloth, or hy p<t . tilllg a narrow, ::;hghtly tWl, 'ted strip of hn.ndken;hicf, a .tring, or tape, over tonguc, a ' flll' baek a::; til Hngle::; of the lllOllth\nll allow' In'inl'Y the end . under tbe lower jaw a 1ld i.i them

The cnd ' lllay be again fn ,t enecl on the top of the head to preycnt ::;lipping. An cIa ,til: band lllay 1JC u 'cd in,'tead of the -trip of handkerchi f, ete.

RULE lIT.-Imit((te th e //Iove/nents of b,. eflthinf/.

Fir -t: Induce a.t a, conyenient di'tn.l1ce hehind th e patient'::; head, gra.. p the pa.ti nt'.. forearm.' ju:-,t l)dow the elho\\; the ann.' upward. , ,md towardH you, wIth a H\\ coping l1l0YClllCUt, lllakillg the e]1Jo\\,:-; almost ton ·h the oToUlld (111 either of thc pa.ti ent" head, or (;1'0 ·1ng the f01'enl'lll 0'1'('1' the top of th c hca.d. By thi .. lUCHm; thc CHyity or the oh ,t i ' enlarged, and air i.. drawn into the iung:-;.

. 'eeonc1]y: I ru71lcP e.lpimtion. - Bring th e pati nt'flexed ,U'U1::; fon\ al'c1, do\\'nwardl:l <md inward, the an11::; 11)0\\:-) firmly again ·t thc body \\ ith the clho\\',' ...,0111e fonr or five inch::; from the ... , 'ee aL 0 Drowllillg, pug s 143 anu 144.

.140

breast hone (8ee Fig. 56). By thil:l means mr is expelled from the lungs.

Thirdly: R.epeat these lllovementl:l, alternately, deliberately, and per.'everingly at the rate of about fifteen time a minute. Continue until r:;pontaneous breathing i. ' established, or until u. doctor arrives.

56. EXPIRATIOX.

'When spontaneous breathing COl1lmencm:;, reo'ulate the artificial respiration to corre pond with the natural Hope' of re toring the patient lll<lT be entertamed even after two hour " time.

RULE IV.-E.'i.:cz'te TeS2Jimtion . - ,Vhil ,t the above mea ures are being taken, other u eful step' may be such a applying smelling 'lIt , or ::ll1uff

141

to the 110 tril', al'l.d devhing h ot and cold water alternately o,'er the head and neek.

1 ULE Y.-Induce ('irculation and warmth after .1n·eathing 1m.' heen restored. 'W rap the pa,L1 nt 111 dry blanket. or other coYcring, and rub the limbs energetically towanl' the heart. Promote warmth by hot fianneb, hot-water hottle.·, 01' hot (\\Tap! cd in flannel) applied to the feet, to the Illllh. , and hody . \Yh en the power of s"\\'allowin o ha ' returned gi\'e .-ip.' of hot water, tea or coffee of wine, l)ntllCly and ,,'ater, etc. The patient ·h01.lId be kept in hed and to go to ·leep. Large poultICe:-; or fomentatlOll .' applied to the front and back of the che 't \rill 'ene to a .. i ,t hreathing.

\V,ltch the patient Cal'cfllll'y for .01)1e timo to ce tIl.a.t the breathing cloe ' not fail; ,' houlel any . igns of f,ulul'o appear, at once hcdn artificial Te pi ra liion.

.1IolI'ard's .1l--fetlwd.-Thi. method is e 'pecially npplwnUe to Cet es when the pntient'r:; arm is broken.

Deal with the clothilll-! anrl tungue, ete., U::5 de 'cl'ibed !luelor the J h'o::5ter mctho(l.

Tllrn the patient all the hack. P1.1<.: e n, roll of clothing benen,th the l)ocly, :--;0 a ' to rai.e the region of tho btomaeh aboye tho leyd of any other part of the body. Placc the patient" hand' al)oye hi::5 head.

Klled a. tride th' paticnt':-; hip ', and \\itll tho hnllr:; of the thumbs re.. ting on eith r 'ide of tllf' pit of the ·tOlllal!h, let thc fincrcr. gru::5p the adjal:cnt part of

FIG.

the chest. Now, u .. ing the knee ' a' a piYot, throw all your weight forward all yOUl' hand.., nn(1 at thc time, queeze thc "'H,i, ·t betwcen them as if you ,,-i hed to force oyerything in the chest upward toward the lllouth; decpen the pre, 'I';ure "hile you can count 'lowly 1, 2, 3; then suddenly let go with a final pnsh, \\'hich you hack to your fir t kneeling po ition. Remain erect on your ,,,hile you can count 1, 2, :3. Then repeat the :,mme motion ' as before, at a ratc gradually in 'rca 'eel from 4 or 5 to 15 timeR in a minutc, anel continue the moyement. ,,,ith rcgnla.rity. Jnc1nce circula.tioll and warmth in tlle manner under TIule V., Sylvester' , mctllOd.

,Yhen a sufticicnt nUllll)cl' of a. 'i.. tant .. are prc.'cnt, Howard's and ",yhester " method .' lllay be com1lilleel, the pre urc on the CIIC.'t heing mel.el ,inmltalleou '1y.

""hen from any can c, fractlll'cd rills, neither of the above method' can be carried out, Labot'rle's method of artificial reHpiratioll should be tried. It useful in Rufl'ocated children. It carried out a follows:- The patient is placed 011 hi 1jack ; the mouth clearecl; the tongue is .'eizccl using a handkcrchief or something to preycnt it .lipping from the fingerl'-thc lower jaw depl'es.. ec1; the tongne is pulled forward and held for two seconcl ' in that po ition, tllCll allo\\'cd to reccde into the month. Tbp.se rnovement::; should be r8up.nt,cc1 nhont fifteen 143

tilllC , a lllilllltC, Aftcr il'eatwcnt iiS the ,au.c as in

• . alld Howa.rd' methods.

To RESTORE TUE DROWXED.

Pcr:-.ol1. ' completely in Iyater for or fifteen miuutes hayo been restore(1 Hl'tIflcml lllC<ln:-.. If, thereforo, thc i. within a rca 'olHthle timo, ah.. eneo of .wn, ' of lIfe 1. llOt to detcr immediate attempt. to re.torc f>roWUillg person: ' attcmpt to whllt .'ubl1lcr!.!:c( 1, ,lllcl, in 'onsequCll(;C, Inttcr llIh.nled Into their ;til' and they hecome n xlated inSCll.,ih1c'. The fir .. t thin u to do "hen the hody IS l'c(;m cred IS to O'ct rid of the \Yater ,md froth oh tructi11g the ail' .. , and thon .to Cll'tincially .re.'tore 111·l'iltl,illg. 1let a(;colllph . hecl oy tl:e clothill!.!.: and opcning the mouth, nml cl arlllg' hoth It anel the ha(;lt of tbe throat. The patient , hould theu be turned face duwnward " ,,,ith a pad llelow the che.. t and "iih the forcheael upon the right forearm. \Yhilst in tili:., po.. itioll npply prc ' 1.:re 11,'" thc luUl(b, to the paticnt's hack oYcr the lo\\er nbs, and the pre ...'u1'e IIp fut thrce thc patiellt Oll thc nght ,'ide, lLl<Iintainillg tha.t po ' ltlOll abo for three ::>c(;onel ' , Hepl'Ht these movement nlicrnntd,'-" (l.' IOllg as frotll ;twl watp!, is ' ue frolll the mouth. 'I he c operatioll ill tbt' l1l 'e!ye, tend to promute l'e"pil'ntion, but it, i::> "he'n the air p:\ , agc-.; nrc l:ku' of froth

and water, to adopt Sylve ter's or' Olle of the other methods of artificicvl reo 'piratioll already clcserihell.

'Whil e performing the c send someone to the neare ·t te> procure blankets a1'1(l dry dothing, hot-water bottle', etc., and to fetch a, eloetor.

STRA

Owing to con ·triction of the 'windpipe by n. cord a rope, or tightened neektie, etc., rounel the neek the breathing may be ' ted and a pbyxia calvecl.

Treatment.- lit the con'tricting band and commence artificial re 'piration.

'Yhen a foreign hody, a. n. coin or piece of meat. obstructs the ail' pa .. 'age, suffocation lllay elJsLlC.

Tr ea tment.-Open the mouth, forcibly if nced l)e; pa the forefinger right to the 1Jack of the thrunt anel to di 'lodge the obstructing body; if Ylnuitmg re. 'ult , from thi' ·tep ,'0 much th' hcttel'. If un 'ueces 'ful, thump the hack harcl- betw('en th8 shoulder,' whil. t the head is bent ,Yhen tlJe foreign body remo\'ed, but breathing is commence artificial respiration.

HA TGING.

Ura, p. the lower limbs and rai. e the hoel}' to take the off the rope. Cut the rope, free the neck, and COlllmence artificial re, piration.

145 BY :--I .HOKE OH GABEl::!.

the patient into the fresh a.ir, duthe,', and flip the hare ehe::;t with a towel, wet with told \\ elter for 13 ,·ec011(1::;. If thi.· fails to re::;tore hreathiuS(, 'lpply artifieial rcspiration. Before entoring ct huilclill<f full of :..mlOke tie ct halldkerehicf, wet, if po.. 'ihlc, ronlJel the hcn.d, to\'erillg the 11o::;e and l\lOnth. It j'j \I (Ill to lUOYC • lowly k 'epillf!,' 10\\, or even cnnding, '\\biht ill n room full of smoke in Hcarch uf <l :-;ntfowt ,c1 IJCl.. ·OU. Every oppurtuuity of 1 ,ttillg' ill fre. hair 1)), opcning (luorH 01' windows HI]() ulc1 he ,·cized.

:--IUFFOC \.TlO:\'" BY :--I\\,ALLOWJXG 'VERY HOT ,VATER. Thi .. aeeiclcnt not illfrc(l'lclltly oeeun:i to children attelllpting' to drill k fr0111 the pout of a kettle. a 'ponge or flanllel (or other) cloth, ,\\Tullg out of ycry hot water, to the front of the ncck, from tll' chin to the tup of the br '(It:it-bolle, awl et the patient before the firc. Give il:e to :mek if it can l)e had, or if not, eolel water. Olive or saleul (lil, it de... rt-spoollf111 at iL time, '\\ ill 'oothe the 'Scaldcd throat amI tend to ca::;e the pain.

144

C IIA PTER VI.

P OI ON AND P OI ONI;\T G.

WHE N a p erson has tak en po ison, the 'ndden onset of symptoms, thei r appearan ce soon afte r h aving tak en food or d rink, or after h aving swall owed some substance inadYertently, may be th e fir t intimation of t h e danger.

Su.mIARY OF SIMPLE D IRECTIO T, FOR THE T REATME NT OF P OISON I NG.

Send for a doctor at once , stating what has occurred .

When the patient is not insens i ble , gi ve :-

1. Milk. -It i.. ::;nfe to gi ,'c copiou draughts of milk . Milk, ·when 'wallowed, clots 01' coagulates, and th e poi. 'on maybe the r ehy enc lo ed in the milk do t, and the whole got rid of by an cmetic. Cream UlHl fl ou r beaten up together may be giYcn a ' \\'ell a::; or instead of the milk.

2. Eggs .-Beat up a couple of raw egg ' \rith milk or water. T he r aw egg 'et ' 01' coagnlntL':-l in the stomach , and as in the C<1SC of milk may includc the p oison in the clot .

3. O ils .-Giye. e\'cral poon fn!. of oliYe, 'alad, or li nseed oils. Any yegetaLle or animal oil, such as that in which ardincs are p r e ' er,'ed or cod -li ,'cr oil,. rc.ay be giYen. 1\1incral oil::; a r e not ,'uita.l>le. Th e

147

oil sooth es t h e 'urfacc a lready inj ured by t h c p oison, a nd p r otect' t h e uninj u red pa r t' of the stomach or gull ct. Oil is not to be g iye n wh en ph o 'p h orus is t h e ca ll 'e of t h e poi on ill g .

4 . Tea, - S troug tea, (a h andful t hrown into t h e kettle and boiled) acts as a neut l'ali 'cr of man y poi 'on ' and i ' <1.1 \\'ayK , a fe.

5, An Emeti c. - Giyc :m emetic, e.I'cept when it is seen t hat tlte lip,,! and mouth al'e stained OJ' uurned (uy a cids or alkali e,) The CIllCtiu l1lay De :- ( a) a de eltspoonful of lUu.tnrc1 in a tumblerful of luke-warm water j (b) a tallle ·poonful of Halt in a tUlnb lerful of lukc- 'Yal'll1 water; (c) for a you ng chi ld, a tea 'poonful of ipecacuanha wine, repea ted t\\'ice at inten'al ' of 15 mi n ute ' , may he given in tracl j Cd) the nngc!' or a feather pa::;.. ecl to 010 back of the throat and moycd about mavel'Ye to un load the tomach. The emetic may l)e gh' Cll fir 't, or after one or morc of thc al)oYe remcdic haye been ac1minis teredo

6. If an acid i ' knowll to bayc been 'wallowed, givc an alkali at once j and 'houlc1 an a lkali have becn the POii)Oll give a n acid.

7. Treat for Shock wh en it Occur ' ,

In all cases, any vomited matter and food , or ot h er sub s tance suspected of being the poison , should be preserved .

146

BROAD FACTS 'WO R T H Y OF RK\I E MB R AN CE.

When a person has swallowed a poison and threatens to go to sleep , keep him awake.

When there are no stains about the mouth give an emetic, also milk , eggs , oils ( except in phosphorus poisoning ), and end up with strong tea .

When there are stains about the mouth give milk, eggs and oils , but no emetic .

PO I SON RRANGE D .ACCORDL. G TO THEIR ACTION.

NARCOTIC.

Opium, or one of the ::;ubstances derived from it, such or some one of its preparations, such a Laudan LUll, or Paregoric, or .'ome of the popnhr remedie , such a Chlorodyne, syrup of poppie" allll various soothing syrup, and cordial, all po '8ess th 1 poisonous narcotic properties as, ociated with th name of op ium .

Symp t orns.- T ndency to go to sleep, which COlltinues to increa e until sleep becomes deep and hreathing stertorous . Finally, it may be impo, 'ible to rOll.e the patient, and death is imminent. The pupih> arc 149

contrac t ed to the utmo't extent (p in -p oint pupils) ; they do not respond to light. T he face is pale, the skin clammy, and a smell like that of poppyheads may ue detected in the b r eath.

T ?·eatment. - UiYe an emetic and k eep the patient 'lwake . T ever giye an emetic when the patient is insensible. Keep the patient awake by walking him about , slapping face and neck or chest 'with a wet towe l, and by giying strong black coffee to drink . lapping the sole ' of the feet with a slipper may be tried when oth l' mean ' of rou ing fai l. Employ artificial respira.tion if the breathing ha ceased. iORROSIVES.

Acids and Alkalies are the chi ef examples of thi . c: In ' . of poi on .

Acids .-The acid::; most commonl)' taken as poi 011 , U1'e, (the sa.lts of lemon, salt of borrel); Carbolic; 'ulphuric (oil of \' itrol); Nit ric (aqua forti ,); Hydroc:hloric or :JIuriati<.: ( 'pirit of alt).

ympfom.".-Burning pain in t h e mouth, throat, t\,nd stomach' acid ta 'te; stain ing of t he lip and mouth of a white, yellow, or da rk-brown colour j retc:hing and yomiting: 'hock; exhau ,tioll and (;ollap e, or 'uffocation . 'Y hen the poi on i ' carbolic acid the 'mell of the breath help to di 'clo 'e the fad.

148

150

Treatment.-Fir t wa 'h the lllouth out freely with lime water or other alkaline lllixture, uch as chalk, wh iting, magne ia, or wall pla,ster, in water, milk, or olive oil, and afterwar ds let the patient sip SOllle of it. Demul cent drink uch <1.::> barley ,,'ater, milk, etc" lllay be given sub equently, and egg ' beat n up with water or milk. Treat shock.

Alkalies .-Oau 'tic Potash, Cau ,tic oda, Quick L ime, and strong Amlllonia are the principal examples of alkal ine cor ro ives, 1'hey cause 'Ymptom resembling t hose et up by acid. ' , q,nd it i.' only by seeing the bottle label that un, killed persons can be ure of distinguishing between and alkaline poi ons .

T1'eatment . - vVa h the mouth out with n acid mixture, a lemon juice or vinegar, diluted with an equal quantity of wate r , give milk, olive, salad, linseed, or cod liver oil, or egg beaten up in water or milk. Treat, hock.

Do not give an emetic when the l i ps ana mouth are seen to be stained by a corrosive fluid , whether acid or alkaline , as vomiting is likely to further injure the corroded surfaces of the stomach , etc .

