Issuu

--0-_ Lord lrriot.. Hrs GRAOE WnLUU DROGO, D UKE OF MANCIIESTER, K.P.

~~i1i£1J 1)£ ~~£lle. The Right IIonble. WILLIAM HENRY, BARON LEI GH.

~omm~ndet' o£ :m~nleu ~~stle.

HANDBOOIC

Sir EDMOND A. II. LECHMERE, Bart., .IlI.P., F.S.A.

<f3he ~o uncll.

DESCIUI3ING

President-General Sir JOUN ST. GEORGE, K.U.B.

AIDS FOR CASES OF INJURIES

lllajor:Genera1 the lIIost IIoub1e. the Marquis CONYNGITAM. The Rlght R onble. the Earl of DUDLIi:Y. The Right Rev. the Lorll Bishop of ST. ALBANS (Olwplain-Generctlj. Sn' EDWARD G . L. PERROTT, Hart. Lieut.-Genero,! Sir II. C . B. DAUBENEY, K.C.B. JOHN FURLEY, Esq. Colonel JAMES BOURNE, M.P.

OR SUDDEN ILLNESS.

!;xecutive $£fice11S. (Who are ex-o.tficio jJlembel's of tile Council.) Chancellor-General Sir JOliN I::>T. GEORGE, K.C.B. Secl·etm·y and Receit'er-Rir E. A. R. LEOIIMERE, Barr. , M.P., F.S.A. Almoner-General the ViSCount TJ':MPLEl'OWN, KC.B. RegiSt1·cl1'-Lieut.-Colonel GOULD 'W ES1'ON, F.S.A. 6'enealogist-Rev. W. K R. BIi:DFORD, M.A. Libml'ian-EDWU; FRESJIFIELD, .Esq., M .A ., F.S.A. ASSistant SecretCll'y- Cal' litin PEflRO'l'l'. Ambulance Depal·tment-Director: .IlInJ· or FRANCIS DUN OAN R A ~.T A D.O.L., LL.D.

. ., ll"J. .

PET E R

S 1-1 E P II E R D,

1-1. B.,

Y MEDJCL\L DEPARTMENT;

SURGEON-MAJOR, ARM OF ST JOIJN OF JERUSALEM. ASSOOIA.TE OF THE ORDER ' . •

••

PRO UTILITATE JlO.MINUM. Bankers-TH E LONDON AND WESTMINSTER BANK. I , St. Jam es's Squo,re, S.W. Communications may be addressed to the Secretary of the Orner of St. John, St. John's Gate, C1erkenwell, Lonaon, E .C.

1878.

· .' [Copyr'ight registe1'ed at S ta t wne? s Hall] .

CONTENTS. --0--

PaIN TED BY THE A

LONDON: RMY AND NAVY Co 117, VICTORIA STREET W-OPERATIVE SOCIETY, LIMIT , ESTMINSTER, S. W. ED,

PART

ANATOMICAL AND PHYSIOLOGICAL OUTLI~ES. PAGE'

Secti on 1. The Skeleto n II.

The Muscular System

III. The Neryous System

IV. The Organs of

Special Sense

8·

911

v. The Bleod and Organs of Circulation

The Organs of Voice and Respiration

22-

VI.

VII. The Organs of Digestion VII1.

The Organs of Secretion

JX. The Organs of Excretion

2:';

26 2&

CHAPTER IV. p.A.GE

'I:L~MORRHAGE OR BLEEDING:

PART II. MEDICAL AND

Causes of' .... Method of E'"xammation f. ..P ... ... ... Important Symptoms an~ th::~oInsd~ou~d Insensible 11 n lcatlODs ...

Treatmen t of

In toxication

2!:l

Treatment of 40

CAPILLARY:

Treatmen t of

INTERNAL:

Treatment of SITUATION

THE MAIN ARTERIES OF

AND THE BODY,

THEIR TREATMENT WHEN WOUNDED:

. NJURIES OF THN HEAD:

Apoplexy .. . Epilepsy .. . "Blo.od Poisoning '" .OpIum Poisoning .. Shock or Collapse .. .Concussion of Brain 'Compression of Brain

VENOUS: PAGE

CHAPTER II IMPORTANT D ISEASES AND I

ARTERIAL :

S URGICAL OUTLINES.

CHAPTER I.

INSENSIBILITY'

General treatment of

33 on

vi)

33 34 34

Hremorrhag e from head and face and neck armpit upper arm fore-arm palm " thigh .. , bam back of leg " front of leg and instep " sole of foot .,.

31 35 35

41 41 42 42 42 42 43

43 43

CHAPTER III. EATMENT OF CA SES OF

Drowning .. . Hanging .. . ·Suffocation by Gas'~~ Sunstroke ...

CHAPTER V.

38 38 38

FRACTURES:

Varieties of Signs of General treatment of

44: 44:

viii FEACTURES-con timled. Fractures of Skull Lower Jaw'" Collar-bone ::: Ribs Upper Arm ::: Fore·arm Wrist and H~~d Trugh Knee-cap ... Bones of LeO' Foot and An"'kle

CHAPTER VI. WOUNDS: Incised: Treatment of With Protruding Internal'Or ... . ... Contused and L gans: Treatment of FOREIGN B acerated: Treatment of .. ODIES IN THE EYE... . ...

" "EAR ... " BURNS AND SCALDS: Treatment of FEOST BITE: Treatmen t of BED SORES: Treatmen t of BITES FROM RAnm A NIMALS' .. Treatment of .

PAGE

45 45 46 46 46 47 47 47 48

48 48

CHAPTER VII. MATERIAL AND ApPLIANCES FOR THE HELIEF OF THE SICK AND INJURED. PAGJil THE ORDER OF ST. JOHN LITTER STRETCHERS, AND ROW TO USE THEM ... Rules for carrying SPLINTS .• FADS BANDAGES DRESSINGS STIMULANTS POULTICES LEECHES ... DISI~FECTION :

49 49 49 50 50

51 51 52" 52"

54: 54: 51

55 5G 56 56

CHAPTER VIII.

Definition of Disinfectants Rules for Disinfecting Unoccupied and Occllpied Rooms Rules for Preventing Spread of Infectious Diseases BATHS: Cold Cool Temperate ... Bot ... Medicated .,. Disinfectant Alkaline

52 53 53

57 57 58 CO

CBAPTER IX.

61 62 6~

62 62

x POISONS:

CHAPTER X. rAGE

Definition of Classes of General tre~t~ent '~i Emetics Substitute for Sto~'~ch P~~p Arsenic Antimony ... Acids Alkalies Phosphorus Mercury Nitrate of Silver Gases Narcotics Alcohol

nEATH:

63 63 63 6-1: 64

65 65 65 05 65 65 65 66 66

CHAPTER XI.

--0--

TnlS brief ~1anual is simply intended for nonprofessional readers.

There is no attempt made

to popularise ~1edicine or Surgery; the object is to furnish a few plain rules which may enable anyone to act in cases of injury

01'

sudden

illness, pending the arrival of professional help.

Cases of Sudden Cd uses of '" Appcarancf:s of

INDEX '"

PREFACE.

66 G7 67

...

LONDON,

30th October, 1878.

INTRODUCTION. --0--

AT the request of the Members of the Central

Ambulance Committee of the Order of St. John of Jerusalem, I have hurriedly arranged the following Manual for the use of the Metropolitan Police and the other Ambulance Classes now organised by the Order of St. John in all parts of England. The careful work which I should like to have bestowed has been

rendered impossible by the

exigencies of the Service requiring me to proceed on foreign service. I have been aided by kind and able coadjutors, who have given their knowledge and experience.

XIV

I trust that this handbook, given cheerfully and gratuitously-like all the work conducted for and by the Order-wiIl be found to be in some degree "PRO uTILITATE IIOl\IINU:\I."

P. SHEPHERD.

JU~IOR UNITED SERVICE CLUB, LO:\TDON, S.\V.

3 0tlt October, I878.

PART T.

THE IIUl\lAN BODY. SKELETON, or bony framework. IT. MUSCULAR SYSTE~l; the organs of motion. III. NERVOUS SYSTE~I; brain, spinal I1UUTOW :llcryCS of scnsation and motion, and sympathetic nervc··. IV. ORGA~S OF SPECL\.L 8EXSE; eye, car).> tongue, nose, and sbn. v. BLOOD AND ORGAXS OF CIRCrL\.TIOX: heart and blood-vessels. . VI. ORGANS OF VOICE AND RESPIRATION j larynx, lungs, and windpipe. YIT. ORGANS OF DIGESTIOJ.. ; pharynx, gullet~ stomach, and intestines. VIII. ORGANS OF SECRETION; salivary glands~ liYer, and pancreas. IX. ORGANS OF EXCRETION; kidneys and skin. 1.

B 2

5 I.-THE SKELETON. The skeleton is 1' " 1 1 . :ancllimbs. CHIC ec mto threc parts; head, trunk, (a. head

(skull-cap. (face. Sl:EI.ETON b. trunk Jback-bone and bre as t - b one. ribs . Lc. limbs shoulders and arms. , haunches and legs. The HEAD contains the b . ram, and thc organs of si g1lt , Jlearing, tastc, and smell.

The CHEST contain tl l'eBpirntion. s Ie organs of circulation and

Th~ BELI~Y contains the dio- . . . , secretlOn and excretion &-c oesvn c apparatus, organs of The rrJ>ER LIl\IB ~ '. wrist anrt hand and is tlOnsl~t: of shoulder, arm, forc-arm The LOIYER LI Ie Olg~1U of prehension. ' ankle, al.ld foot alllI~ t~Onslsts of haunch, thio'h lengression. ' Ie organ of support a~d' pr~~ The SI\TLL is COm) ~ d f . fourtcen, Lone'S. lotie 0 C'lght, and the FACE of 1 FrOl.lt~1 UOJ"(liewlj. 1 ~ccIpital (back of head). SKULL~ 2 le~lporal (t emple bones) 2 ~anetn:l (7·00f). . 1 EthmoI.cl (sieve), j!001'. L1 SphenOId (u.'edge),j!oo)'.

2 Upper Maxillary (jail'). 1 Lower Maxillary (jaw). 2 Malar (cheek). FACE 2 Palate (1'00f of mouth). 2 Lachrymal (tew·-bones). 2 Nasal (nose). \I 1 Vomer (ploughshare). L2 Turbinated.

The F ACIA.L bones, except the lower jaw, are firmly joined together, and form cavities for t,he reception of t he organs of sight, taste, and smell. The TRU~K is divided intoa. Thorax or chest. b. Abdomen or b elly. c. Pelvis. The THORAX is a bony cartilaginous cage of a coni\.'nl shape; it contains the organs of circulation and re8pira.tion,-heRrt and lungs, and many great bloocl-YC sel:;; awl nerves. The bones of the thorax area. f)pine (behind). b. Sternum or breast-bone (in ji·ont). c. Ribs and their cartilages (at sides). The SPIRE is a hollow flexuous column, and is div:dL',l as follows : Cenical or neck portioll, 7 vones. Dorsal 01" back portion, 12 bones. SPInE ~ Lumbar or loin portioll, 5 bOlles. I Sacrum, ?'tunp-bone, 5 bones fused into olle. LCoccyx.