IRRITANTS (METALLIC POI"'ONS).

The chief substances contained in thi group are: - Arsenic (Fowler', solution); (corro ive sub-

151

Antimony (butter of antimony, tal'tcl,r emetic) j LMd (1-Ural: of lead); Copper (verdigris); Silver {lU1;ar caustl(;): poison, matches).

I ymptom." .-A llUl'llll1g pam in the throat etllel at the pIt of th stomach; a metn]]ic taste in the month· retching and vomiting and great dread and <l,larm. The appearance of the vomit, ,'ncb as the green colour in poi, 'oning hy copper, and the fact that pl.lO.'phorn ,' glows in tbe dark, may assi ·t in dctel'lllmmg the poi ,'on taken.

Trcatlll ent.-As ,' i., t the vOlllitino' hy givinO' an . Af' ,..., b oCllletl(;. tel' vefore it ha, ' acteel give a couple of -eggs beatel: up wat.er or milk, or if they are not at banel plam lllIlk, . strollf!' tea, and, except in the cas e of phosphoru:-;, olIve or :alad oil.

. E 'pecil:tlly after poi ' oning by metallic initallts it U> to counteract hy prompt treatment the -<lepre mg lllfiuence,' of shock.

d.ead1 :r: po is ons are ,'trychnine, Prll ' ie A.CIc1, yallIde of Pata ' 'ium, Belladonna (deadly mghti'>hade plant ), Digitalis (fox -glove ), Henbane, Hemlock,. and .'eyel'al va rieties of plant ' , as fungi (often mIstaken for mn hl'ooms) , lahml1um seeds mOll k hood, etc . '

S!JJJ/ptoms.-Each of the e poi 'ons has own symptom ' . and evered nervous symp ' tom ' early III 11l? t, and . are the mo t prohllil1e])t e\ lrlence of tJw pOI on h een t a k(' ll.

T7·eafmenf.-Aclmini:-,ter all emetic hcfore cOlwulsions 01' inl:lensibility cOllle on, and when c.:e .. :-;ation or brcathing threaten: apply artificial re.'pirn.tioll.

GEXERAL l\ OTE.

:Ma.ny hase a double action and t 'chnicnlhmight be grouped HIlder morc than of the heaetiugs given. The rule in clec1ling with n. poi 011 of thi:-; cOL1lplex nature i ' to note the train of symptolH"" alld treat the patient, n. the ymptoms nn:-;e, ,1.(.:con1 LO the general direction gi Yell on pagl'" 14 G t o

153 HAPTER VII.

IKJURT E' OF SPECIAL

TilE EYE.

The move' llPon the eycball, moi -tening and: clean ing the :-,nrfnce; and when closed the e"cli(h; pn'Yent foreign hodies injuring the eyebalL A

IlHlCOUS memhrane co'-ers the inside of the e,elid.. anel the .' nrf,lce of the globe of the eye, and it'i.' au thL." membrane that foreign collect.

BODY IX THE EYE.

TJ'eatment.-Pr "ent the paticnt ruhbing the eye, yinI-!,' a child',' hands dowll if necessary. Pnll clowll the \ower eyelid, when, if the foreign' body i.. . een, it CHll be readily rcmoved ,,-ith a camel'.' hair lml.'h oj' the corn el" of ,t handkerchief twirled up aml wetted.

\Yhen the foreign horlyis heneath the upper (l) •rasp the llpp r eyelid between the finger and thumb lift it forward from off the eyeban; then pll<:;h up the lower eyelid heneath the upper, and let The hair of the lower lid hrn .' he: the inner i'lul'fnce of the upper liel Hnd may di ' lodge the lJodv. " honld ,1 ing-Ie manipulation not be uC'e ' fnl, it hm or three t.tl11e . if nece If the foreign hody i. not cldodg el, call the enrice' of a doctor at' ,' oem a I (l'sihle. (2) lVlIen, hOll'ez'er, skill eri he7l'

152

-cannot be had, a on board 15hip, or elsewhere, proceed as follows to examine the inside of tho upper oyelid :Seat the patient, 0 as to fa.ce the light; stand behind the patient, steadying the head again15t tho chc ,t; place a. tooth-pick, wooden match, knitting needlc, or ..my narrow, firm rod, on the upper lid of tho injured eye half an inch aboye the edge, pro' 'ing it uackwards as far a po' ible. Xow 'eize the upper-lid oy ]a:he, ' between the finger and thulllb, and pull them upward ' over the rod. Tho eyelid will be oYertocl, and the foreign body, if it is there, can be readily 8 nand l'emoved. (3) When a piece of teel is embedded in the eyeball, drop a little olive or ca8tor oil on the eyeball a,fter pulling down the lower eyelid, c]o e tho EdH, apply a soft pad of cotton wool on the lid, and secure by a bandage tied 'ufliciently firmly to keep the eyeball teady, and take the patient to <.l doctor.

FOREIGN BODY THE EAR P A " ·.AGE.

-When a doctor can be had, even within twonty-foul' hour, never attempt to treat a patient with a foreilTl1 body in the ear. A pea in the caris n. soriono' accident, and any attempt at removal lllay lead to fatal consequences. If the patient, a child oo'pecially, cannot be induced to keep the finger ' from the ear tie the hands down, or cover up the ears by tying a. handkerchief round the head and over the ear'. II .an insect is in the eaT-passage, fill tho 0<),1' with o1ive 155

oil, when tho ill 'ect will float, and may bc removed. ever yringo or prohe tho ear.

FOREIGN BODY IN THE X O,'E.

Induce the patient to blo\\' the 110o'e viol ntly; give a pinch of snuff or pepper to the unaffe<.:ted no.. tril so as to induce sneezing. . nilling up water or YJ-'inging out the no, tril with water ml1.y effect diblodgement. There i' no immediate danger from a foreign body, say a shirt button, in the noe.

THE eHE'T (THORAX)

The thorax is bounded in front by the hrea. t-bone (stcrnum), and the rib cartilages; behind hy the vertebral column (the 12 dol' 'al vcrtelm ,) ; and on either ic1 by the rib '. Aboyc, the thorax i.. hounded by the 'tructure' at the root of the neck, and blow, by the diaphragm (midriff), tho moyable mu.'cular partition ,,,hich eparate ' the che 't and ahdomen.

THE ORGANS OF THE 'nEST (THORAX).

The heart and lung' occupy the Ghe t. The pOo'ition and structure of the Heart is with the oro'an of the circulation ( ee page 69). 'Vonnds of the heart are usually insta])taneou ly fatal.

The Lungs occupy the ll€st-front, back, and 'ide, . They are de 'Gribed under the Re piratory system ( 'ee page 135).

154

Womms OF THE LUXG.

W"hen a rib i:.; brokcn, and the ends elri \'ell ill\rarcb, the pleura and lang arc apt to be torn . Thct:i e oro-all!'>

lllayalso be inj mcd by a with a knife, or bayonet penetrating bot\\'CCll the rib'. A riflc bullet lllay the <.:he't, wouncling the lung ill it, pa ' age ,

Signs and S Y/JIp tom s. -Difficulty of breathing, ylllptom of colhtp.. " faintnet)t:i, t)pitting- of blood (red and frothy), usually indicate injury to the lung . Air may e 'cape honeath the ::;kin or into the cavity of the chest. Internal hwmorrhllgc lllay r sult, the ac cumuht ing in the (;a\'ity - oF" the <.:het)t, (;aUslllg pa11or. .'10wnes.· of breath, hlurred yit:iion feeble pulse, sighing, yawning, delirium, and fnintne going on to unl'on ciou sno t-;.

Tl' eat m ent.-Lay the pati nt clown with the h ead low, give ice to t)uc k, apply ice over the inj ured part, kcep the room (;001 by free ventilation, turn the paticnt towanb! the injured ·id e. Do not tie a bn,nclage ro.und the che.. t when the lun g i. ' injurec1 by a hroken 1'1b, <l)) there is dallger of the rough cnds of the fracture causing further damage to the lung. Hhou1d the injury be accompanied by a 'urface apply clean &c,

TIm ADDOMEN.

The abdomen i ' uOlllldeu abo,e hy the diaphragm 157

(lllic1l'ilt,), l)c1ow hy th e bone::; of the pelvi., behind uy the vertehral l'Ollllllll (the lumbar vertelm:c), and in front and H,t the sides by the mnscnl ar of t}Je nl)(lom en.

Wounds of the front wall of the abdomen lllay he eit her ycrtical or 'When the cavity of the clhclolllCll i opened, the intes ines or other on.!,·all llla)T protrude through the wOUJ1cl.

Tr eatment -( 1) 'Yh en the \yound of the front \yaH of the abrlomen i - ve rtit;al, lay the pati ent down flat with the lo\\' er extremities .traight ; coyer the wound oye r by a pad of dry lint , or lin en, and place a bandage rOllnd the llOc1y fairly tight. (2) 'When the ",onnd tran 'yor 'r, !Jend the kn es ))0 as to r elax tbe ti . .'ncs of the wall of the 3.bdoUlcn, and raise the -houlders to allow of the edges of the wound coming together; apply a pad and handaO'e, (3) 'Vhcn tIl inte tine or other organs protrud e through the wound in the abdominal wall, belld the kn cc , mi.'e the hould er.', and apply lint, a towel, or a clean ::;ponge wrapped up in soft linen , wrung out of warm \\Tater, and k eep the part warm until tIle doctor arriyc ,

Ey ery wound that injure the stomach, 11\'er, spleen intc .. tine , or pancrea.', mnst traverse the abdomen. Bloorl or the conte nt of the to mach or inte ,tine. will therefore e. L:ape iuto the abdominal cavity, cau ' lllg of intcrnal hremorrhagc.

156

THE ORGANS m' THE ABDOMEN.

The Stomach lim; immediately beneath the " pit. of the stomach )) j ust below t h e b r east-bone.

Fw.57.

Injuries of the stomach are attended hy extreme collapse. and sometimes by retching, and vomiting, of dark blood like coffee grounds.

15!)

Treatment. Lay Lh e patient down on hifl back? apply an we-hag over the pit of the stomach. Nothing 'houlcl l)e given by the month.

The Liver lies in the upper part of the ahdoll1en. whe.re it is mostly coyered 1)3' the right lower rih '.

Injm'ies of the Ii "er iliay be caused h,· a 1J]ow orer the organ, hy frac:tured rib::; pelletratin'g it, or hy the ,· tal> of a "harp weapon, or 1>y a bullet. The t!,Teat clanger of a "Ollur] of the liver is hwnlOrrlulO'e . thehlood e"capillg iuto the c.wity of the abc10111ell.t' , The· injury is attendeel 11Y pai1.1 and ',ycllillg in the region the li"el', and l)y the sign ' and ',),l1lptOlllS of llltel"lwJ luclllorrbage.

'F1· ea lm en t.- Lay the patient down, giYe ice to suck, apI)Iy icc o,'er the region of the liver, turn the patient tOIl ard, the right .. ide.

Th e Sp le en lie' l>Cllcath the rib , at the upper part of the left side of the allclolllen.

The c<"tll,·e.· of inj my and the dangers are similar to. tho 'e of the liYer, ilnd the treatment i... ·imilar, only that the patient .. houlcl be turned towardt:> the left .·iele.. Ill)nrie ,' of the pleen arc mmally speedily fata1.

InJ u ne s o f the Intestines cau.. e.sJlllptoms of collap.. e, and internal hrcmorrbage may occur, or the content· lllny escape into the cavity of the a1)domen. the patient lying down and a. qlllet'b po,' . i1lle. a largoc pad of flannel or cotton ,\ 001 to the abdomen, kept ill place by a to\yeE

158

,n,pplied fairly tightly the ab<:lom ' n a,nd pinned in three or four place ' . 01ve by lllal.ttb.

The Kidneys lie at the back III t h e regIon. o j the loil.l. They ma,y be injur ed when the low e::;t nlm (the 11th a nd 12th) are fractur ed by a, cru:5h, ulow, or by n, bullet or so me 'harp wea,pon. :Blood would e:cn,pe with t h e urine, and th er e would be p tti n and perhap., ' \Vellino' oy e r the inj m ed kidney.

Th; Bladder li e' in the pelYi . , aw l may be wounded by a fn1.cture or 'orne of Yic. ?one ' . The sign and symptoms would be to 1)(L:S' water, or if a little i::; pas::;ed It 1::; tnwed \nth hluod.

i"reatnunt. -Wh en ei the r t.he kidney or hhtclc1 r iK \\'olmded, k eep t h e patient (luiet until doctor fllTiYes, and meantime ctpp ly hot fomentatIOlls over the painful or illj m' ed part.

Rupture (hernia) <;on -j,'t: f a protrn:ioll of <til. internal organ, u ' ually the howel, through the wal1 uf the abdomen . It most freque ntl y OCI,.;111' at the groin. Should a ::I udden bwclling , pain and. icknes::;, take place, send f,or 'L. tl0 'tor lll::;tantly, and meanwhile put the ptLtlCnL en:, position, and place ice or cold w•.Lter appheatIOlls on the affe\.:ted pa.rt,

CnAPTER YIII. BANlJAGl TU.

Esmarch's Triangular Bandage has been (Ie. 'crihed in 'hapter 1. It may be applied to any part of the body.

For the scalp (Fig. 5:'1) ._ Fold a hem about 1 .1 illche: deep along the lower 2 hemler, place the handage on the head '0 that the helll Jie.· all the forehead and the point hang. down at the ba<;k; theu car ry the two end::; ronnel the head aboye the car,', ero::;::; them at the back, and bring them forward anel tic on the forehead; then draw the point downward:, and turn it up and pin it on to the top of the head.

FIt;, ,) .

In applying thi' bandage, care mu. t be taken to put the hem cIo e down tu the eycbl'O\Y " to c.1.lTY the end above, not oue?', the C,ll", and to tie them d0C down to the eyebrow, and IlOt hio'h up 011 the forehead.

For the forehead, side of head , eye , cheek , and for any part of the body which is round (a ' the arm or thigh, etc.) the narrow uanlla,fe mu t be u.ed , it.' centre placed on the and !l

l61

the ends b eing earricl1 round the limb and tied over the wound,

For the shoulder (Fig, 59) ,-P lace the centre of a bandage on the tnj urod ::;hould er, with the point running up the Hid" of tho nock; turn up a hem j

FIG, 59, FIb, 60,

carry the end - round the middle of tl.le .lLrlll and tic them' take a 1:)ecu11(l bancb.ge, fold It mto a 1n'ofl.(1 bandage, place one cud oycr the point of the bandage, sling the ann by carrying the end ot the bandage oyer the, 'oundhoulder, md at the side of the ncck juring the point of the fir t lnmdage

16J

nucleI' that pal'.t the ,ling 1'0 ting on the injured flho1l1dor, elmw ,It tight. tnI'n it down, and pin it ,

For the hlp (Fig, GO). -Tie a llarrO\\ Land'vre rounel the Lorl.v above the haullch-bones tyin()' knot on the . ml1e ,-ide thc' injun; m70thcr l)an.cl;lge, tlll'l1 ,l P a hem according to' the ,ize of tJ!O patIent, pbue Its centre on the wuund, can)' tile end::::

r'r;, oj ,

round th thiglt,. and tie thcm j then carry the point 11 p unclor tlte \\ al::;t Land, tnI'll it down oycr tbe knot, and pill it.

For the .hand Fig. Gl).-. 'preacl ant a h11lc1a[re, place t.hc on i!lC 1)(mkr "itlt tll' fingel'. to\n'lnls the penut ; then thl ' puint over the ",ri .t, IX!.:) the tm) l'lllL UYer the wri t, e '0 and tic tlkl11. :2

162

For the foot (Fig. 62).-Spread out a bandage, place the foot on its with th e. toe the point, draw up the pomt ovor. the ll1steJ?' bl'lng tho two ends forward, cro " and tIe them eIth er on the ole (if to keep a splint on) or rmmd the a nkl e.

165

1 back. hanclagc if; applicrl a.. tile fm egoll1g, Lut l)eglllmng by placing tho lJHudag'e 011 tIle hack.

For the knee. prea(I out a. banchlgo, fulc1 a narrow hom on thc I'o wer lJorc1cl" lay the poiut (m Ole tlligJ: <llld the middle of the ]U\\ Vi lJOi'cler just lJv]o\\, til, kucccap, ero. thc cncl,' nl'.t llohiml the knec, then oycr the thigh, again ulldel' the k "c and tic ill front below the knee-cap. Bring the p,?int (A) down tu (B) ('eo } 19. Gb) and fa .. ten with a HU fety pill. If tho handa )'e i.. not large ellollgb to he l)]'(>ught the econd time 1ll'l0\\ th e knee tie it on til, thio·b. '

FIG. U3. l!'lg. 64.

F o r th e che st (Figs. 63 and 64:).-Place the middle of the bandage on the injurec1 .. ide, ,',' ith the point over the shoulder; carry the two ench; round the ·waist and tie them; then draw the point over the shoulder and tie to one of the ends.

FIG. 65.

For the elbo'l,I\!. - Thi..., is illli!al' to tha t for the knee the point and middle of the lower border Leino' placed on tIle ba ck of the and forcanll re pecti "L'1y.

164

168 CHAPTER IX.

CAR RYING r ATIENT

In accident' where the patient has bern rend.er eel unable to walk alone, he may be carried by the bytander making either of the following ·cats.:( 1) The four-handed seat is made by two

FIG. 66.

persons grasping their left ,Yri,ts with their right hand, then gra ping eauh right wrii':lt with their l eft hand' (<18 Fig. 60).

After the hand ' are clm;ped together, t.he hearer' ·toop down behind the patient, who .. it" 011 the hm b.;, and at the arne time plac e.' one arm round the lleck of each beRrer.

167

FIG . C7.

T his eat is 11 ed wh ere the patient is .. uffieient l, conscloll' to give some a'si .. tanee to t h e hea r er.. and is a ble to u r::;e his a r m ' , but is u n ahlo to wnlk . T c

FIG. 69.

l ower the patient the brarers toop down o r kneel on one knee, gently place the patient on a chair or bcd, &c., and unclasp and their hand',

The two-handed seat il-J made by two hearers cIa ping their hUllCl. ns ill Fig. 67, and placing their free hand on each other's shoulder. 111 case of the patient being a l-J h or t person the bearers .. houl d place their hand Oll each other's hip (as shown in the figure), instead of on tho f:>honlder.

Instead of the grip [-;hO"'l1 in Fig G7, either of those :-;hO\nl in Fig:-;. Ge' and 69 nlclY llo n 'cd. If that shm\ 11 in GD he adopted, it i.. well to wear gloye.' Ol' to hold a handkerchief ill the Thi . .'eat i · H,ed 'Y!H3l1 the patient i.' unabl e to auy a,', i.taLlce with hi1:) arm', and lllelY bo u:-;ect 'Lo lift a helple'.' pn:< icnt:- .

11.. beHrer on ench :-;ide of the paticnt .toops down, ·C.' one arm uncleI' his thigh. · , ncar the knees, and cln.:-;ps the ll<lllcl of the beal.'or. Tho then p;'\,.' . their ;U'HL' ruund the back of tLo patient and gra p Hell ." holllclcr (or h11). '1.\' lower the patient the )lcarcl'hunld .toop clU\L1 91' kneel on one knee. '\ rhOll the lower part ut the patient'. UOCty H l'C ring npOl )H'cl, ur 1)1acl: \\ here it tu place him, the bearcr. the h 'H1ds \\hich T'e under hi · hutlod,:-i, taking CHl'(' to "uh ·'.Il't the llPpCl part of the hod,r. \\ ltich call then he gently lowered

The th r ee -ha nded seat is <1 modification of the lhoyc, un:l r30111ctime' u 'co for a hort pel', on or 2hiltl.

I t i made a follow :-One bearer grasp hi own.

169

FIG. 70. l 71

left forea,rill ; the oth(;)' hearer grnflps the right forearm of the first hearer with hi,' left hand, and the fir,'t bearer grasps the left forearm of the 'CCOllrl hearer with hi' left hand; the f:lecond bearer placc' his right ham1 Oll Lhe left shoul der of the finit bearer. 'rhe forearm :-:;hould in a ll case,' be gm:-:;ped slightly aboye the wri"t (Fig. 70) .

'1'0 lower the patient the bearer"! 'bollld ,-toop down or kneel on Olle knee, gently plnce the IH.tient on a chair bed, &c., and ullc:la, p and withdraw their hand:.

One bearer may carry ,1, patient 1)), the Fireman ' s lift <.L::; follows :-

To Lift the P atienr ,-Turn the patient face down\\ cuds with hi::; extended anrl anll,' cloe to his .;iele, , ; place yourse'lf at head, clown, 'l ightly l'ai, 'e hi.. head and shoulders <mel take holel of hi111 do.'e uucler hi armpit" lockine; your on hi ,' back. Hai.'e his body a' high n' it can l)e lifted with your hancb and arm' in thi po, itioll ; then reoting hi . body a' far :1.' po.' 'iblc on your left knee, -hift your arm.' and take him r01md his wai. t, lock your klllC18 and lift him to an almo't npright pO'ition with hi' head 1'e tillg on your left 'houlder, your left thiu'h 'upporting as mnch of hi"! weigh a, po ,i hle.

Holdin o' the patient in this po itiol1 with your left arm, gra p hi ,- left wri t with your Tigh haml throw hi.. left arlll oyer your head, and <1 t the '1:11118 tillle drop yourself iuto l.t tOOpill.l( po 'i tiOll; let go of the

170

patient with yom' left arm, ,,·hich then place hetween hi' thighs. The pu,tient' body will llOW fall across

FIG, 71. "

your shoulders, and you should now ri ' C to an upright position, 3.D.d balance it carefully. Transfer too

173

patient'::) left wri8t to your 10ft hanel, and ,' 0 leaye your riu'ht hand free for teadying when carrying the pn.ti '11t downshtir', or down a ladder (See Fig. 71).

To LOlce1' the Prtiipnt.-rrransfer the left to your right hand, take your left ann from

FIG. 72,

hetween his thigh and place it round them, bringing them to the right-lwlld :-,icJe of YOllr l)ody. Sink clown upon your right knce, lct the pa.tient'i) leg ' re. t on the lfrounel "while you :mppurt hi ' body on your left thigh, plaee yonr left anll ronnel hi ' riO'ht . houlclcr, let 0"0 of hi::) left wri:-,t, and plltting' yoni' right ann unc1er-

172

neath his left arm and round hit:; back, place him gently on the ground (Fig. 73).

N .B.-Those bearerH ,yho p r efer to carry the "'cight of the patient on the right shoulder 'hould read " left" for "right" and vice vel'sa throughout the above instructions.

The plan of ca1Tying th e patient by the (t?'ms and leg with the fac e dOUln?l'ards, cOlnmonly called the "frogs' nza1'ch," must never oe w:ed, as death may ensue j?'o?n this treatment.

",Yhere a proper stretcher ealmot be obtained, a temporary one lllay be made in either of the following ways :-

(1) The 'leevos of a coat lllay be turned in 'ide ; t\\·o stout poles are tllell passed through them, and the coat buttoned. Tbi ' makes a good .. eat. (Fig. 73). The patient bit' 011 it, and 1'e ts against the llack of the first bearer.

If a longer stn,tcller is required, t" 0 coats nnl.'t be treated in the same way. (Fig. 74. )

(2.) A sack may be taken; a hole is made in each corner of the l)ottom, and t,yO poles pa:-,ed through the sack and out of the holes. (Fig. 7:"3.)

(3.) A large piece of carpet, acking, tnl'pan lin, or a lJlanket may lJC spread out, and two stout poles rolled up in th e sides.

Two lJearer then ,tand on each ide. They trra,p the middle 0f the pole " 'ith one hanel, and near t, be

17 5

end with the other. To carry the patient they must walk sidewaYH.

(4.) A hurd le, broad piece of wood, or shutter may FIG. 75.

be employed <1, a strcteher; but if either of them i H.ed, "iomc 'tnt \\, It ,'tY , or dotiling :-;houlcl be placed on it, and then n. pieJc of tout cloth oracking; the

174

sacking i. u 'eful in taking the patient off the tretcher ,vhen he arrive at the bed- 'ide.

Always test a temporary stretcher before placing the patient on it.

Temporary .·tretchers mu t be carried, ,md the patient placed on them as laid down in the" tl'etcber Exercise' "

1. eyer allow .'tretchers to be carried on the houlder::;.

A ' a general rule carry patient feet foremo .-to The exception:::> are: (1) when going up hill with n patient whose lower limb ' are not injured; (2) when going down hill 'with «, patient who::;e lower limb arc injlll'eel.

In carrying a patient on a stretcher care ,' houlcl be taken to ayoid lifting the f:ltretchcr oyer ditchc.' or walls, but where thef:le cannot be ayoidcd the stretcher must be carried in the following ways :-

To CRO S A DITCH.

In ero ' ing a ditch, the .'trctdwr .' houlel be ]owcred on the ground, with it foot one pace from the cdae of the ditch. 0". 1 and 2 then de 'cend. The stretcher, with the patient upon it, is aftel'wards advanced, 1. os. 1 anel 2 b earers* in the cHteh . upporting the front end of the . tretcher, whi]c it · other end rests on the edge of the ground aboye. 'Vbile the

-These numbers are explained later in the detailed Stretcher Exercises.

177

, tretcher is tInt · supported, No. 3 descends. All the Nos. now carry the .. tretcher to the opposite side, and the foot of the is made to rest on the edge of the ground, whIle the head of the stretcher is ,npported by No.3 in the ditch. 1 o. 1 climbs out No.2 remaining in the ditch to assi t No. 3.

. tretcher i.. lift d forward on the around above and re'ts there while No '. 2 and 3 climboup. Nos. 1 3 then re, ume the carriage of the stretcher.

To CROSS A 'WALL.

The. tl'etcher is lowered with the foot about one pace from the wall. Nos. 1 and 2 bearers then take hold of the foot of the stretcher and No. 3 of the head' the. ·tretche r is rrri ed till the foot is placed on the No. 1 then clim h· over the wall and take ' hold of the foot of the .. tretcher, ,,,hile os. 2 and 3 .upport the head; the stretcher then carried forward till the head re t· on the wall, No.1 supporting the foot. No . 2 and 3 then climh over ' the wall and take hold the head of the stretcher, which i· then lowly lrfted the wall 011 to tho ground, and the bearer take theIr u ual places.

To LOAD A 'Y AGON.

The stretcher is lowered with the foot one pace from the end of the wagon. Nos. 1 and 2 take hold of the foot of the tretcher, No . 3 the head. The stretcher

176

1S then rai 'cd and carried forward till the front wheel ' rest on the fioor of the wagon. No. 1 theu j into the \ragoll, while No. 2 goe' to the hea.d of the str etcher and help::; No.3. Tho [olLret ·her .1l:) then pu hed lowly into the wagon. If the tttllboard canuot he 'hut, the stretcher must- ho lashed firmly to the .. ide ' of the wagon.

To "C NIJOAD A srAGON.

No. :3 a.nd 3 t."l.ke hol(l of the hertc1 of the stretdlCr' while No. 1 get · into the "'H,gOll; tho ,trelcher i' then oTa.dually drawll out till the foot-\\ hed:; re:;t on the of the \\'ngoll. TO. 1 jump.' ont of the \\'cl,O'on and with No. :3 takes hold of the foot of the Xo. ;3 supportin c)' the head. The stretcher i::; then gently dnnrn a waT one pae ' anel l()\Yl:,!'ed. The bearer ' then fall in in their usual plnceo..;. 'Yh en foul' heare!':; are attending to the patient, X os. 1 and :3 would lift the foot of the strekher, while Nos. 3 and 4 lift the head. Thi ' apphe ' t o cros ing a dikh 01' \\ ,tll, as ,rell c1.S to londing anci unlo[\,ding a \mgol1.

17U CHAPTER X.

STRE1'CRER TRANSPORT.

The "Furley" ,tretchers (Model 1899) are of three pattel'lls, Yiz., "Ordinary," "Telescopic-handled," Rud "Police.'} In general principle they are alike, the component parts l)eing designated the poles,

FIG. 76.-{)fLDINARY Tl:I.ETCliER-CLOSED.

Fw. STRETCIIER-OrE

handle ,' , jointed traYer.' e bars, foot -wheel, bed, pillow ,'ack amI . ling,'.

The Ordinary Stretcher (Fig. 76), i. 7 feet 9 inche,' in and 1 foot 10 illeh e' wide. The hed i · 6 feet 111 length, and tbe htl.mUc.' 10} inche . The foot-wheel ' mi:;c the tretcher from the ground. At tl.le head of the. tI'eteher i ' a cmwa oyel'lay (the pIllow' .'aek) wI11ch can be filled with .' traw, hay, K :3

178

Pl!£ £iZ f : •

clothing, etc., to form a pillow. The jointed traverse bars are provided with joints, so arranged as .to gual:d against the possibility of .the catchmg theIr fingers in them when openmg or closmg the The poles are rounded on the top, have an III Ide bevel to add to the comfort of the patIent and prevent cutting the canvas. Th e Tele coplc-handled pattClll (Fig. 77) is very similar, but is so arranged that the handles can be slid underneath the pole, tIm reducing the length to 6 feet, the of the beel being 6 feet. This arrangement IS of great value when working in confined spaces, or when. a patiel:t has to be taken up or down a narrow staIrcase WIth .harp turns. The Police stretcher is similar to the Ordmary pattern, but is more strongly made, ha, in addition straps for securing a refractory patIent.

"Then' closed, the poles of the lie close too-ether the traverse bars being bent ll1ward , the bed neatly folded on the top of the pole ' and held in position by the slings which are laid along the canvas, and secured by a strap placed tran vel' ely at the end of each sling being passed through the laro-e loop of the other, round the poles and bcd, and then buckled.

In closing a stretcher care should be taken to rai 'e the centre of the canvas when pushing in the traverse bar, as it is otherwise liable to get caught in the joint of the traverse bar.

To prepare, or open, a stretcher, unbuckle the trans"er::;e straps of each sling; remove the lings from the stretcher; sepan1,te the poles; take hold of each tnwer 'e bar and draw it forward. The slings will then he folded to half their length, one being laid neatly oyer the hn.llClles at each end of the 'tJ·etcher.

As' a general rule, the stretcher will he prepared by Nos. 1 and 3 bearers in Exercises I. II. and III.; and hy :N o. 2 in Exerci e IV. These bearer howeyer, if required, a 's ist the other bearers m attendino- to the patient'· injurie . yarious movements detailed in the follo\\"ing Exercises should be carried out .steadily, the hearer working in unison, hurrying bemg carefully avoided, and every attention being paid to the bearer whose duty it is to give the word ' of command.

'THETCHER EXERCI E ,

Originally drawn up hy ir John Fnrley, and revi ed in 1904 to accord with the drills adopted by the Royal Army Medical CorpR :-

EXERCISE No.

FOR FOUR BEARERS.

l. 'rhe Instructor select· the bearers and numbers them - 1, 2, 3, 4, at hi ' di cretion. hould one maq he taller and tronger than the others, he 'hould be

180

181

styled Xo . 3, a he will havc to bear the heayier part of the burden .* All orders are to be given by No . 4. " Fall In. ''

At the n . wd ' "Fn,l1 in, " No. 1 2, and 3 take pOflitiOll 0n the l eft i:ji(lc of and facing the patient. .I. o. 1

FIG . 78.

places him elf at the patient's kn ees, No. :2 at the hips, No . 3 at the patient'· shoulders. At tho time No. 4 passes the prepared streteher on the ground by the right side of the patient about t,,·o

• Bearers should, however, be taught to take any of the positions named in the following Exerci ses, whether thrtt of No.1 , 2, 3, or 4 hparpr.

183

pace. a,yay from him, and then takes po. 'ition opposite to and facing No.2.

3. " Ready. "

The b eal'C'l's Imeel down on the left knee and take hold of the patient, No. 1 pas.ing his hands and fore

4 3 2

FIG. ,£t.

arms beneath the paticnt'.. leg.., hand wide apart. Nos. :2 and .J, pm; their hand and forearm' beneath the patient', hip. and. loin., and O'rasp each hands . o. :1 pa 'c. hI ' left hand acro the che t ancl 1lJ1(1 r the ri ght ..houldcr, <.Uld hIS rJO'ht hand heneath the left -illollldel'.

]82

185

4. "Lift ."

On the word "Lift/' the bearer rai e the patient gently and r est him on the knees of Nos . 1, 2, and 3bearers; as soon as he is securely rested, No. 4 disengages hands with No.2, runs round by the head of the s t 1'etcher and places it under the pati ent, close to the oth er FIG . 80.

bearers' feet, being careful that the pillow is immediately under the patient's head (Fig. 7 ); he then kneels dO""'!1 and locks hi hands with those of No.2 (Fig 79).

5. " Lower ."

The bearer place the patient on the tl'etcher (Fig. 80), disengage their hands, and then stand up.

" Stand to Stretcher. "

No. 1 goes to the foot of the stretcher, with his back to the patient; No. 3 to the head with hi face to the patient; Nos. 2 and 4 remain on each side of the stretcher.

7. " Ready. "

Nos. 1 and 3 place the slings (if u 'ed) over their shoulder , stoop dowll, and slip the loop ' of the lings on to the handles of the stretcher, which they then grasp.

As soon as all is right the word i given" Lift. "

At the word, Nos. 1 and 3 bearers rai::;e the stretcher teadily together and stand up.