6 The STERNUM, or breast-bone, forms the front of the chest j it has attached to either side a collar-bone and the cartilages of the seven upper ribs. The RIBS are twelve pairs of bony arches forming the \\·alls of the chest. They are all attached behind to the ~pine. The upper seven are termed tnte ribs, being fixed to the breast-bonc by their cartilages: the lower :five are termed jioaling or jet/se ribs, having no attachment in front. The ABDOMEN is supported behind by the lumbar ;--pine, and below by the bones of the pellis. Its contents a l"e as follows :_ Liver. Stomach and intestines. Pancreas or sweetbread. Spleen. Kidneys. Many large blood-vessels and nerves. The PELVIS is the basin-shaped caYity "'hich forms t he lowest portion of the trunk j and contains the bladder,

the internal organs of generation, part of the intestine, ;md several great blood-vessels and nenes. The pelvi:) j" composed of four boncs2 Innominate or haunch-bones. I Sacrum or l'ump -bone. I Coccyx. The If NOl\IU\fATE or haunCh-bones, with the lower portion of spine (sacrum and coccyx), form the lowest portion of the trunk. The innominate bones on their outer surfaces have cup -like depressions for the reception of the heads of the thigh-bones.

7 or collCl?'-bone The SHOULDE R I.S f ormecI by the c1cwicle " l or blade- bone. d an scclJm CLCl\VIC LE; or co llaI' , -bone , has a double curve;

.t . d ' ~· d·no. n eck and chest. T he it mal'ks the h ne IVI 1 '" . 'on the back of the The SCAP UL.A, or b:adhe-b~01~e~c{11~rms the socket for s ape, ' h t l' S of a tnangular ces, b the humerus or ar l11- one. 1 H umerus, arm-bone. , 2 Hadius and -elna, fore-arn _. UPPER LIMB) 8 Carpus, wrist. I 5 :;Uctacarpus, palm. , L14: Phalanges, finger -bones. f ") )er arm extends frum The IIU~lERU~, or bone 0 bUI ~ it is 'J'ointed to the J 11 to the elbow ' a OV, the s lOU c er low to the bo~es of the fore -arm. scapula, and l ' , b ne of the fore -arm, lies on Th~ -e r N ~ IS the argCl 0 . t the i:sicl/ a;lcl exteucls from elbow tD Wl'lS .

r J

The n .~DIUS lies on the outside of the fore-an:1 . 'hich The (' ~\npUS is. a ~l~uble row of small bone;j \\ h I t form the "\TI'ISt- Jomt. METACARPUS con. ists of five bones, and forllls the body of the hand. The PHAL~\NGES are the fourteen finger-bones. The LO' VEH. LI MB is composed as follows : 1 Fcmnr-thigh-bone. I 1 Patclla-knee-cap. ) 2 Tibia and Fibula-leg- bon S. LOWER Lnm ~ 7 Tarsus-ankle-bones. 5 Metatarsus- instep-bones. L14: Phalanges- toe-bones.

e~heo

r I

HIP JOINT is a ball-and-socket joint and i1l The VOLUNTARY MUSCLES. form a fl eshy COV~l'i~l~ :-,omewhat similar to the joint at the shoulder. ' to the skeleton. Each muscle conSIsts of bundles of ~bl c~ The FEl\1UR, or thigh-bone extends from hip to knee enclosed in a covering, or sheath, and two extremlttes or joint-, both of which joints it h~lps to form. t endons £01' its attachmenb to the bones. . . All muscles.have t~e power of contrac~IOn. u~~ler btlln~l-, The PATELLA (knee-cap) is the small oval bone which 1a.tion, and it IS by thIS property that mohon IS gn'"en to t.1C forms the prominent point of knee. . The KNEE JOIKT is formed by the lower end of various levers of the body . femur, the patella, and the upper end of the tibia. The INYOLUNT.Al~Y, or non-stria~ed ~usc1es, arc . The TIBIA is the main bone of the leg, and extend~ found in such organs as the stomach andmteshnes, and (~O not act in obedience to the will, but obey the sympathetIC from knee to ankle, on the inside of the limb. The FIBULA is the small bone on the outside of the n ervous system. ji l?b: the ~o\y.er ends of ~he tibia and fibula form proIlr.-THE NERVOUS SYSTEU. mment prOjectIOns at the SIdes of the ankle. The TARSUS, ankle-bones, are seven irreo'ularly shaped The nervoUS system is composed as follows : bone~, .:firmly united together; above they a~e attached to 1. Drain and 0 pair::; the tIbIa and fibula, and in front to the metatarsus. of nerves. Cu.) CEREBRO-SPEAL AXlsi 2. Spinal cord & 31 .The METATARSUS forms the instep: and togethel' L pairs of nenes. WIth the tarsus the arch of the foot. 3. Ganglia and The PHALANGES, bones of the toes, are fourteen in (b.) SnIPATIIETIC SYSTEM { nerves. number, two for the great toe, and three for each of the The BRAIN is the largest and ~10st important mf\"S others. ()f nervous matter; it is subdivided mton.-THE MUSCULAR SYSTEM. 1. Cerebrum. 2. Cerebellum. The MUSCLES are the active organs of locomotion' 3. Medulla oblongata. they are formed ?f bundles of reddish fibres; they are th~ lean flesh. ThOlr fibres can be well seen in a piece of The CEn.EBRU~I, or brain proper, consists 01 t \YO overdone meat. similar ovoid masses, divided above by a deep groove, awl Muscular tissue is divided into two varieties: striated connected below by a tra.nsverse commissur~. -1 , and nOl?--striated, or voluntary and involuntary; the It is the seat of the ll1tellect, the emotIons, and t.1l former IS under the control of the will, the latter acts will. independently. ' rille