Not e. - Kos. 2 and 4 will now adjust the slings on the shoulders of Nos. 1 and 3, taking care that each is well below the leyel of the collar and l ies accurately in the hollow of the houlder in front. They will also lengthen or shorten the slings, having regard to the patient's injuries and the relative heights of the bearers.

9. " March. "

'rhe 1110ve off :-Nos. 1, 2, and '* stepping off with their left foot, and No. 3 with his right foot (Fig. 1). The ·tep hould be a short one of twenty inches, and taken with bent knee. There 'hould be no spring from the fore part of the foot.

184

10. " Halt. "

The de tination being reached, on the word " Halt " being given, the bearers remain steady in positil)l1.

Fig. 8 1.

II . " Lower."

At thi order the bearers place the stretchel ;=;ently on the ground, lip the loops of the otf tho handles of the stretcher, remove the ,'ling.. from the

1 7

and then np; ecHO being taken let the feet rc,u.:h tbe ground beforJ hIS head.

12. " Unload Stret c he r- Re a dy ."

The uearers preparo to take the patient ott' the stretcher, as at Orders 2 and 3.

13. Lift. "

The bearer.. rai 'e the patient no' at Order ± (Fig. 79) j No.4, in this ea e, eli 'engageD hand ' from No.2, remove' the .·tretcher (Fig. 7 ), and re. umes po ·itiOl1. If necessary, the bearers will steadIly together, and carefully carry the pa t:ellt to the vehicle, b d, or other place to which it ha.. heen arrang cl to convey him.

1.1. " Lo w er. )J

The p<"ttient is carefully 10wGfed.

EXERCI E No. II.

FOR THREE BEARERS.

1. Numl e1' the lJearer. 1,

All orders will be given by No. who will look after tho inj ured part of the t'· body 1imbs, to .ee that no bandage or splmt become and al. o that o. 1 bearer, in lifting or carrymg trctcher, not touch the feet.

186

2. " Place the Stretcher. "

No.1 taking the foot of the stretcher, and No. 3 the head, place it in a l.ine wit h t he patien t's body, the foot of the stretcher bemg close to his head.

3. " Fall In. "

No. 1 places himself 011 the left side of the patiellt 3 2

FIG. 82.

in a line with his knees, No. 2 on the l eft side j ust helow the pati ent's shoulders, and No. 3 at the right tlide, and faces No.2.

4. " Ready. "

All kneel on the left knee. No. 1 places his hands, well apart, underneath the lower limb, always taking care, in case of a fracture, to have

189

one hand on each side of the seat of inju ry. Nos. 2 and 3 grasp each other's hands under the shoulders and thighs of t h e patient (Fig. 2). 3 2

. 3.

5. " Lift. "

All three bearers ri e together to their feet, keeping the patient in a horizontal pO 'ition, (Fig. 3).

6. " March. "

All take .' hort side-pace. , carrying the patient o\"er

188

FIG

the stretcher until his head i immediately above the pillow.

7. " Halt. "

All three bearers remain steady.

1'\. " Lower. "

The bearer stoop down, gently place the patient on the .t retcher, di engage their hand, and then stand up.

9. " Fall In. " On this ol'dcr boing giYon,

No. 1 place him elf at the foot of the .'trctc hcr " 'ith his back to the No. :3 pbce' binl.'l'lt nt the left ,ide of the patient, I'\,nd No. 3 at the hend, with hi' face towards the patient.

10. " Ready. "

0 '. 1 and 3 place the ,lings (if n 'eel) oyer their ,'houlders, stoop down, and slip the loops of the Oll to the handle of the stretcher, which they then gra'p.

, 'oon as all i ' right the wOL'd i ' giyen-

11. " Lift. "

At this \\'ord, No,. 1 and 3 bear r1'i rai.c the stretcher steadily together and stand up.

No.2 "will now adju.'t the slings on the. houlc1ers of ...os. 1 and 3, hking care that each is well belo\\' the level of the collar, and lies accurately in the hollow of the shoulder in front. He 'will abo lel.gthen or the . lings, having regard to the paticnt's injuries and the rciatiYe height'l of the h('arcr,.;.

191

12. " March ." On this word being given, Nos. 1 awl 2 .'tep off with the left foot, anrl No. 3 "with the right. 'rhe step should. be a short one of t,,,enty incheH, and taken with bent knees. There .'honlcl l)c no :->pring from the fore part of the foot.

1 ;3. " Halt. "

The dc::;tillation being reached, on the word" Halt" the hearer: renwill .'teacly ill po ·itioll.

14-. " Lo w e r . "

'rhe l)(':<11'o1's place the .-tretcher gently on the gronucl, lip thc loops of the slings oft the handle::; of the 'tretche1', l' 'lllO\"C the slings from the 'houlders, and then . tUllcl liP; carelJ8ing taken tu lei the patient' fed reach the ground Lefore head.

Ii}. ' Un l o ad S tretche r - Ready ."

The bean:r prepare to take the patient off the :trdcbe1', n, ,tt Order.' 3 and 1- (Fig. c'2).

1(). ( L ift."

The l)carel" rai::;e the patient, tt: at Order 5, and canJ" him hy hort Hide step', clear of the. 'tretcher, to the yehide, hed, or other plu,ce to which it has hee11 arranged to conyoy him (Fig. 3).

17. " Lo wer."

Tlte patil'l1L i t'ardull.r luwored.

190

EXERCISE No. III.

\VHEN ONLY THREE BEARERS ARE AV.AJLABLE AND THE STRETCHER CANNOT BE PLACED AS IN EXERCI E II.

1. The In tructor numbers the bearers-I, :., 3. All orders will be given by No.2.

2. " Place the Stretcher. "

No . 1 taking the foot of the stretcher, and No. 3 the head, place it on 'the ground by the side of the patient, and as close to him as practicable.

3. " Fall In. ''

The three bearers take the same po ition on one side of the patient, as laid down in Exerci e No. l.

4. " Ready. "

No '. 1, 2, and 3 kneel down on the left knee, placing themselves as close to the patient as they conveniently can, and then take hold of him as directed in Exercise No. 1.

5. " Lift. "

Nos. 1, 2, and 3 raise the patient as directed in Exercise No. I., and then move in a kneeling position up to the stretcher (Fig. 84).

6. " Lower. "

The bearers bend forward, carefully lower the patient on to the stretcher, and disengage hands.

19:3

7. " Stand to Stretch c!". "

At thi::> direc.:tion u.ll tbe bearers ,·tand liP ; No.1 goes to the foot, TO. 2 rClnains in pm;itioll at the side, Hnd 0. :3 goes to the head of Lhe streteher.

) " Ready ."

J 0,'. 1 ilud 3 pln·e the sling.' (if used) oyer their

3 2 t

FIG. 84.

SILOtl1clel's, :-;toop (1()\\l1, ilncl slip th loops of the 'lings on to Lill' halHlll't> of thetl'cl<:hcr, \"hic:h tlley thcn gmsp.

9.. , Lift. "

1 <tnd 3 l)cal'cr ' raie the stretcher togetbcl' :lml stand up.

192

)94

1\o. 2 will II",¥, ::Idj nst the "lings on the shoulders of Nos. 1 and 3, tl1ktng care that each is well below the level of the collar, and lies accurately in the hollow of the shoulder in front. He will also lengthen or Rhorten the lings, having regard to the patient's injurie and the relative heights of the bearer ,' .

10 "M arch ."

No 1 and oli' with the left foot, awl Xo. " 'itll the rig ht. 'L'he step should he a short Olle of t wellty inches, and tukeu witb bent knees. There ::-.hould be no spring from the fore part of tbe foot.

11. "Halt."

The destination being reached, on the word (( Halt' the bearers remain in position.

12. " Lower. "

The bearers phte the ,tl'etcher gently on the grollnd, the 100ps of the "ling ' 011' the hancllcs of the stretcher, remoyc the :lings from the shoulclerH and t h en stand uP ' tetre heing tuken to let the pati eut'· feet reach the g round hefore hi.' head.

13. " U nload Stretcher Ready. "

No. 1 on the left side of the pati cnt, a.nd in a line with his knee, No.2 on the left jn't below the patient'!') shoulder.', and I o. 3 at th e right side, GLud fates TO. 2. All kneel Oll the left knee. No.1 place.· hi .' hands, '\Y cll apart, llllllel'l1enth the lower limb ', alway..; taking care, in C<lHe of cl fnwture, to have OllC hand 011 each .. ide of tlw eat of

195

injlll'Y· Nos. 2 a.nc1 3 gra.·p euell othel"H lIallrh; under the ::;houlders and thig:hf' of thc t' t (1 Fig. 2). ...., ." pH lell . ompare

H. " Lift. "

, l?ea,l'el's Lo their feet, keeping the p:l.tlcnt III a. hOrIzontal PO,'ltlOll, awl earry him lnr . hort :-;Icle step,', clear of the Htrcteilel', to the bed or to \\ hich it 1m,' ])Cell kllTi.llJ'''ed ycy hun (FIg. '3).

If). " Lower. "

The patient is carefully lowered.

EX.EIlCI. ' E 1\0. IY.

FOR c . E IN A.'[) X ..lRROW VdlEl<E Two MEX OXL Y CAN BE EXGAGED.

• T OH .. 1 anel l'Hl'cfttlly place the .. tretchcr in a 1ll1 e With tl:e lll,Fll'ecl llliln' .. body, the foot of the :-.tr\tcher bcmg', If pO:-;Kil)]e,"'< eloHe to hiH hea(t

. ,)l o. 1 ,'tl'addle.. aerOH,' thc patient'::; leo'H placino' hi nght fO.nt, with the toe turned out\\'ul'd,',oa' little the pc.ttl kn ccK, and \\ ith the toc of the left foot tlJl[Chll}O' the heel of No. :?; h e then .. toops dO\\'Il,

, • It is not advisa.!)le to. be too particular a,' (,1) the head or of .a b stretcher Ill.<1. l1l111e , a it would pJ'obuhly he (Iuite lI11PO, 1 Ie to reverse 1t. . () 2

pa. ses the left hand under the patient's thigh ' and' the rio'ht hand across nnd under the patient's calves. No.2°p1aces h i' feet oue on each side of the patient between his oody and arm', the toe of each foot as near the armpits n' pos 'illie. He then stoops dm\ n and pas es hi ' hand::; l)ctwoen the sider::; of the chc:-,t

Fw . .3 . and the arm' ul1derl1CC"tth the shoulder', and lock the fingers (Fig. 5). If the patient'::; ann' be uniujured he may put them round the neck of No.2, and by this m.ean::; gn'cl,tly Cls:,;i ,t him in lifting. ,Yhen both are ready _"To. 1 will gi vc the order " Lift and mo v e forward. " Th patient is then to be 'lo\\"1y liftc(l jn·t sllffi<:ient to allo\\'" hi ' body to clear

-the stretcher. Both bC'1-l,rcrs will slcmly and gradually move the :Xo. :2 11y v ry l:lhort .-tep,', No. 1 hy benc1mg IllS hody forw<wc1 at) mnch as he <.;an 1f'1'lhont 1fwlling his feet (Fig. '6). .l o. 1 now giYct) the order" Halt " whereupon o. 2 remain .an d 1 o. 1 ad mllel',' hi .. l'i!!ht foot to hit; left, and :lgnin (t(lYance" hi,' left foot till the to' luuche.' the lleel of .J.: ;\0. 1 then giyc,' tho order " A dva n c e " \\ hon the pctlient will H(tain be moved f(lJ'\\<Lnl: T.het;c lllO\·emcnt. arc to 1,0 'u until the patIent J,' oyer the !'>trett:her, \\hon he i,' to lI e gl'l1tly Imrcrccl.

The oearer!'> "will thcn act in the ordinary lll<.tllner a jar n.. the natl1l'o of the locality will permit.

196

2 I

197

The Ashford Litt e r is made np of either of the FurIe), strctchers mentionecl on page. 179 and <l wheeled undel'-carriage(l,nc1n. wn,te l' prooI hood and a,prol), or, if PI' ferred, <1, light \\'et-rel':'i::;ting CiUlva::; covel'. The FIG, 87.

-treteher i kept in pO 'ition on the nnder-ca rriitge hy the foot-whcels, which fit into 'lot.' ill the ::;icleH of the under-carriage, and it can be relllOl cd at pleasure. The under-carriage i ' fitted with a crankod a:\.lc, whicb allows the bearer ' to pit 'S wilh the

190

uetween the wheel - instc<t.(l of lirLing it on')' thclll. At hoLh enels arc two legs fitted wilh Hutonmtic selfl()cking hillge::; which <t.l1ow the leg.' to l)c tlll'llecl up a:-; l1a11(l1<.'s \\ hen \\ heeling the litter, awl secllrely lock Lhl'1ll eithcr m; leg's or hnndlcf->. The hood aml. aprol1 fit into sockets ::;crewed to tbe .'t retcher, III wJlCcling till' litter, care .-hol1lcl be ta.ken to keep thc patient ill a horizontal position. Should it l)e neccssary, t\\'O call m.il} lift the litter and paticllt.

T he Rea-Edwards Litter, introduced ill I !)o4, i' used in a similar manner, a.nd one lliodel of it is titted "lth pnoumatic tyres, whit.:b add illlllll-ILl·I," t(J Lhe comfort of the patient awl Lu L1w e<l,e of pl'upul'iou,

198

:WO CnAP'l'ER XI.

[hI>. ["iJvh I.A,c clw'eI,1· Females only, in accol'(!-tJlce /I·ilh • 'yllabl£s 58.)

131 E. )lACDOWEL CO GRAYE, M.D., F.R.C.P.l.

PJ{gP A:1ATIOX FOR OF A 'E8.

VVIIEN ne\\"t; of ,\,11 necident come,', prepa.rntiom:i , ' honIJ at once be madc ' 0 as to hn,Ye ever)Tthing ready hefore the in.1 llred i brought in. Of course the preparation, ' necclfnl will yary according to 1,11 llHture and extent of the in.1 I.mt the follo\ying ,He the ehief \\' hich may 11(1,'1'0 to he dOlle.

ellOICE AX]) PREPARATIOX OF Romf.

.\ rOlJln he In <.1, bad cn .. e thi:-; ,11on1<1 be one no' it i ' diHieult to (;<llT\' an illJ mod through n,1.1'1'O\\ pn.s.. ngcH and np- 'tail' . l -1l1e.' 8 there :-'0111e such rCH8011 ngnill't it, the injnred O\\ll room i.. best.

The w<\,] to the room lllll ' t he denreel, projeding furniture <tnel mat. in the hall or in lohhie' be removcd. If the injured persoll i.. L:[lrrie<1 on a door or ..hutter, or eyen on n, 8tretcher ,1 L:onplc of strong kitchen ehnirs should he plrtced rend .y to support it, whereyer the bearer ' would he lild.:ly to r efl.ll il·e rc .. t.

20 1

Useless fnrnitnre should he removed from the l)ec1Toom. ThQ bed should be out from the wall ..;0 that both sideH ca,n be ctpproached, and the clothe.. turned back to 011e side to their fun length. A hot llottle should be got l' ady. If there is mueh collap8e 'everal hot bottles and hot lJlanket. may be required; cover the hot bottle: with flannel.

If the injury iH ycry HeYCre, if mud-stained Imvc to he rellloycc1, or if cxten .. ive dl' s, ings hayc to he applicd, it Ill,t)' bc 11 'Cl' !->nry to have another hed, ;t conch, or ,t btble plac (1 IlC,U the bed to lay the sllfferel' 0n in the firHt il1')t;uu;e. ThiS heo <llT,lllge(l that ,'oiling (10 no harm; old .. heds waterproof lllatel'ial .. , tllin oildoths, or even lle"'!::>papcr, Illny lH';cc1 ,v a protcc.:tion.

1)1 FT[:\(1 A:\D (' ARRYIXG

1£ pre,'cllt ,It the pL1L:C where the accident oc 'l1lTl'd, it \\' ill lleL:eSsary t o see that thc patient i, ('arc flllly lifted after proper Ie Fir ·t has 'n rell(lcrecl.

The foll()\\ illg , h0111(1 be remembered :-Se1ect the proper 1Hltl1 her uf pel'HOn' to n;' ist, and do not let them lift the patient ll11ti1 they thoroughly un(lc1'tHnd how they arc to do it.

For orclin<l1'y (',t, cs, wherc t11 injured per 'on 11<1 ' to he lifted a Ycry "hort c1iblt1Ce, three hdpel" are . ul1ki1'11t. T\\ 0 \ \\ hoholllrl he ;t') f,lr as po, sihle of

equal height) are to bear the weitrht the third i::; to 'upport and take charge of the inj nrccl part, 'l'his best done by <1, per on who ha' becn through a " First Aid" course.

If the injured person i' in 'cn::;ihle, HnoL/l('r helper Hhould support his heael.

The lifter, one at en,ch side, slwulcl kneel Oil 011t.: knee, and pass their hand under the 1>ael\ at the lower part of the 'houlclc( -blade', and under the hips, cIa 'ping ench hi right hand in the other" left

The injured patient shoul(l, if prac:tieahle place llit-' Hrms round the neck of the uearen;.

'l'he third helper Rhonlcl attend to the of illjury , if tlli", i;:; a fn:wtnred limb, be hould 'upport it l)y placing the palms of hi.' hand uncleI' tll Jim1), Olle auoyo and one belo\\" the Heat of the illjury gra-;ping' it firmly but avoiding u11noc.:os8a1';" pres,'un:.

rrhe helpers should r ema in tIm: until the ortle1 " Lift" is given, and then they should all lift Hlc)\\ 1) and 'teadily, ayoiding jar., attempts to c.:hange po::;ition of hands, etc.

H the injured person i::; to be placed oJl a strcLc.:her or shutter, this should be placed" ith the bottom end at hi head; the bearers '!tonlel then move, one at each side of it, until the patient i.' OVel" it. The word "Lower" should then bc giycn, awl the injured person hould then be slowly lowered. A pillow or folded-up coat ' honlel he ready, and n.' the'

snrfercr lowererl, thiH should 1Ie placecl under hio;, heHcl.'\<

Iksick" n, Htrct(;iler, a,ncl su1>::;titllLes SllCit a gate, a :-;illlLtn, or a door, other llH'l:Ul:-i of ca.rryillg can b e i . ' .

III Hlig-ht inj mics, where the lll.JLll'ed I llnn,ule to \\a1k, two hearers C;tll C'llT} hIlll b," fOl'lI1111g a foul'handed, three-lu1.l1(bl, or iwo-hn,llfled . eat. ,

A four -handed seat i:-; forllled a c1esc1'l1)('rl on U,lgl' 1(;(>.

A three-handed seat is m,uk as clesc.:l'il)erl on pal,':l' 1

The two-handed seat i .. m<1.rlc it' (ll'Tril)l,(l un 1()9. . .

\ Sillglc helper lift hy :nppmllllg With one arm til(' t \\ () kllecs, ;wcl with the other the back. The arms 11lW.. t 1)0 pn . 'eel w 'llllndcr before COlllllll'llCillg- lift.. \ sillgle helpcl' (;an gin.: 11," pl:ttmg' ;11'111 ronnel the \\'ai::-;t, grClspill!.!,' thl' nght awl the injnrecl perso11:-; left. ann. ronn (l Jus ()\\ 11 ned:, holclillg the left bawl wltll O\\'ll left Ilan<1 . .\ capital :::;tretchel' call Le illlproyised out of a "hed and two broom h :lllflle, (I]' other ,bart P()lL-.. Each Hide of the i .. \\ utlllcl lip Oll broom

'Of Full directions are giyen in 'ha pter X.

202

203

11andle llntil there i' just room for a peri-1on to lie betweell. This requires four bearer, t,,·o at each ::,ide, :to preyellt the sheet slipping.

CARRYING UP STAIRS.

In C:c'lrryillO' n stretcher up stairs the head ,'11onl<1 fir t, and all extra helper should a ' si"t at the 10\\ L'l' encl, I>U clo' to rai '0 it and keep the ,tretc\J I' noarly 1101'izo11 tal.

The two, three, or four-handed seat may 11' ll:-oed I'llI' up ,'tail"; ora strong chair, tho paticnt hcing -carriecl up ba,ckwi::l,rds. In the latter ca:-;c Ol1l' hLlpl'l' ::;honld \\Cdk after the chair and help to Huppurt it alld to the injured person ::;lipping onto

LIFTING INTO BED.

If tll" 11c(1 i,' narrow and there i room the tl'etchel' ' llOUlcl b -.: placed on the floor with the head ('In:-OL' tn the f{)( Jt 0[' thc heel. The injured pel'l.;oll ,'jlOlIlrl theu he lifted oyer the foot and placed on the 11ed. 1 f tlw llCd il> too wide to admit of this, the I>tretch 'I' ..,!tollld be placed beside it, and two :-;honld stlllel at the far side of the stretcher. One helper pa-.,scs one .arm Ghe shoulders and Ol1e beneath th' middle the back, the other helper plclc:illg' hi , lmder the lo\\'er part of the back and undcr tll' 1m 'C,'. Thc injnl'ed person is then liftecl, another helper pull::; tho btr etcher, and after a Ringlc t<'p forward the burdcn i,' placed on the bed.

205

OF BED.

t a feather hed, ,houlcl he-

A firm mattreHH, no 'r 1 . , T h' ., much injury, or 1 (res, lllgH selected. )f t raw-::;heet ought to 11 (,' phwe(l ha.\'e to he f four or morc Lhi<.:kllcH, 'e,', on thc llccl. It I,' d :0 reach from the )l1iclcllo of e:-...tellcl (L<.:rOHS t IO 0 'ta l ll k ce' A l)iece of water, t 1 'wk to 1C n . the VatlCll .s ().>< • ot thill oil-cloth .. !tonIc! 11c placed proof <)1 1 t thc draw-, hect l)cc()lltc::; uncleI' the ell:,\,\\ -H : ld bc rolled IIp llwl II '1 1 the sutl ,cl pm tlOn S ou "m cc , , . thl . under the patiellt. dC1Ul part dm thigh Hpraille cl ;lll kIe cluel 1)\ fractnre or t lC, t;,. lIe" '(Fig. Kt-I) shoulel be t her C'\SC):) ,\, ()lac I t-iOlHe 0 ( " f'''' dIe" is to sllpport t 1e '1 The llse 0 ,\, CIa 1 , ' f. reHHino' Oil the lim) lll'cl -clothe,' fUlCl keep them 110m P l ,t'o'ol:(Fi u 90) and ( 1", ' l) Lilrec- eg<1C( H " r' ' 'lg. l' 1 'lb corks 'IT"- paHf) cl . '1 'tIde ' llHl \ )e u, C( . 1 1 , 11111 al' al : 'I s with its poinL guardcc >y ,\ throl1gh the 10: tio 1)ec1 01' 't lIail in the wall, 1 t' 11 ..,trIll O• ,,0 1 ( cllrl;.. :Ll.Ie ICC 1:" " f the heel-clothe" \\,illrclIe\'c the PICtSHlllC 0

HE)IO\ TilE ('LOTIIE,'. 1 few rule :; Iu c:luthes off all il1j urec person:t

, houlcl 11C home ill h better to sn,c:ritice the T ,. ons c·t es It IS n1uc . . _ n SCll < 1 T ri8k of iner the lllJur:. dut he . than t() nUl ,tl) , , '<1 'C of r;':H't \( red ann In rClll()yillO' a Gont, ctc" III ,1. c ti '-t " '=' ,1 Iel be drawll Ollt 1S. the ulllnJurcll aUll lOU

204

FIG. 90.

Tn putting on <1nythill<f the injured arm ,'honld be 11Htill fh'," t.

In 1mrm; and r-;eald ' nothing should ever le dragged {Iff. A sharp pc\.ir of seis,ors should he u::;ed, and {\yel'ything not adhering r-;hould be cnt away. If .allyLhiug' ac1hel'CH it should be left until medical aid em 1Jl' ohtained. The clothing adhering may, "ith .c.1.c.hantage, l)e Hoakcd with oil. To r move the tnHlHel'," from a ,8Y rely injured limh, the OU' ',de "l',1.111 .. hOllld l)e ripped 11p. FOR

As , '0011 the inj med person has l)een attendeel tn, pn'pamLill'l ,'hentlel he made for the ,'ul'geon' yi .. it.

['he pl'ep,lmtiollS needful "ill depend upon tll llaLlll'C of the c,ve. '1 he following hint ' may be of thC' :

fire in the room will generally he of :eryice, '\'en ill '"llllHllCr. There .. honld be plenty of \mtel', llOth hnL all ,1 eold, al::;o Hcveral ba ' in., ple11ty of clean towel.' and soap. There should he ,om thing' to l'lllpLy water into; .t foot-bath doc .' welL The ha:::;in. hould he placed on a table, coyered with a dean white doth; it 1nl'ge towel makes anita1)1 ' doth; til . towcls, fo]e1ec1 up, .. hould be plaeed on the ,"<une ta111l'. and the hut and told water .. houlcl he within

------

207

reach. 'lhe foot-bath should be undcr the table· or close at hand.

In the case of a burn, cotton wadding, dotlt'>, old linen, oil, flour, brea,d, and bicarbollCLtc of 'oth (baking soda) should be ready, and matcrial1-3 t;hould b e torn up for bandages. 1£ a chellli 't', shop within reach, carron oil and plenty of t:otton wool 'hould be sent for.

In the ca e of lu:emorrhage, plcnty of and at least two ba ,in' 'hOllld he 1'o 'u11-.

In the case of a pen:;Oll l'e::;cued from dro\\:ning tht; 'heets should be taken off the bcd, plcnty of blanket should be heated before the fire, and 1-3cyeml hot bottles should be ready.

If poultices are likely to be required, hoi ling watcr, linseed-meal, mustard, a loaf of stale Lreacl, a 'mall k1. 'in, a large spoon, .. wcct oil, and to\\, flanncl or h<tndkerchiefs may be req ni red.

For fomentation, have boiling water, flannel, a kitchen roller, and two ticks, or a large tn\\ el.

'Vhen summoning a medical man to ,,11 <tct:idcnt always let him know what kind of cai>C he i' required to treat, so that he may bring whateyc.>r i' needfuL By thi means valuable tillle lllay be sayeel.

209 INDEX. ---:}.--

1'1(1/1'

Alltl.Oll1Cn '.. ... 156

AecHlen L c'tses, preparation for 2()()

Aeids, pl'isolling'i)y ::: l4!1 poisonhlg by .. J.'i0

Ammoma, poisoning by ]50

AI1'ltomy... '" ... In

Ankle, spmincIl 67

Allt?rior tillial artery.. H4

Anti llLony, p Lidoning Irr Lil A()rta '" ... tiD, 7

Apoplexy ... IOU

" to distiuguilih frolll colhtpse from (ll-illk . 111

A ppal'l'll tly rl':-;til I'l' H:3

Aq U':\. fOl'tis, .. onil·lg 11\ 140

An;l, hlcetling ' " PII " hOJle of ::;) " fradul'e of"

AlIl1]Jit bleeding from::: no

Ar 'e n,ie, poi, oning h,\' 1'-0

ArterIal hXlllorrhatfc ,. . 1:3

".. "gl'1l 'ral

}H'lll(,lplef4 of of l.f

Artel'!es ... .. (:i8, it'

Artel'Jcs, eour:-;e of the lIlaill 1

Artery, axillary "

facial .. , femoral... . .. iliac ... plant:l r " poplited radial ... subcla \-i,ll1 tij)ial " nlnar '"

AJ'titieiall'cspirati()ll Atlas . Amidc,.; :.: .. , al tpn- :. :

Axi:; ... . ...

Rnck, lJ:lud 'lge for Ba0khone ...

R lllr1age, to fHSi II

Bandage, to folcl

Bamhlges

Banlltging '"

13e<l, prep tratioJl of '"

H cllac.lolltla poisollinCT hy Bite,; of <lIlilllals .:>.

Hi,tIder '" ... ..,

brachial Pane 83,86 83 79 4 94 carotid

digital...

foot

...

. .. dorsal, of

1 Q:: 949:3 94 4 13.' :20 6!l 2() ..,.) , 35 161 20.) 151 1:31 llV

Blood :no

Page 69

Bones, general description of .. , 20

Brachial artery... g3

" " cligi tal pressure to 89

Brain 102 compression I)f ) 0, ., concussion of 10

Brea tbone 24

" fJ'lcture of .,. 48

Breathing, stertorous ... 10")

Broad bandage . . .. . :37

Broken boncs, see Fracture.

Brooch-bone 28

Bruises 121 Burns 128

Capillaries .,. .. . 69

Capillary hremO! rhage 73, 101

Carotid arterie·... . . . 79 " "wound of 79

Carpus ... .,. 26

Carrying, means of 203 " 166 "upstairs 204

Cartilage... ... ... 29

Caustic (Lunar), poisoning by... ... .., 151

Cerebro-spin'll system ... 102

Cheek, bleeding from ...

Chest ... ... )55 bandage for 164

hlorodyne, poisoning by... ... ...

Choking ... ... .,.

Circulation of the blood

Circn lation, organs of .,.

Page

Clavicle .. , .. , .. , 14 144 69 69 24 48 " frl!.cture of lothes, removal of

Coccyx ... ...

Collap e from drink injury 1:28, 2m '21 )10 lOti :24 ..j. " fracture of. ..

Comminuted fracture ., .

Complicated fracturc ...

Compress, grctduatClI .,.

Compression of tbe brain ...

Compound fracture 'oncussion of the bl\lin

Contused ,,"oun(h .. , Convulsions (infantile) ..

Copper, poisoning hy Corrosive poison.., .

Craule

Craniulll ... " fracture of Crepitus... ... .. ,

Cyanide of potasRiulll, poi . oning by ... .,. :12 7,) lOR lOH 1'25 ]20 1;:)1

Deep palmn,l' an;h 4 Diaphragm ]:n

211 Paql'

tDigital artery . w01.mcl of . 4

Digital compression .. , 74

Digitalis, poisoning by ... Iiil

Direct compression .. , 74

Direct violence... 31

Dislocations 64

Ditch, to cross with . tretcher 176

OOl'sal artery of foot .. . 94

J)ress, woman's, on fire 1:30

Drink , collapse from ... 11 0

Drowning ." ... 1-13

Ear-channel, from bleeding 2

Ear- passage, foreign body in ... ... 1.3-1

Elastic bandage tourni· 77

Elhow, bandage for 165

Elbow, blee(lillg from h nd of ... Elbow joint 30

El ctric shock ] 17

'Emetics ... 147 . caution as to giying ] ;50

EpilepRY .. , ... ... 112 l.riangulctr bandage... .., .. , :3')

Expiration ] :ri

External carotid artery 79

.. . " fra.cture of Fibuh ...

Fibula. fracture of .. . Field tourniquet .. .

Finger, bleeding from .. . li'inger hone, fracture of Fireman's lift

First aid, meaning of Fish hook em hedded Flexion of lim h ... Foot, hand age fol' hleeding

149 '2(),,) :2:2 44 :35 L51

Eye ... .., ..

Face 23 Page Fetcial artery, to com81 114 93 press Fainting... . .. artery ... " " digital compressiun of .. , 96 a.rtery, to apply tourniquet

...

, );'i;3

Femur...

from bone. of ... ,. crn. hed 9 26 ;:)8 28 62 77 4 57 171 19 127 78 164 95 2 64 8 ForearUl, hIe ding from hones of 25 ,. fracture of .. , 54: ]Torehead,

bleeding

0 Foreign body

ear pa'l

154 Foreign

eye

Foreign body

155 166 F :2 }'our-hall(led seat

1)anclage for ... 161 "

from '

in the

hotly in the

1;')3

in the

Page

Fracture, apparaLm; for trea,tment of ...

Frost-hite

Fungi, poisoning by

Fracture, causes of 31 " " " definition of .. 31 general s for treatment of arm of bone of foct 41 52 64 of brcastbone 4) of colIal'- hono 4 of finger bOll e 57 of forearm ... fi4 of knee cap ... GO of leg 62 of lower ja.w 4(j of metacarpn fi6 of peh-is of ribs of shouldcrhlade of skull ()f spine ot thigh-hone ,igns and 57 46 52 5 ) symptoms of " varieti s of ... 34 32 127 .31

Ganglia... 103

Graduated c0mpr.. 75

Green-stick fracture 34

Gunshot 12;')

212 H::emorrhage Pa[le 72 74 92 arrest of ... " internal

Ham, bleeding from Hand, Imndage for bleecli ng from " bones of Hanging .. Haunch bones ... Hea.rt " con traction of Heat apoplexy ... struke poi qoning

Henbu,ne, puisoniJlg Hernia... ..

144 2G , 69 71 115 115by 1;)1 by luI 160 Hip, handage for mcthod of 163 ... HmllclUs . . ., fracLure of Hysterical fiLs ... 141 25 :12 115

Iliac artery 70

Impacted fracturo 34

Inci cd ..,I·ot/nels .. 124

Indirect compro" ion 74

Indirect viol nee .. 32

Injuri es of p ecialorgans 153

In ects, stings of ... 134

Insen ibility 104 general treatof 104.