r I

CEREBELLt:~l,

.. th th e cerebro-spillal, \' l I s andti thcn Thc or little brain, lies at the back of branches communicate I thefl cely involuntary musc e 'jar 'su e ' the head; its function is to r egulate the movements of the system, Th% the involuntary, the body: body. funchon th blooel-supply, the nutIltplO . 1 sis of ey O'ovelll C and excre t'lllg forO'ans ala y The MEDULLA OBL OKGATA is the upper enlarged tl'1th secretin. fI' > 'blood-vessels of \ 1l<' part of the spinal cord; it is in this I)Ol~ion that some C1'OS8- ane, ese ;1'oduce; enlargement 0 1 " ing of the J1Cl'YOUS fibres takes place, whereby the route of n cr,;' 't I which they are ehstnbntee.' communication of nervous influences is changed from one pal s 0

S~~~t;'ol

~~s~~,

tlll'~W

:,lide to the other; anel this fact accounts for a blow, i n j u r y \ . . X S OF SPECIAL SENSE . or disease on one side of the head producing paralysis on the IV.-TIIE ORG~ opposite 'ide of the body. k

The SPIRAL NERVES are thirty-one in number, on each side j they al'ise from the spinal cord by b,o roots, an anterior or motor, and a posterior or sensory. They act as conductors, to and from the spinal corel.

The organs of special sense are1. Eye. 2. Ear. 3. }(ose. 4. Tongue. D Skin. p' '. b een t ermed 'The <,11'(' The SPECI~L SE~S~.~:~~~ fact that. they :.ecel~~~ G ateUJU!}S of 1\.110 Wleclge., imI)l'essions regan.lll1g SUIIoun it to t 1Ie b ram . a.nd tl'~nSIll 'h their nerves. t anII con ists essenill 0 ' objects throug " . l' struIllen ( \. The EYE is an OptlCU 11l. c1 three hUIllours or rerno's or tWllCS, an so COlltj[lll~ of threel · coa These transparent IllecliR. a1'\, clelic" It..' fractm 0' mec lao f b' eets are focussee on < 1 < "I tl t imao'es 0 0 J . h structec la " t t . t the bR.ck of t e eye. sheet of nervouS ma er a The tunics are , b l' 1. Cornea in front. 1. Sclero~ldc, behl~~ ~ Iris in 'front. 2. Chor01, e I n , ,

The SYl\IFA.TIIETIIIC KERYOUS SY>-:TEl\I COll.'i ts of n dOll ble chain of small nervous centres or ganglia" which lie along the sides of the spinal column; theil'

3. Retina. h't coverill"" . tl tel' fibrous w 1 e .., , The. CLEROTIC IS Ie ou tic nerve and blood-vessl'lc;; ;behind, itis perforated by the op

The CEHEBRAL NERYES consist of nine pairs; they arc motor, sensory, or compound in their functions . A motor nerve conveys an impulse from the brain to some 111uscle or organ. A sensory nerve receives and conveys an impression or sensation to the brain. A compound nerve contains motor and sensory fibres, and is consequently IJossessed of a double function. The SPINAL CORD is a cylindrical column of soft llerVOU3 tissue, extending from the base of the skull to nearly the lower end of the ICrte bral canal; it is about eighteen inches in length. It is both a neryous centre anel a conductor of neryous infiuences; it gives off thirty-one pairs of nen-es from its sides. If the cord is cut all parts of the body below are paralysed.

~0.its sides are fixed the muscular apparatus' in front it i

ear consists of a funnel , canal 01' tube, and a drum or membrane at its inn or eml. The drum divides the OUTt:l' anrl middle l)ortions . . ' The middle portion or tympanum commulllcates WIth the mouth. The internal car is the part where the filaments of the nel'yes are spread out to receive the yibrations or sounds. Blows on the external car, and concussions from gun. hot amI other explosions, arc apt to rupture the tympanum or' drum. The TOSE or oro'an of smell, is a double-chambered cayity, lined with a m~1Cous membrane, over which is spread numerous nen-e filaments, branches of the olfactory nen-cs, for the reception of odoriferous impressions . The TONGUE, or organ of taste, is situated in the. fi001' of the mouth. It is mainly composed of muscular tIssue, and is freely supplied w-ith blood-vessels and nerves. Its upper surface is studded with papillre. The nerve filaments are spI'cad out over the surface of the tongue and back portions of the mouth. The SKIN, or organ of touch, is the entire coveriJ?-g: of the body' the moc1ifiell skin (mu cous memu1'Cllles) 11ll1l1g passao'cs 'alSO possesses this property. The nerve fila.mcnt; end in small loops inside th e papillre. The sense of touch is most delicate about the tips of the finger::: n,llll lips.

]omed to the cornea.

Tile U?RNEA is th~ clear portion of the eyeball; it is attached ~o the sclerotIc in front like the glass of a watch. :l'he CHOROID. lies beneath the sclerotic, forms the Huddle coat, and IS very freely supplied with bloodvessel::;. The mIS is .continuous with the choroid.