Inspirati on 137 213 Pa(Jp. 159 lniesLines

InsLrumental compression 74

rn ternal carotid arim'y 78

Internal hremorrhage 82

Interv rtebral discs 21

Involuntar'y muscles 31

Irritant poisons... 15U

.Taw, lower, fracture of 45 .Toini, wounded... 126 .Joints 29

Kidneys ... 160

Knee, bandage for 16.3

Kncecap . .. 2 fracture of 61} 37

Laborcle';:l method of arLificial respiration . .

Lime (quick), poisoning by Lip , bleedillg from Litter, A s hford .. . Liver

fracture of ...

La.burnum seeds, poisoning by ... 142 151 124

L'l.cerated wounds

L :trge arm-sling ... Larynx .. . 39,49, 50 13:5 14 151

Laudanum, poisoning by Lead, poisoning by L g, bleedi.ng from " bones of " fracture of ... Lifting and carrying Lifting into bed Lightning, effects of 95 28 62 201 204 119

Narcotic poi ons 14 " J arrow bandage 37 .,-e cUe, a broken 1:25 Nerve 10'2

Nervous system 10'2

Nose, bleeding from " I foreign body in 155

Oil of vitriol, poisoning by 149

Opium, poisoning by ... 148

. 95

P ay"

of 150 . I 19"' .. 1.39 135 1;36 poi so ning by ... 1.')0 26 ;36 " fracture ot '" l)ones,

Metallic poisons Middle line of body Monkshood, poisoning by 04 :2 ]50 :20 Morphia,

l\Iuscle3 Mu cular action 151 by 14 :30 32

Lungs Lungs, wound

puisoning

Pad, to make .. . ... 75

Palate, bleeding from... 81

Palmar arches ... '" 84 " " bleeding from 84

Paregoric, poisoning by 14

Patella 2, fracture of 60

Pel;is 2G " fracture of Phalanges .. ,

Pha.lanx, fracture of Pharynx .. , .,. . .. poisoning by PhySIOlogy ., . ., .

Plantar arterics... ..,

Plants, Yarious, poisoning by... ... ..,

Poisoned wounds ...

Poisoning, dircctions for treq,tment of 00' ."

Poisons and poisoning classification of with double ac-

146 14 tion ... 152

Popliteal artery ... 1 93

Posterior tibial artery.,. 9':1:

Potash, caustic, poisoning by... ... ...

Preparation for surgeon Prussic acid, poisoning 150 207 by Pubes

Pupils Page... 1()6.

Rabid animal s, bites of 131

Radial artery 00. S3, bleeding fronl ... )7 comprC!:lSiOll of Radius ... " fracture of ...

RespiratioJl, arlifiei. .l .. ,

Respiratory SysLClll ... Ribs 00' " fracture of...

Room choic" and p1'Cparation of Rump-bonc

Rupture ... ,'acrum ... ,-callIs .. , "'calp, bamlage for " blecllillg from Scapula... .., fracture of

Sea't's crew tourniquet

Shin-bone ...

'215

Pa[je

Sickroom, choice and prepamtiou of 200

Simple fracture... 32 , keleLoll 00' 20 t:-;ki 11, wonncls and injuries of 121

Hkull 22 " of 44

I .. :39, 49 & 1)0

NJ1Iall ann-l'liJ\g .. 40 , 'nake-bite 1:B

:-\Olla. callHtic. pni!:loning llv 1;'0

Hole, arterial blceLling from fl5 ,'plccn 159

'b'etcher, Furley to to prepare Page 179 176 181 to make a temII{ porary 174 " tranflport 179

',trycl:nine, poisoning by 151 tmllll1g... 10

Htyptic 101 ,'ubclH.Yian artery 3 digital cOl;lI)ression'

Sufl()cation hy smoke or era.seH .-.

Pulse ... . .. 'Punctured w ounds 1:51 26

.. , 124

Shock , hock. electric houlder... . ... houlder, banrlage for .. . " blade... .. . " fracture of houlder joint ... 21 }(M

Hpinal canal 20 c')l'cl lC2 , 'pilll'

HlJinc , fra(·tmc of HpiI'iL uf "alt, poisoning hy 149

,'pllnt, an<rulal' 00' 54 , 'plinls 3;, " to secure :3 ,'prains ... 67 :-llernnm ." 24 " fracture of 4

Htcdorous breathing 10;) ,'Ling' of inseets, &c. 1:34 ,'tomach ... 158 , 'trains G 144

• 'l r<'tdlCl' cxen.:i 'cs 1 )1

Sufi')cation lly swallowing very hot water .,. uu-;trok'

Superficial palmar arch

Surgeon's yisil, preparation fOJ'

SyhTes tll ',,; m ethod of artificial respiration ... ,'ympaLlletic system 'yncope

Tail-bon

Tarsus

Temple , bleeLling from ... Thigh-bone 00. " fracture of Thora -

Three-hand d seat

Tibia fracture uf 91 20, 1O:-{ 11-*

Page

57 26 57 135 131 19 9-4 151 126

146

71,103

161 o 2-10 1)'2 166 77 2 106 117 2-425 52

21 12

21 2l .) ,-. 26 5 L:J.> 16\1

Throat, bleeding from inside of 81

Tibial arteries .. , 94

Tongue, bleeding from... 80

T onsils, bleeding from... 81

Tourniquet 75

Trachea .. . Two-handed seat ]69

Ulna " fracture of U lnar artery 25 55 84,86 bleeding 'from

Uloai' artery, compression of ...

Unconsciousness

t"'" aricose

Venous hremorrhage

Ventrides ...

V , poisoning

Vertebra...

Vertebrre, cervical dorsal , lmnhar

Vertebral column

Vitrol throwing

Voice box

Voluntary muscles

Wagon, to load and unload 177

Wall, to cross with stretcher ·Wi.nd-pipc ' Vound of abdomen Wound of lung ...

$1. 30bn tlmbuIance Bssociation. General Price List.

INTRODUCTION

This Price List, which is subject to revision from time to time, has been compiled with a view to assist members of the As ociation and others in the purchase of the necessary equipment for corps and divisions of the Brigade, ambulance stations, classes, and first aid and nursing work generally.

A complete and reliable Ambulance Equipment is an actual necessity, and experience has proved that employers of labour <md others interested in the district reailily subscribe for . the purchase of such appliances. Collecting cards, stating the purposes for which subscriptions are required, will be supplied gratuitously on application to the Head Office of the Association, where also any information with regard to its work can be obtained.

'tores of the value of 10 . or upwards will be sent carriage paid to any part of the United Kingdom.

Owing to fluctuations in market prices it is impos ible to guarantee that the quotation herein can be adhered to.

Quotation will be furnished for articles relating to Ambulance Nursing and Hygiene, not mentioned in this list.

Orders and correspondence should be addressed to the t. John Ambulance Association, t. John's Gate, Clerkenwell, London, E. C.

Remittance hould be made payable to the t. John Ambulance Association and crossed "London and W estminster Bank, Lothbury."

216 Page

Veins 7 6 104 100 71

veins

...

Page n, 99 (j9 by 131 20 :20 21 21 :20 1:31 31

I\Tolinds

" 177 1:35 •• }.")7 ];"';6 1:21

HORSE AMBULANCE CARRIAGES & WAGONS.

• Registered design 418,030.

A number of improved designs for Ambulance Carriages have recently been perfected, and several specimens can usually be seen at t. John's Gate, varying from a light vehicle, to be drawn by two men or by a pony, costing with tyres to wheels £32 lOs., to a large single or patr -horse wagon capable of accommodating three patients in a recumbent position and an attendant inside. A fully illustrated price list will be sent tn application.

The "Ashford" Litter (l 99 model) con ists of a twowheeled under-earrin,go filted with elliptical and either of the" Furiay" stretchers, with a cover so arranged ona jointed fram e that it can be folded up inside the stretcher, ()[. with a hooll and apron (ax shown aum·e). The under earriage having a cranked axle, the bearer ean pass between the wheel with lhe stretcher, and thus avoid lifting it over them. \Yh en the legs of the under-carriage are raised, and thus form the handles by which to propel it. t'hould it be neces ary to pet over rough ground, two bearer cn-n eu ily lift lhe litter and patient. The" Clemet on " Rtr teher can he u<;ed in. tear! of the" Furley" pattern.

PRIO]' LIST. 3 "

ASHFORD " LITTERS .

-With Iron Tyres to Wheels. With India Rubber Tyres to Wheels. ! Without Without I . I With Oover or With With Oover or With Hood and Hood and Oover. Hood and Hood and Oover Apron. --- Apron. Apron Apron.

Under -carriage (n o .S(,re (,ch er)

Litter comple t e with

Stret ch er "

Ditto with Telescopi c

handled Stre t ch ed,

Ditto, with Police Stretchert

• Prices quoted for Litter wi th Ordinary Stretcher include Wide Wt'bbing Slings but no Chest :-l Stra p. Leather, instead of Webbing Slinge, 55. 6d. extra; Ohest Strap, Is. 6d extra If su pplied with ou t any Slings, 4s. allowed.

t Pricr l quoted for Lit ter w ith Telescopi c-bandled Stretcber incl u de wid Q W ebbing Sling s a nd Ohest Strap Leatb e r, in stead of Webhing Slings, 5s. 6d. extra. If supplied without any slings, 4s a llowed; a nd if without Ohpst Strap , Is. 6d. allowed.

t P r ices quoted for Litter with Polioe St r etcher inclu de wide Webbing Slings and Lea ther Straps fot' secu ring a refractory patient. Leather, irutead of Webbing Sling!!, 5s 6d. extra

Hood and .Apron, complete

E x tra So ckets and Studs, per set ... Waterp r oof Sheet (wa shable) to be laid on the stretch er bed Cr a t es (returnable ) charg ed 4s 6d. for each Litt er.

£ s. d. .£; s. d . £ s d. .£; s d. £ s.

t>RICES

THE 1 1MPROVEDASHFORD LITT E R. 1899 MODEL.

............ 810 0 9 5 0 11 0 o 11 15 o 12 10 0 14 5 0

I II 2 6

12 17 6 - 14 7 6 16 2 6

111O o 113 5

0 - 14 15 o 16 10 0

... . ... ..... - 12 2 6 ] 3 17 6 - 7 6 17 2 6 "d o tz:j t: 1 15 - u:,

Ordinary

s. :: JJ '-' - 2.C"D (I) :2 tl ,.., '? ;.!.. g. tl :r. ft 3 g h (j 8 ::: ;: fr (JPl g cP r? CD r-4 3 ... g. (fJ (J)o (t) c-t-;:l (t) D"' CD (t) Sl> I-d p,. '0 p 0 ci g _ ,..... c 0.. .;: 0 '"""" §=: (") ..., u ;:::: <0 g' """! - CD 5' g: (t) ...,. :i 0 0 rf I ""t> 1-3 ::r: s ...:. r. ,Iv c-- t>j e::-" :,.. C • c.. t?;j g, 0> ;;. \:I:jo .,.. g. p p';D" 0-':1 o 0 ;." 0 c-tCD .",..., D"' c-t- (") :> g. ...,00 ;...; :r. (D'& 0 £ s. d.

10 0 o 1 6 o 10 6 ...., ::t m N m ;l> . m o ;.. N o Ul c ...., ..., m o t"l t: UJ Ql

fitted e iLh er with bicycle whe els and extra pneuma Lie lt yre or with light, but strong WOOllen wheel, eith er wi Lh solia india,rubber or iron tyres. Owing to the redudion in the h ei ght of the wheels it is easy to li. f t a loaded sLrC'tch r -over them, <Ind the cranked axle has, Lherefore, heen rel)la<:e<1 by a stra ight one <:on stru cte(l of tubular steel.

«RE \-EmL\RIIS ,. L1TTER, fitted with pneumaLic tyrcrl wh eels, "hn willg the" Clemetson ,. tretcher.

Ball bearings are fitted to the wheels, both cycle pattern and wooden, and the hubs are so arranged that the wheels can be removed from the axle without disturbing

the bearings. In place of the four legs made to niHe as handles , two fixed legs fitted with small indiaruhber wb 'el.., or rollers are pla('ed n,t Lhe foot en d, while a combine(l leg and h andle fiLted with a crossbar and <.:ap ahl e of being raised or low ered is u sed at the head emI. 'Vhen mis c1 afl 11 har-dle it may be locked in one of two pOHitions, and when lowered it is locked in a crtil' ::tl posiLion. The a(lvanta.g eq claimed for this arrangement are Himplic:ity, eafle and rapidity of manipulation and the facility a'fforcl e(l by the two fixed l egs for raising the litt r, if nec: on to the pavement. The question of l)<tlance has been carefully studied, and the stretch er i.. hifted forward so that the middle of it is several inches in front of Lhe a perfect balance when the stretcher is in a horizontal position hcing then obtaineu, and con elUClltly there i, no weight on the hands of the p er. on propelling the litter.

The pn umati(' tyrec1 wheels ar c strongly recommended in {;a os wh re the small a1110unt of care necessary to keep them iJlfiatetl C.,11 be given, a the cOlllfort to the patient and ea e in propul ion are increa ed beyond all comparison with any Ii Lter .vet proclm;ecl. It will be noted thaI., Lhe prices al e 'onsiderallly lower th an of Lhe" Ashford" Litter, and the following nre gi\Ten as examp'es, out 0\\ ing to th YH"t number of combinations that can be made with the (lilrcrent . tretchel'il and it is impossible within t'easonable limitH lo HeL ont quot tttion for Lhe whole of them, hut Lhese may be calculated by adding togelher the

6 PRICE LI T.

PRICE

LIST.

price of LIle under-carriage, streL(;hel' selected, and hood and a p ron or cover, see pages 4 and!) to ] 2.

SPECIME N PRICES.

Under-carriage only, either with pneulll<ltic-t,rred cycle wheels or olid rubber tyrcd woo(len wheel. , £10.

Litter comi)letc with ol'dinar.\ :;treLl:her (no sling,' or l'he"t strap) and hood and apron, .f.:l4 {)(l.

Di.tto with Telescopic Handled Stretcher (with chest strap) and hoot1 and apron, t.:l4 11s.

]f with iron tyred wheel price ' are .£2 less.

The lowest pricedlittel' complete i iitted \\' ith iron-tne(t woollen wheels, ordinary (110 Rlings ur :! hc , t s;rap) and coyer. Price, £ 10 8,. 6d.

'When ordering please .. which wheels are l'('quiled.

CLEMETSON"

STRETCHER.

. , STRETCllER, with back raise(l, also ,ho wing extending leg,' .

On Lhi" stretcher the patient ean be moved u. clesired, from the re('umb nt to the sitting po:;iLion. Thel e is no complicated mecbanis m to geL out ot order, antI the adjustment depend,..

I'imply un the kdance of the patient's body. The stretl:her will/it either the" Ashford" or the anI " C nclelCarri-lgc. Price £:1 . Od. ; "ith extending leg, {4.

Hood and Apron, Yentilalccl, :1.:2 ]5 ' . Od. Q

8 PRICE LIST.

PRICE LIST

9-'

THE"

'1.0 PRICE L T T.

ADJUSTABL E LEGS F OR STRETCHERS.

Primarily ihcse leg", whidl are independent of alld culditional tu Lhe ( l'clinal'Y foot wheels, are intend ed to faL:ilitaLe .the carriage of a streLd1Cr in a railway compartment, in whie;1 ease two II ( ne side \\ould be lowered and adju»lec1 by a te l escopic arrangement to the proper height, so that the -foot wheel s on one si(le would rest on , he seat, and the adjustable legs on the other s id would rest on Lhe floor. The four legs may be used to nl,i, e the str etcher as t'efluircd. '''hen 1l0t in me they are folded up imme-liately under the pole, of the, t r etche r . Price pel' set of four, ] 'is.

FIRST AID SOX

To be fixed belo\\' the llxle of the" Rea-Edward,," or " A hford-Edwarus" Litter.

This is intended to b' kept pumanently lL ttel.Chl'll to the litter and is not desiuned to bang ill a station or Lo he :lrried. by hand . b

Contents :- , 'cl of l-iplints, 12 Triangular Bandages, 12 Holler Bandages, :2 a-lb. packets each 'otton and Baril: Lint, Adhesive P laiHter, Pair of ,'eissors, Knife, :2 (lZ. cel.eh Oli \ e Oil, Tinct. EucRlyptl1s B.P.. , 2 oz. ,'al Volatile, :2 oz. pil'it Ether Comp ., Graduated leasure Glass, Kic1ncyshaped Dres ing Basin, 6 Tampons for washing ,\ ounds, Tourniquet Pins, Pins, .Jeedle., Thre1(l anel Tapc.

Price,

l'l{lCE LI::;T.

" FURLEY" STRETCHERS WITH THE LATEST IMPROVEMENTS, .899 MODELS.

ORDIN.\RY TRETClfER-CLO ' ED.

' l'he improvements in all pM tern, of the "Furlcy"

• 'Ll'etcher, 1 99 Model, are numerous. The comiort to the pa.t ient is incl'ea ed; the tl'ekher is stl'.Jnger, more rigid, allli lighter, it folds up more closely, a'd its handles are more comfort:tble to hold and afford greater protection to the hand , of the hearers in passing through n<1rrow dool'ways 01' passage,. :-lhould it he nece, ary to reduce the width of a 10ided stl'et<.her ill order, for example, to carry it.,int.o a railway cal riage, this can be done, either when it is resting Oll Lhe ground or , upported by the bearers, without trllllhie 'l.ncl without the ;;lighlest jar to the p .!tient. The pl'ie" of the str tchers is lowcred . All minor points haTe becn most carefully considered, and the tretchers eonficll'lltly l'ecolllm'l1de(l as thoroughly efficient in e\'cry way.

,[,he.l' stretchers adapted for use alone or as part of the " A.·hforel" Litler, and th) eO\TCI', hood and el,p l'on, army rug, and waterproof shect rlc'lcribCfl in this list cue uitable for n;;e with them.

Q 2

TELESCOPIC H.A.XDLED TRETCRER-OPEX.

PRICES OP THE "FURLEY" STRETCHERS, WITH THE LATEST IMPROVEMENTS ( 1899 MODELS ).

N. F.-The prices of Lhe Standard Models are shown in heavy type.

Without Slings or Ohest Strap.

With Wide 1 With Wide I With Webbing Webbing L eath er Slings Slings Slings (no Ohest and Ohest (no Ohest Strap). Strap. Strap)

Ordinary Stretcher, for General il.nd Brigade use, taking thp place of hoth the olel ordinary

and military patterns ........ .

TC'leRcopic-hancllecl Stretcher for workill.€f in confined spaces 19

Police SLretdlCr, very str ong, with Ash Poles, and provided w i th L eather I"Heaps to !'!ecure a refr actory patient('omplete, with ,Yide \V ebhing Slings " "Leather Slings

Sling!'!, "\Vid e ,Y rhbing '"

] )0. l (' ;\thcr

{or if purchased with the Stretchrr instead of ,Vphhing Slings (5/6 extra)

Cover for Stretcher...

Superior Rood and Apron (see illn ' (ra'ioll , pagp 6 )

Berl for Stretcher

Army Rug to co"('1' Patient on Stretcher

W ith L eathel' Slings and Webbing Chest Strap.

£, s. (1. I £, s. d. I £ s. d . £ s. d.

61 1 17 6 1 1 19 6 2 2 5 o 12 o 2 :3 0 Z 4 6 9 0 2 10 6

per p air

per pair £ s. d 2 17 6 :3 :3 0 0-:1-0 09 6

c:> ,.. P""' W Ii> (C '":l ti: ::: g 2. E3 o 15 0 :2 HI 0 n 8 6 o 6 6 ,.., en cr'Q' :, r e-: 0 c ,,0;S' 0'8 .-0 0 ;; g'" C < r. OJ _.. " " 8;:: o. [;. .." g. '" ", 0 _ <: OJ " '- m ? ,om Q > o. > g>;l? --l gOb " ",<1 m or" c. '" " - 0 o m 0 " " --l of"" co .",, " .il 0 , " s. --l } 11 .0" r- 0"· '" 0 0 '"' c ;:IJ ::: tj po '"d I" 8 t<: r; if. ;-3

LAMP .

Thi!:! is fitte d \\'it11 a socket by to fix i l to a Li Ller, Of lle COnYC11ienLly carri {1 oy hanel, or atlachccl Lo a hclt 01 the clothing.

PJ'ic'C' complc·ie. [)H. 6c1.

Dressing Basin , kidncy shaped. mnde. ()f ellamelled IrUll Price IH. 3d

Knife "rith strong blade ... Pair of Scissor s P,flch Del.; pel doz . s. eaeh Is.; per doz. lOs.

Carrying Sheets for carrjring patients up and clcm n 'sLam" or otherwise about a house. De, igned by J. C. Derham, Esq., Blackpool , and 1\1rs. Alfred Paille, Bedford. The sheet il' fitted ffith rope handle _ and eletachable hamboo poles, and, may be placed on a stretcher w ithout (l isturhincr the patient P rice complete 158 .

LARGE HAMPER FOR AMBULANCE STATIO AND RAILWAY PURPOSES.

For contents see page.

P RICE

11 6

PRICE LIST.

THE HAMPER CONTAIN

et of CanelSplints.

1 pair cis,ors.

PRICE LIST. 17

SMALL AMBULANCE HAMPER.

vVith waterproof cover and strap, for u se in factories, 'l)11ieries, stations, and large works, bS well as for parochial .an(l domestic usc.

I Elastic Band Tourniquet.

. Carbolic 1 Cotton 'V ool .,. In Tin Cases. Boric Lint .. .

1 Roll Adhe ive l)la"lLer.

20 Roller Bandages, assorted.

1 doz. Triangular Bandages

3 pieces Tave.

4 oz. Sal Y ola,tile.

i oz. Bicarbonate of :-loda.

:l: oz. Olive Oil.

4 oz. •'pirit Ethel' Compo

i-lb. Tin Powdered Boric Acid.

4 oz. Tincture Euc3lyptns

B.P.C.

ol pair Pean's Forcep".

I Knife.

12 , urgeon's N celUes.

I packet each Safety all11 Plain Pins.

1-oz. Carbolise(l Chine 'e Twi t. :-lilkworm Gut.

I reel each Blaek antl\Vh i te Hewing Thread.

1 Kidney-shaped B<1<;in.

1 ,'topper Loo<;encl'

1 Cira,dl1ate(l ::'le'1s11 reo

I c.lke :20 per cent. C-lI'IJOlic ,'o:1.p.

I r ail Brush.

:3 Empty oz. Boltle'!.

Price Complete £4.

CONTAINING

,'plilltS. I Elastie Tourniquet. 3 Tampons, for wash;ng \\'Ounds. :2 Packets Lint. 4 Roller Bandages (wide and narrow). 4 Triangular Bandages.

Cotton 'Y 001 ... . .. } I T' C Boric 'Vool .. . . . n In ases.

'pool of Adhesive Plaster.

Knife, t i :lors, Thread, Tape, N eecHes, and Pins. complpte,

Le ngLh, 1 H. 6 in. Depth, 5 in. Width, 7 in. Price £1 11". 6d.

I e' PRICE LIST.

SURGICAL HAVERSAC.

IMPROVED..I:' ATTERS, httell with a tll1, so illTMlgeLl t.hat an,] article can be taken out without Llisturhing the rcst of the contents.

Coments: 1 Set of plints, 6 Triangular Bandages, 6 Roller Bandages, wide and narrow; Cotton \V ool, Boric Lint, in tin ca es; 1 Roll Adhesive Plaster, 1 pair cis ors, 1 Knife, 2 oz. Olive oil, 20z, Tinct. Eucalyptus B.P,C., 2 oz. Ral Volatile, 2 oz. pirits Ether Comp" 1 Graduated (lIass leasure, 1 Elastic Band Tourniquet, ..Pins, Needles, and Thread.

Price £1 lIs. 6d.

Whit(Linen Ration H aversacil Is. 9<1. each.

PRICE LIST.

NURSES' WALLETS.

ORDI NARY PADLOCK nAP I'; .

\\'ithout illRlrumcntH, 4R. :{J.

FiLLed complete, containing Bow

])l'eRsing Forcepil, :-)patula, Probe. pairs 'cissor" (round and sharp poilltecl), Clinicnl Thermometer, alla Klllfc',

Pricc s, 9<1,

T, JOH:"<'S PATTlmN, as i11u;;l,nLted, but improved by Lhe adtlit ion of fla.ps to protcet the instrument.

\Yithout illstl'lUllCllts, j,. 9(1.

Fitlea complete, contailling Bow

Drctising Forcepil, Artery Forceps (also u eful for drcssing), ,'patu <1, Probe, Director with Ear ,'coop. 2 pairs ,\:i", ors

(roulHI all<l sharp pointed), linical Thermometer (minute, rounel), Knife, Pencil, ancl

PlllS, Price 21s.

FIRST. AID BOX FOR" ASHFORD" LITTER OR AMBULANCE STATION.

This is primarily def'igned to be placed on the" Ashford" Litter (1 99 Mod el), but it is further adapted to be hung up (n a wall. A detachable leather handle is al so fitted fo r carrying purpo ses.

For contents see next page. l' l:tl C 1£ LI T.

CO TKNTN OF FIR, ''1' AID BOX. (Illustrated on previous page). Zl

I et of 'Wooel en I:)plillLs; 1 Elastic Banel T ourniquet; Carbolic '\Vool, Boric Lint , ill tin cases; I Roll A uh esivc PlaRtcr; 12 Roller Bandages, assortecl; 6 Triangular Banda,ges; 3 Pi eces of Tape; 1 Pait' .scissor ; 1 Knife; I Kidney, ' hapecl Basin; ] Gra.cluated Measure; 2 oz, Olive Oil; 2 oz. Tinct. Eucalyptus B.P,C, ; 2 oz. Nal Volatile; 2 oz. ,'pirits Ether COllJ p .; oz. anon Oil; Pins, ,'afety Pin R, Neeelles, Threacl.

PHH'E COMPLETE £2 lOR.

Tourniquet , Elastic:.

Tourniquet, Field

., a limited numher, noL quite up to

fltandanl patt I'll .., G

Tourniquet Braces (serve Brace ' or Tourlliquet) 2 6

Splints, \V ooelen, per set :2jO; 'ane... per set I (j

Tow for splint padding ... per lb. 0 (j First Field Dressing (Army regulation pattern), Price each

Jaconette. 4-1- inches 'wicl per yarel

I arbolized, or Styp tic, Tow ... ... ...per lb. Waterproof Lint (lJl case to bang on wall) , ...

SAFETY PINS.

All faRten or unfasten Oil either side.

Facile No., Gno or I:) pel' :3 doz.

" "S GO:{

I>nchc"s Duplex, 1: o. 2 doz. " Assorted , peclal Blanket, 'af >iy PilL ', :3 ill. in.

Ambulance Station Pla te, Enamellecl Iron, 35. 6cl. each. Stretcher Depot Plate, Enamelled Iron, 6d. each.

:.W PRTCR: LItiT.

s. d. 1 6 2 6

o 9 2 3 () 9 2 (> () 6 0 0 :? () ., .> 1 0 1 6

PRICE LIST.

Nursing Chart, d signed by Miss I nderwi(;k, ld. eaeh, hy post, 2d ., per doz. 9d . Temperature Chart , Id. each, by post :2d., per dozen 9el. Nursing and Temperature <?harts in sets, to record the N ursin a of a case for a fortmg h t, 3d., by post 4d. Registers. b Cla s Attendance and CertificaLe (two to set), 6s.. Case Report I s.

Large Physiological Diagrams. For Lecturer ' omprising: The Human ' keleton, the Artenal and VenOU8 Sy. tems, the Heart and the Blood, imple Fractu re, Compound F ractlU'e, ... Price, per et of ix, 15s. may be hll'ed a course of "First Aid" lectu1' s, gIven uncler the of the Association, for a fcc of 3s., or with the aclchtlOn of Sp lints, Tourniquet, and p lain Triangular Bandages, for ct fee of lOs.

Boxes of Stationery for the use of CIa s Hecretaries amI others connected with the Association, containing tw lve sheet of high-clas -pape!-,, suitably anel envelopes bearing the devlCe the OCla.tlOn. Pnce 6.d., by post 9d. Twice that quantIty, Is.,. b y post Is: .3(1. Medallions , issued in accordance wlth speclal regulatlOns, for which see leaflets No. 6:2 and 62A, to b had on application. Coinage Bronze, 2.. ; ilver, 7s. 6cl.; (iold, £:2 l Os . ; including engraving name and number on hade Morocco velvet-lined case, 2s.

NURSING INSTRUMENTS

:Bow Dressing Forceps , full size, Is. 3d.; small, exlnl. well finished, Is. 6d. ..

Scissors round-pointed Is. :3cl.; sharp-polllted, for delIcalc work, 18. 3d.; stronger, Is. 6d.; small round-point '<1, blades take apart for cleaning, Is. 9d.

Spatula 9d. Probe ,9d. Direc tor, with Ea r S coop , I s. 9el.' Artery ForC€ps , :2. 4d. Knife, very thin, ivory handl e, two hlades, Is. 9cl.

PRICE LIST . 23

CLINICAL THERMOMETERS.

Round. Ordinary, I s . 6d. ; minute, 2s . ; half-mi nute, 2s. 6d.

Flat. 'trongly rccommen d ed as bhey will not r ol l. Ordinary, 28 ; rapid (speci:t.lly selected and reserved for the Association), with very open scale , 3s . 6d.

Lense Front e d. ·When held in the proper p osition the column of mercury is magnified , an r 'l0 easily read . A l iLtle practice i required to ascer tai. the correct position in which to hold the instrunlent. Price, ordinary, :2s.; minnte, 2s. 9d . ; half-min ute, 4s.

Kew Certificates (to order), Is. 3d. each . N .B.-These <:ertificates ei thel' state that the instrument is correct or point ont any slighL error there may be; they are Hot llsually considered necessary.

r .B.- Ii nute and half-minute instruments will only register in the time Htated under favourab le circumstance. .

BATH THERMOMETERS.

To Dr. Forbes' specification . Japanned , with zillc scale 2s. :3d.; Clinical Thermometer size, in case, Is. 6cl. .\'0 liavilil!J is trt/.:en /01' breakage oj Thermometers in t,'aJl.sit.

TEXT BOOKS, &c.

"FIRST AID TO THE I NJURED." By James Cantlie, F.R.O .• '. The authorised Text-book of the Fir ·t .Aiel Course . Is.; by post, Is . 2d.

«CATECHI'lU OF FIRST AID ." Compiled from Dr. Cantlie's .Manual. 13".r. Brown, L.R .P. , L.R.C .. , and .J. Carvell, L .. A . Price 6d.; by post, 7cl.

"HI TTS AXD HELP"; FOR HOME NUR I - 0 HYnIE:XE ." By E. Co grave, 11 D., illustrate 1, with chapter on the application of the roller bandage, by R. J. Collie, \l.D. The authorized Text-book for tbe KUl'sing Cour. e. }s., hy post, 1s. :?cl.

2-1

PRICE LIST .

TEXT BOOKS, &c.- (continttea).

"HOME HYGJEKE, " By John F. J. ykes, D. c., (Public Health) M. D .. &c. Illustrated. The authori.ed TextBook for the Home Hygi ene 'ourse, Is., by post. I s. 2d. 'CATECllIS\l ON HOME NURSING, " hased on Dr. Text book). By J. Brown, L.RC.P., L.RC.S., and ,L

M. Carvell, :M.RC.S., L.S.A. Price 6d., by post 7el.

o. QUESTIONS A D AKSWER9 UPON Al.1BULA CE WORK." B)

John W. 1\Ia,rtin, l\l.D, of 'heffield, and John F.RC.. Ed., of Huthlersfield. ls., by post If!. Id. "QUESTIONS AND ANSWERS UPO NURSING." By John \Y . Martin, M. D. Is. Gn., by post I s. Scl. "FIR'T AID TO THE ( 'ix Ambulance

By Professor Fretlerich Esmarch. Translu ted from the Germiln by H.R.H. Princess Christian. 2s.. by post:2 . :2(L "ELEMENTARY AND SURGICAL 13,: -Walter Pye, F. R C.,. Zs., by post 2s. 2cl. .

DR. G. H. 's " FIRST " being a card 1,0 hang giving treatment of various accidents. 2d., by post 3d.

To RESTORE THE ApPARENTLY DROWNED, }Jl'inLcd in largeType with Two Diagram. Unmounted, each :2d. Mounted with r ... d border, and varni hed to hang up, 6(1., PO:lt fl'tc? packed, Is.

" How TO ACT WilEN CLOTHING TAKES FIRE." By J. K H Mackinlay, M.R.C. ' . Unmounted 2d., by post 3<1 Mounl ed on card and varnished, 4<1. ; by post, packed, '/ d "FIRST AID Card of concise direction for wc).istcoat pocket, each 4d. !let' dozen. 'pecia.l quotations for large quantities. ,. PECIMI!: PAPERS, First AiJ and Tur.ing Course." 3d., by post 4d.

SMALL ANATO)llCAL DUGRA I. ,howing the humanskelelon, main arteries, an<1 points where pre Sllre should be applied to arrest bleeding. 2J., hy pORL ::h1.

PH-ICE LIST. 2&

TEXT BOOKS, &c.-( contmuerl).