It is a thin

?ol~u~'ed curtam surrounding the pupil, the size of which

It go\ crns, and thereby regulates the admission of ljO'ht. The,~T)ETINA . a ~no~t (1el'lC~te. semi-transparent sheet :5 \ , IS of nell OU8 matter, lymg III the mSlde and back of the eye. . Tho Tn~NSPARENT MEDIA, by ,yhich the rays of llght are refracted before they form iUl<wes on the retina

aro-

G t

Aqueous humour. Crystalline lens. Vitreous humour. '1110 CORNE~\" is also a transparent refracting mediuu). The AQUEOUS HUMOUR lies in front, between the lens aUll the cornea. ' . The CRYSTALLINE LENS lies behind the pupil' it '

1;-> a double convex lens.

~he VITREOUS HUMOUR lies behind in frOJ~t of Tetma, and occupies about four -fifths of the ~ye. Th~ prl~IL varies in size; it contracts in a brio'ht lio'ht and dIlates m darkness. :5 :5,

'~'~e EAH, t~e organ o.f hearing, is composed of three

}JOI hons: an ExteTnaZ, lJIlddle, andlnte1'nal.

The external

Y,-THE BLOOD & ORGANS OF CIRCULATIOK. The BLOOD, or <. Ti ver of '((e," is the most imporb111t and abundant fluid in the body; it is contained in the arteries. veins and capillaries-is everywhere present--proyjde ~.

.------'-

14 the tissues with nourishment, and removes their waste pro~ ducts. The total quantity of blood is estimated at about one-twelfth to one-eighth of the weight of the body. Its colour in the arteries is bright red; in the veins dark purple. Great loss of blood produces death j so also does any considerable change in its composition. Blood removed from the body separates into two portions-a red clot and a clear fluid. Its temperature in the body is :_ from 98 dcg-. to 100 deg. Its composition is as follows ('Yater. Corpnscles-?'ed and lL'hite cells. BLOOD

' i

A.lbl~men.

Flbrme. , Fatty matter. LGases. The organs of circulation areCa.) HEART. Artel'ics. Capillaries. Veins. The IIEARTis a hollow muscular organ, situated between the two lungs, and enclosed in a sac called the pe1'ic((TClium. It is about five inches long, and three and a-half inches broad, and is divided into two halves-a right and a lefteach siclc or half having two chambers, an auricle and a vcntricle. The right side receives the venous blood, and drives it to the lungs to be purified and returned to the left. The left side receives the arterial blood, and forces it through the arteries to every region of the body. (l}.) BLOOD-YESSELS

:::EUJ

I-

en >en

16 The openings betwecn the chambers and the mouths 'of the large vessels leading into or out of the heart arc guarded by valves or trap-doors, to prevent regurgitation. ACTION OF TIlE IlEART.-The heart acts by altcrnately contracting and dilating, at the rate of seventy to {'ight-j times per minute. The two auricles contract and dilate Simultaneously, and so do the ventriclcs, but the former alternately with the latter. CIRCVLATION._The impure blood returns from the boely tbrough the veins, and enters the right auricle; the right auricle contracts and forces the blood into the right Yentricle; the right ventricle then contracts and forces the blool1 on to the lungs, where it becomes purified. Aiter lJeing puri.fied it returns to the other side of the heart, to the left auricle, which contracts and drives it into the left ventricle; the left ventricle now contracts and dri\(~s the blood through the arteries to the system generally, where it is conveyed by the capillaries into the veins. The preceding is a rough tabular, iew of the course of the blood. THE

ARTERIES.

The artel'ies are the vessels '"hich convey the blood from the heart to every part of the body. The Pulmonary Artery arises from the right ventricle of the heart, and carries venous blood directly to the lungs, frolll whence it is returned by the pulmonary veins to the left auricle. This constitutes the lesser or pulmonic C/l'Clllation. The AOl-ta arises from the left ventricle, and .carries through its subdivisions arterial blood to the body generally. This constitutes the grcatcl' or systclIlir' ./·i}'('uZrltion. The aorta and its branches resemble a

17 . , The laro'er trunks are ~lsually highly. rall1lfiecl tIee;otectecl sit~ations; the arterIes terfound minateIJ?-m the the mo~tIIP,. capl anes,. a ncl the ycins begin in them. ARTEInES\ND VEINS :DIFFERENCES BETWEE~ from the heart 1. The arteries c,a~'ry blood away towards the ~xtremltIebs'l od towards the heart from 2. The vems carry 0 the extremities. 1 blood. Veins carry dark 3. Arteries carry ree purplre blood'll . f the arteries are stronger and m!:e ~i~st~~~ a~dohave no valves, except where they leave the heart.

f the veins are thin, and han

vaf~c~ho~l w~~~r °inner wall, ,ybich prevent blood

from flowing backwards. fi ' I tl arteries 6. Some veins are quite super CIa; Ie lie more deeply. ' . . 7. Tb e current is slower 111 the vems. PRINCIPAL ARTERIES.

Th A ORTA arises from the left ventricle of thel~leart e l' t arches backwarc s, ane it ascends for a sholrtftCl~dancoef' c spine through the the d d I no' the e Sl e escen sao :5 t'l 't is opposite) the f our th chest and abdomenh) ,U~J.l d '~des into the two iliacs. lumbar vertebra, w ele lu 1 . . T h INNOUINATE ARTERY) a short trunk aTl~lll~ e t 1 upwards for about an mc froma-half, the arch of ad~r~ad' and and IVI esex.me~c0 \he 1~ight carotid and 1'ight .subclavian.

The RIGHT CO:\nIO~ CAROTID is a branch of the innominate artery j the LEFT COMMON CAROTID is a branch of the aorta. These two vessels ascend the neck, one on each side of the windpipe, to about an inch below the angle of the jaw, where they divide into the external and internal carotids. The comse of each vessel is indicated by a line drawn from the joint of the collar and breast bones (st enw-claviculaJ" aJ"ticulation), to a point midway between the angle of the j.")'w and a prominence of bone behind the ear (mastoid ]J?·ocess) . The INTERNAL CAROTID commences at the division of the common carotid, opposite the upper border of the thyroid cartilage, and proceeds up,vards to the base of the skull, which it enters and supplies the brain. The EXTERNAL CAROTID is the outer branch of the common carotid j it proceeds upwards towards the ear, in fron t of which it passes on to the temple. It supplies various branches to the face, temple, and back of head.

The course of this ye scI is indicated. by a line d~a"'1~ f rom outer side of axillary space to a pomt at t~e mf(l~yc of the bend of the elbow, or l)'y the in?-er bore ~r 0 1C · m usc Ie ; failino'b these to"'mdcs' , by Its pulsatlOn.. b lCeps The U\"DIAL extelllls do,,'mvards along the raclial 01: outer sid~ of the fore-arm, hom al.ittle below the beml o~ the elbow to the wrist i it here wmds round to the . ba~.l, of the metacarpal bone of thumb; passes thlol:ol: betwcen the thumb and forefinger to the palm; and fonllR the deep palmar arch. . . . The ULN.AR is the larger of the two ~IVISlOl?-S of the ' l' 1 It descends alono' the ulnar or mner SIde to, t~le b lacna . then, entering I:>the paI m, f orms th e sup edicl',l wrist; and ( palmar arch. The CO:\nIO~ ILL\"C AH.TERIES are formed by the bifurcation of the aorta ' they pass dowmY3:TC1s ~nd OL1b\:~l'~l~ to the brim of the pelvis, where they dIVIde mto extcIJ)ul and internal iliacs. The EXTERNAL ILIAC commences ~t the bifll1'c~:-, tion of the common iliac, passes along the brIm ?f thc l~cl \ 1::; and makes its exit from the abdomen at the mIddle 01 the: fold of the groin. The INTERNAL ILIAC is the inner. division of t.h~ common iliac; it desceuds into the pelVIS and snpplIes the organs there. .. The FE:\IORAL, the continuation .of the exterm~l ]11<1.(;,. descends alonD' the inside of the thlgh for twO-thI!-'ds of its l eno·th, and then passes to the back of t~e .thl~h to becom~ the popliteal. The course of the artery IS lllchcat~u by dra.wing a line from .t~e middle of the fold of the grOIn to the inside of knee Jomt.

The SUBCLAVIAN, on the right side, is a branch of the innominate artery j on the left side it is a branch of the aorta. They leave the cayity of the chest by passing under the collar-bones and over the first ribs, and t erminate in the armpit by becoming the axillaries. The AXILLARY is a continuation of the subclavian j begins at lower border of first rib j and, after crossing the armpit, ends in the brachial at the margin of the anterior fold of the armpit. The BRACHIAL is a continuation of the axillary j it lies well on the inside of the upper arm, and extends from the anterior fold of armpit to about an inch below the elbow, where it divides into the rawal and ulnar.

The POPLITEAL, a continuation of the femoral, ext~nds along the back of the lower third of the thigh to a h ttl e below the knee joint; it runs down the middle of the ham; and divides into the anterior and posterior tibial. The ANTERIOR TIBIAL, a branch of the popliteal, passes to the front b etween tbe two bones of the leg and descends to the instep, where it divides into branehes fo~ the toes. A line drawn from head of fibula to a point Imdway between the two projecting ankle-bones (malleoli) w:ill be parallel to this artery. The POSTERIOR TIBIAL is the other branch of the popliteal; it run~ down.the bac~ of the leg, and, passing along the depressIOn behmd the mne1' ankle-bone, supplies branches to the sole of the foot. The PERONE~L arises from the posterior tibial, passes ~lo\l'1l on the outslue of the back of the leg, and divides mto branches around the heel and outer ankle.

V eins are divided into snper:fi?ial and deep,; the fO:'lUe can be readily seen under the skIll, the ~atter he d~epl.)flan,c " rrhe current m the vems :1ccompany ar t enes. bt ' 0"\. s towards the heart, exactly the reverse of what 0 aIllS m

THE YEINS. The veins are the vessels "which servo to return the blood from the capillaries throughout the different parts of the body to the heart,. The PULl\lONARY VEINS are four in nun~ber' two for each lung. They carry mterial blood from the lungs to the heart. The SYSTEMIC YEI JS return the dark impure venous blood from the body generally to the right side of the heart. l\lost veins are provided with valves to prevent the reflux of blood.

the arteries. '11' 't o'ain and The veins starting in the capi anes .tU11 e a o c ao'ain till they form t,yO large trunks, wInch empty thems~lves in the right auricle. YEINS OF HEAD AND NECK.-The jugul~~sd form ed by numerous branches from the head, fa~c, < neck )ass down from about the angle of the Jaw, to the insIde of the chest, and, nniting with the subclaVIan; form the innominate vein, VEINS OF UPPER EXTnE1\lITY are dividell into a supe?:ficial and a deep set , , 1 t,'. The deep set correspond to and lie alongs,lde t Ie ~~' ones. The superficial set are the ra~ial, ulnar, me(~lan, basl:lc, an~ h r The brachial r eceIves the Cel)hahc and fon11S th" C~~)ll aly. a ,1C. rrhe <. axillary crosses the armpit, and becomcs :1Xl fu '1. the subclavian at the lower border of 'st nu. '1'1 SUBCLAVIAN vein is a continuation of the axillary, lie~ ~~hind the collar-bone, crosses from o~t,er edge ,of ~rst rib to behind sterno -clavicular joint, and Joms the mtemal juo'ular to form the innominate. ~rhe 'INNOnII1~A.TE VEINS are two large trUll,ks placed one on each side of the root of the neck; they umte togother and form the upper 1'(!'IlC/ CClva,. C

The SUPERIOR VENA CAVA, formed ~Y t~e mR~l1 vessels from the upper half of the body, empties Itself In the ?'ight Clt4Ticle.