AWl!: MEMOIHE. Ou (:Mclbuarcl, ill linen·lilll:cl t'J\\clopc,' fur By laLe f:lurgeon-Major P. Shepherd. onLammg useful for Firf-lt Ai(l tn the Injured. ::lcl. by pOf-ll 4el. . ,

GENERAL NOTES ON FIRST AID TO B'E L CASR OF PO.ISONI'\G. By l1ilnes H ey, M.A., M.R.e'., '., L R C I) )1 1 ... 1> l'lCC :.( .; Jy post :3(l.

"gl\IERGE:-<CY BOOK" f . • T .' or lllfiLallULllcoU" glVlli r • ('onClf-lC Lo hang on wall. .a 1HHlt one !-Hluarc. Pl'1C(' :?". fH. ; l)y po. l :{".

A HISTORY OF THE ORDER OF THE , HOSPITAL OF ST. JOHN OF JERUSALEM B ' I Rev \\' r R B'. . .' tit' . . \... . JWFOK.D, Gelle-l1(JuisL of tlle 0 '1 1 L · t C -I 0 11 e1. eLlH leU.- 0 une1 R H . HOLBI:<:UUE Li1 . ,', f) 0 In one \To1 D _ . ,). . ' )tall,lll () t Ie relet. ) .' ," 0., pp. Pl'Ofll'.;e ly illu. Lrated. : 1.H.:e IS. Oll.; by post IS. WIl. A Limitc'clnumbcl' of co pies IllJlll'cdlJ,rdamp canbeh·1d·lt·)s 6cl -I f . • • c • eae t; pos t rec c)s 1uel THE KNIGHTS HOSPITALLERS IN SCOTLAND ' AND THEIR PRIORY AT TORPHICHEN B ' .

T1I0\lAS BEAT:-oO"l l\l.D C]"> Y"'tl 1-' ) " ,. .). \ \ 1 1 t) pacres of llluslimLIOIl". Pril:c ')" 0(1 b l' 1) 0 S( 1.. ., (lUll( III C ot 1. Po.·t

l'RICE LIST.

ROLL E R BANDAGES.

:i in., 6 yards long, PCl' doz.

II. in., 6 yards long

1;; in., 6 yards long

:2 6 yards long in., 4 yards long

-2;; in., 6 yards long

:3 6 yards long

4 in., 6 yards long

-6 in., 6 yards long

ROLLER BAND AGES in A ss ortment.

Each packet contains 6 bandages .as follow 3 1

6 yards long-one 6-inch, two. -me 1, OJ long-two

Fine Grey Calico .,.

I-inch;

Tlain Triangular Bandages

. 1 Bandages (after ERmarch),

Illustrated Tnangu ar B 1 h . 21 applications of the Triangular anc age, s owmg <. each t) 6 with printed ins1.rucbons .. , 1 of 6 " pre oz.

'PRICE LIST. 27 R OLLER MACHINE.

De igncd hy Dr. A_ C. TUllsLall. Price 2s. 6d. COTTON WOOL.

WhiLe a,bsorbent,!:"'good, 1 oz. packet, 2d. ; 2 oz. packet, 4 oz. packet, 4tl. ; lb., 7el.; 1 lb., Is. ANTISEPTIGlBol'acic, per lb., 1. _ 6el.; arbolic, per lb., Is. Sel. ; Alcmlhroth, p rIb., 1 . 6d. ; Dou ble Cyanide, per lb., 28. 6el. LI NT.

Medium quality, 1 oz. packet, :2d.; 2 oz. packet, 3d.; oz. packet, 6el. ; lb. packet, ] Ud.; 1 lb. packet. Is. 6(1. ; Boracic quality, 1 lb. packet, Is. 6Ll. ; 4 oz. packet, 6el.

OAUZ E S.

nppliecl in 6 yard lengths, width about 36 'I'll . e arc inches.

Unmeclicated whit Alembroth nouble yanide .Boracic 8. d. per length /) 10 1 0 1 2 1 :2

GA U ZE TISSU E

A layer of ab ol'hent cotton wool between two heets of .gm;:w, good quality, per lb., Is. 6el. ; snperior, per lb., 28. R2

Fine

Best

Grey Oalico,or

quality, Open Superior Wove White Opea white, with Grey. Wove . woven erlgee.

B 0 2 d. 9 3 3 0 Z 3 4 d . 1 0 Z 3 6 3 6 3 6 4 6 4 6

d. 9 II I) 6 () 6

4 yard ·

P I' packet

<;. tl. I () 4 6

per doz.

BADGES

PLASTERS

Manufactured oy lessr:,; A. De t. 0111111:1. .&,

L eicester Adhesiye PlastC'r all Cambric, in tillS of· =-s. c1 yard , G ineha wlde ... :.. 0 6i

The Leieestcr Adhesin

Ri.hbD11S, III tin ho-:<e8, 6 yards long.

111('h wiele .. , Gel.

1 illch \\ iele ... 8\1.

Kational Rubber PIa tel' (Antiseptic).

ou spook 5 yds. i11ch wiue 9el. Is . I Is. I.6t1.

2 I s.9d.

Ditto in card box, in. wich' . i Ylls. IOllg tin 1 4 /i " ,,5 " COURT PLA TER, TRJCOLovR.

Large Size, 9(1.; :\fediu1l1, 3d.; :3d.l lel. 3d. 3d. Go. gel.

.Arm Bedge s , with the device, under .Lhe authority of tj,e Centra l Executive COl1umttee, havmg been first approved by H. R.H. the Grand as the official a.nd recognized Badge of Lhe A. SOClatlOll andBngade.

fT.B.-Tli is dl'sigl' is llrotf'dcol, aId be ol,tamed. dU'ect flom the {)entral Offico. . No. 1, for the u e of inclividnal certifica.ted pupl1s--

In Cloth and, ih Ter (Regi tered Number, 3,52'2) ... 2 0

In Cloth and \Vorst d 0 6

:S m all Celluloid Badge for button hole, arm, or b r ooch... ... ... ... .., -- 0 2

'VhiLe ,·'atin ..:\ rmlet, with wov n Badge .. , ... 0

N.B.-Thf'se Badye are not to be worn a.s deco1'a t ion$,

s. cl

In German ilver 0 9 ,'mall ize ditto 0 7i , 'mall ize for bu tton hole 0 6 In Electro Plate 2 0 , 'ma.ll .'ize ditto 1 6 "';mall ,'ize for button hole 1 0 In Cloth

0 9

and, 'ilk .. , .. ,

BADGES .

No.2.

No. for members of the 'to John Amuulallce Brigades' baving the name of the Corps or Division annexed on a . label, only issued in qualltities - (,

In German Silver, first doz. , £1; I ub sequent doze., Us.

In Electro Plate, Drst doz., £1 12s.; subsequent dozs. £148.

In Cloth and Silk, per doz., 128.

In Cloth and ilver. per doz., £1 10

All the above may be worn by member of the, t. J oha Brigade not wearing uniform , and the German SIlver and Electro Plated may be W0rn a the Arm Badge fOl ranks on the.Brigade Uniform.

PllICE LIST.

BRIGADE UNIFORM BADGES. Officers.

Collar Badges (Registered Number, 3,524) pel' pair'

Pouch Badge for ditto" " 3,657)

Sergeants.

Cap Badge (Registcrcd. Number, 3,520)

each

Arm Badge ( " ,,3,52:3) "

Fatigue Cap Badge for Officers and •'ergeants (Registered Number, 3,558)

Corporals and Privates .

Cap Badge (Registered T umher,3,521)

Arm Badge ( " ,,3,542)

Overcoat Badge ( " ,,1,5 2)

Field Service Cap Badge for all Lady Officers of Nur sing Divisions.

Superintendent's Cloak Badge (Reg. ' uperintendent's Arm Badge ( Other Nursing Officer's Cloak Badge ( Oth r Nursing Officer's Arm Ba.dge (

Nursing Sister.

Arm Badge (Registered Numher 3,522)

Cloak Badge ("" :3,521)

Honorary Surgeon's 'ilver Wire CrosH (}JaLtern B)

Superintendent's ilver 'Wire 'tar (pattern A)

Medallion Badge (pattern D) ...

Nursing Badge (pattern E)...

Satin Badge for Nursing. ister's Pin CllRhiol1

Whistle and Chain each

Field Service Cap , complete ...

Private's Brown Waist Belt and Pouch "

White Piping, per Packet of n yards, enough for 3 pair of trou ers (packets cannot be broken) .. 1

Lace , ilver per yare. 1 IBlack ... ... " 1 (A Cap Bancl generally runs S\.hout 24 inc11e .)

30 PRICE LIST.

each TO. ) :3,555} :3,656'

311 s. d 3 () 2 6 6 (} 2 (} 3 92 2 3 0 & 0 4 & H 9 4 (} 3 :3. 2 ()o 2 30 0 0 0 o 2 O· 3 9 7

BUTTONS FOR THE UNIFORM O F THE ST. JOHN AMBULANCE BRIGADE.

issuerl only for the u 'of and )'lembers of Corps alld Divi ion wcal'ing the prescril1('d uniform.

Electro Plate, large '" 'mall ,,'

<German tlil vel', large .,' small '"

.Black Horn, large small

,E LECTROTYP E 5 O F TH E ST. JOHN

AMB U LA N C E I}EVIC E.

Aeries B for for Association. BI'igRde

No.1. For Cards, Ticket, &c.

2. For Note Paper, Small Circulars, &c:. , 3. For Quarto and Foolscap Leiter. ]Ja.per, Oirculars, &c.

4. For Small Posters

5. For Large Posters

Complete, eries

Prints of the above electrotypps, with Lhe exception of No.4, which is c;hown on page 29, appear on the f()llowing :pages.

PRICE LIST. E LECTROTYP E S .

_<\. No. 1 B.

For pri ees sec page 32.

32 PRICE

LIST .

H. d . pel'll()z. 4: II :2 () () () /I 6 /I 4-

nse. use. s. d. (1 1 0 0 1 I) 3 0 ;3 6 1 9 U 5 3 f. 6

.No.1 No.3 B. No.2 No.3

ELECTROTYPES .

No.5 A. For pn ceR Rce p . age , 2.

34 PRICE LIST.

Flags bearing A'soci<"l.tioll c1eviuc -12 feet by 6 feet

feet by 3 feet

BRIGADE FLAG.

For marking the po,'ition of Ambulance tations at Fete!';, Exhibitions, &c., J ft. l?i in. by 3 ft. Price 12s.

UNIFORMS

These may be obtained direct from HebiJcrL and Co . , :315, Bethnal Green Road, E . Telepholle No. 909, LOIldun 'iVall; Telegmphic " Otherwise, Lonclon ."

CHIEF , A

and Poucb : Blac·k Morocco

All orders for the foregoin g Stores should be given to a he -Local Secretary , or to the stores Department St . John : Ambulance Association, st J'ohn's Gate, Clerkenwell, E.C .

'UPT. AND OTlu:a CHlI<:F

(Badg 'S exLra)

Patrol JackeL

Cross-bell, 'iYhile Patent Leutlwr ::\10rocco POllch (BacIge extra)

Forage Cap antI Cover .

Field CdP (BaL1ge e. tl'a)

Uloyes

Legging ' .. , Great oaL (Badge.' extra)

UPT. OF DI\'I 'ION AMBULA:-iCE Ol< FH Patrol Jacket (Bn.(lgecl cxLm) ... ...... 2 6

Trouser, : Two-inch .r.lohuil' Brnid c1ow'u seam 1 :) "White Pn,tent Leather and Black

Morocco Pouch (Badge extra)

Forage C(1,P ancI Covel' ...

Fiehl Cap

Leggings .,. UreatoGoat (Badges e.'t1'a)

36 PRICE LIST.

£ f;. d. 1 7 6 o

1:2 6

PRICE LI'T.

lJ HONORARY SURGEON. £ s. d. 'l'unie (Badges exLra) ... 4 4 Trollsers: T\>vo-inch

side "cams 1 5 0

Ion Forage Cap and Co\e1' ... 1 9 6 Field Cap 0 12 6 Gloves () 4 6 Ureat oat )Baclge' exLra) 4 4 0 CIIIEF

Tunic

(lhlIges exLra) ... Fatigue Jacket (Badges extra,)

:Mohair Braid

Cross-belt

...

TrouRers: Two-inch :'lohair Hl'<lill dUII11 si(le scallls ...

all(1 Black 4 4 :3 /l 2 10 65 (} n 14 f> 156 /) 10 ) 046 o 6 4 4

nl-! 1 5 010 o 4 o -! -! 6 o (). 6 () 6 6 0.

3 acket (Badge

Vest ... ['RICE LIST.

MESS DRESS FOR OJ< FICER. ...

1ST OLASS SERGEANT.

Patrol Jacket (Badge extra)... . ..

Chevron, 4 bars Silver, 3 . 6d., Worsted

'.rrousers ...

Forage Cup (Badge extra) ...

Cross-belt and Pouch (Badge extra) .. .

Field Oap (Badge extra)

Buckskin Gloves ...

Cotton .,.

Leggings...

·Hreat Ooat (Ohevron and Badge extra)

SERGEANTS, CORPORALS, AND RANK AND FILE.

Patrol Jacket, Black Tartan (Badges extra) ...

Forage

(per pair)

Sergeant's Ohevron Il::lilvcr, :2s. tid., 'Worsted

'Corporal's Silver, I s . Sd., vVorsted

OYCLISTS-S UPERINTENDENT.

Patrol Jacket (Badges extra) ... -Oap (Badge extra) ... ...

Breeches: Grey Serge ...

Shoulder Belt and Pouch ... Gaiters .. Hose ... (ireat Coat

Jacket (Badge extra) ... Cap (Badge extra) ...

Breeches: Grey. erge .. . houlder Belt

Gloves (per pair)

Gaiters (per pair)

All Badges to be obtained by the Corps or Division from I't. John's Gate.

If the Oorps or Division is out of London, measurements to be s upplicd to contractors free of charge.

Carl iage out uf London extr a .

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

.. .

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

£ s. d. 3 3 6 1 8 6 2 6 0 1 4 1 1 0 010 9 011 0 0 :2 8 0 4 6 0 0 0 3 6 o ]3 6

0 11 0

Tartan 0 9 6

Trousers, Black

Cap (Badge extra) 0 -1 Cover for Oap ... . .. 0 0 6! Waist-belt and Pouch ... 0 6 6 Field Oap (Badge extra) 0 :2 8 Great Ooat (Badge extra) 0 13 6 Gloves

0 0 8 Leggings

0 :3 6

(per pair)

0 1 0

2 10 0 1 ;3 6 o 12 I) o 10 6 046 046 046 4 4 ()

PRICE LIST. AND FILE.

3U £ s. J. o 19 6 020 o 12 I) o 10 6 046 046

IXDEX TO PRI 'E 11 T.

Ambulance Hampers ... 15,17 " Htlttion Plate 21

Ashford Litter 3, 4

Badges '" 29, al

Bandage Rolling :.1:.tchiue

Bandages 30

Basiu, Dressing ... H

Books 2 l,

Bottles (Water) ]:3

Braces (Tourniquet) . 3l

Buttons 33

Oarriages (Horse Amblllance) 3

Oarrying Sheet 14

Ootton Wool .. ... 27

Oover for Stretcher or Litter ... 1:l

DiagTams, Large 33

" Small

• Dressing Bas in H

Electrotypes .. . ,. . :12,

Emergency Book

First Aid Box ... .. 10,20, 2L

First Field DreEsinga 21

Flags 30

Gauzes .. . .. . 27

Gauze Tissues. .. .. . 27

Hampers (Ambulance) ... 15, 17

Hnvresacs ... .. . .. . 1

Hood and Apron for Litter ., 4

J 8,conette 2 L

Knife H

Lace in

Lamp ...

Lint .. . .. . 25

Litter (A.shford) 3, <1

LItter (Rea-F.dwanlf; ) 5,8

Lowmoor Jacket 13

Medltllions . 22

Nurses' Wallets 19

K ursing O1mrtfl 22 22.'

Plasters ". 2'-

R ea · B:dwarrls Littf'r 5,

Reg-isters ... .. Roller Bandage Machin e 27

Rug 12

Safety Pins 21

Scissors. l j Rlin!;s, tretcher 1Z

Splint Padding- 20

Splints .. :!1

Station pry .... 22

Stretcher Depot Plate

Stretchers ... .. ... 9, 12' A.djustable Legs for. . 10

Temperature Cbart .. . .. 22'

Text Books ... .. .. 28, 21

Thermometers (Oliniell 1 aud

Bath)... Tourniquets 2l

Tow, carboli2:ed 21 " plain ... 21

Uniform Sundries . .. 29, :31

Uniforms .. . .. . ... 37,3?

Wa\!'ons (Horse Ambulan ce) 2

Wfl.ter Bottles .. 1:.

Waterproof Sheet 4-

Waterol'oof Lint 21

Wbhtle and Ohain 31

Wool (Ootton) .. , 2;-

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