22 VElliS OF TIlE LOWER EXTREMITY are divided in to two sets, stlJm:ficial and deep. The superficial are the internal and external saphenons. The former begins about the instep and ascends on the inner aspect of leg and thigh, is joined by numerous branches on its way, and joins the femoral just below thl' fold of the groin; the latter ascends the back of leg to join the popliteal in the ham. The popliteal passe. up thro ugh the ham, and then through the substance of the thigh to become the femoral. The femoral lies alongsicle the artery in front of the thigh in its upper two-thirds. The EX'IERNAL ILIAC is the continuation of the femoral, and terminates by uniting with the internal iliac 1.0 form the common iliac.

23 Th LARYNX is the upper portion of the air-passage, and t~e organ of voice. It is situated betwee,n the tl'ach~~ and base of the tongue in the upper and fore-partofthe nec 1

The INTERNAL ILIAC collects the blood from the organs in the pel vis. The COMMON ILIAC , formed by the junction of he external and internal iliacs, terminate by uniting to form the inferior vena cava. The I::TI'ERIOR VE)TA CAVA returns the blood to the right side of the heart (right aW'icle) from all parts below the midriff. It is formed by the union of the two common iliacs, and joined by branches from the h,c)', kidneys, and othcr viscera. VI.-TIlE ORGAXS OF VOICE & RESPIRATION. The organs of voice and respiration are-Larynx. Trachea. Bronchi. Lungs.

on either side arc the large hlood-vessels o~ th? neck, an~ behind is the gullet. The larynx is a cartllagmous tube, and inside this tube are placed two narrow fibrous bands,

2-1: which are attached before and behind, with a chink between them for the passage of the air. Thc vibration of these bands by a forced expiration produces the voice. Th0 TRACHEA, or wind-pipe, is a cartilaginous and m:l~branous tube, e:x:tend~n~·. froI? the lower part of the lal J nx dow~wa:'ds ~o Its chvislOn mto the right and left bronchuS-It hes III front of the neck, anterior to the gullet. The BRONCHI, right ancl left one to each lung, are formed by the division of the tr~chea. The L,uNGS are the essential organs of respiration; they are t,yO III num.ber, onc in each side of the chest, separated the heart, bloocl-ve~sels, bronchial tubes, and gullet. 1hc lungs are enclosedm clouble sacs or coverings termed jileu ~·te, a~d are composecl of a light spongy textur~ for the ramI~catlOns of the bronchial tubes, the pulmonary artenes, and the pulmonary veins.

~l'~e br~nchi~l tube~, after dividing and subdividing, tel:r:rnate III l1nnute mr-ce~ls? over which is spread a netWOIl... of ?loo~-vess~ls. It IS m these minute blood-vessels that punfi~atIon of .the blood takes place, venous beinaconverted mto arterIal blood. Carbonic acid and watery vapour pass from the blood into the air-cells and oxyo'en passes from the air-cells into the blood.' 0 ME?IIA...\ISli OF RJ~SpmAT!ON.-During an inspiration the c~est IS enlarged by c.levatmg the ribs and depressina- the diaphragm; and durmg an expiration the chest is dimi-

25 nished by depressing the ribs ancl elevating the diaphragm. The object in artificial respiration is to imitate the natural action. The averagc capacity of the lungs is 250 cubic inches. The amount of air (tidal air) taken in and passed out " ith each respiration is about 30 cul~ic inches .. Respiration takes place about 18 tImes per mmute. The VITAL GAPAClTY is the greatest volume of air that can be expired after the deepest possible inspiration. The difference in the vital capacity between a person (hessed and undressed is probably about 60 cubic inches in favour of the latter. This is an important fact to recollect ill employing artificial r espiration.

VII.-TIIE OllGANS OF DIGESTION. The organs of digestion consist of th? Alimentary Call~l and certain accessory organs. The Allmentary Canal IS a musculo-membranous tube, about thirty feet in length, and comprises the following parts:Mouth. Pharynx (back of throat). CEsophagus (gullet). Stomach. Small intestines. Large intestines. The MOUTH, an oval-shaped cavity, contains the teeth, tongue, palate, and ducts of the salivary glands. The PHARYNX lies at the back of mouth and top of gnllet, behind the root of the tongue and laryn..'{.

The (ESOPHAGUS, or gullet, extends from pharynx to stomach, and is about nine inches long; it lies behind the windpipe, and in front of the spine.

It is made up of lobes , lobules, and cells; it has a duct, for conveying its secretion to its resen'oir-th e gall bladder.

The STOMACH is a pouch-like enlargement of the alimentary canal; it lies on the left side of body, under the diaphragm, with the liver on its right and the spleen on its left side. The stomach is the chief organ of digestion.

The GALL BLADDER is the reservoir for the bile; it lies under the right lobe, and communicates ,,,ith the intestinal canal below.

The S~1ALL INTESTINE is the continuation of the tube beyond the stomach; is a very tortuous canal; and is joined below to the large intestine. Th e LARGE INTESTINE is a continuation of the small intestine; it ascends from a point near the right h3.unchbone on the right side, crosses the abdomen under the JiveI' and stomach, and then descends on the left side.

VIII.-TIIE ORGANS OF SECRETION. ecretion is th e process of elaborating special products from the blood, as saliva, bile, pancreatine, etc., .0 be further used in the economy. The Organs of 'ecretion a1'eLiver. Pancreas. Salivary glands. The LIVER is a large reddish-brown organ, situated chiefly under the false ribs on the right side of the body; jts weight is about three to four pounds.

FUNCTIONS OF THE LIYEH, 1. Secretes bile, which aids digestion and acts a'

[I.

purgative. 2. Purifies the blood. 3. Elaborates fat and sugar. The PANCREAS, or swcet!m:acl, is situatecl behind the stomach, in front of the spine; is made up of a number of small lobes; is about seven inches long; and 'weighs about four ounces. Its duct leads into the intestinal callal. The pancreatic juice aids digestion. The SALIYARY GL.A.1"\1"DS are situatecl about the sides of the face, neck, and tongue, and their ducts enter the cavity of the mouth. Their function is to secrete saliYa, which keeps the mouth moist, and assists in the process of swallowing and digestion.

The SPLEEN is a ductless gland which lies on the left side under the false ribs; its function is connected with the blood in some way which has not yet been determined.

IX.-THE ORGANS OF EXCRETION. 8:x:cretion is the process of elaborating special products from the blood to be thrown out of the system as useless. Such are carbonic acid, urea and uric acid. The Organs of Excretion areLungs. Skin. Kidneys.

PART II.

The LUNGS have been already described; their excretory function is to throw off carbonic acid and watery vapour. The SKIN is the general covering of the body; it is composed of two layersEpidermis, Cuticle, or outer layer. D erma, or true skin. The skin is porous, contains sweat and fatty glands, and a frce supply of nerves and blood-vessels. The skin excretes the sweat, and is the organ of touch. In health it possesses a temperature of 98 deg. The KIDNEYI::) are two in number, one situated in each loin (small. of vack). Externally is a fibrous layer or covermg; mternally is a cavity communicating with an excretory duct (ureter). The substance of the body consists of bundles of minute tubes. The ducts or ureters descend along the back wall of the abdomen to terminate in the bladder. The blarlde1' is the reservoil: for the urine. The function of the kidneys is to excrete urine, and to r~mo: e certain impurities from the blood, such as carbomc aCld, urea, and uric acid.

CHAPTER T. INSENSIBILITY. Insensibility is the suspen.sio~ of the ~uncti~ns of animal life, except those of resplratlOn and ClrculatlOn. Chief Causes of In sensibility : . Injuries to bram, compression from fracture. Diseases of brain, apoplexy, epilepsy, &c. Poisoning by narcotics-opium, l1W1]Jhia, chloTojonn. . Blood poisoning from kidney dIsease. The above forms of insensibility are liable to be mis"t.:",ken for drunkenness, and it ought to be remembered that these conditions may be complicated wi~h eacJ:t other and with the effects of drink and that no smgle SIgn can be r elied on in forming a c~nclusion on the condition of the patient.

EXAMI NATIOX OF A PERSON FOUND

IMP ORTANT SYMP TOMS AND THE I R I N DICATIONS.

IKSE~SIBLE.

\Yhen a person is found insensible tile follo'wing direc· tiOl1S are to be most carefully followed : 1. Note the position of the body and its sm-rounding-s. 2. Obtain all information possible as to the cause. 3. Place the body on the back, with the head inclined

to one side, the arms by the Rides, and extend the legs. 4. Compare the two sides of the body. 5. In examining the head, pass the fingers gently ?ver the surface, and seal'ch for wounds, bnnses, swellings, or deprcssions. G. Open the eyes, and ascertain if the s~rface of t~le eye-balls is sensi ti ye to the touch, If the pupIls becom e sUlall when exposed to light, and whether the pupils arc large or small, and of the same size. 7. Observe the state of the respiration, whether easy or difficult; the presence or absence of stertor j and the odour of the breath. S. N oLice the condition of the pulsc, ""hcther strong or weak. 0. Observe the general appearance and posit~on of the limbs; andmo bility, crepitu~, shortenmg 0)' lengthening of the bones of the hmbs. 10. Note the state of the ribs and collar-bones.

C01-,TVULSIOKS occur in apoplexy, epilepsy, and kidney diseases; and in digestive disorders, and teething in children. SHIVERING FITS usher in fevers, and indicate danger during illness. PUL E is 1('('((k in cases of fainting, shock, collapse, alHl h::cmorrhage. In'egulm' in heart diseases. ,"'low ((IuZ labouring in cases of apoplexy and diseases causing pressure on brain. PUPILS OF THE EYES arc fix ed Clnd dilated in paralysis and apopl<:'xy. [/ne'luul ill si:..e in serious disease or injury affecting one side of brain. ContrClcted in cases of opium poisoning, and congestion or inflammation of the brain. VIOLENT FITS indicate insanity, drunkenness, hysteria, or epilepsy. l I.tE IORRIIAGE FROM EAR, OR FROM MOUTH, NOSE, or EYES indicates fracture of base of skulL

F LUSHED FACE occurs in intoxication, apoplexy, ancl epilepsy. GIDDD ESS indicates stomach, liver, kidney, or brain disorders.

STERTOROUS UREATIIL.'\G is found in a.poplexy and compression of brain. DIFFICULTY IN BREATHING is a symptom of lung diseases, heart diseases, broken ribs, obstruction in air-passages, or injury to the nervous supply of these organs. COFGH is a symptom of lung and heart diseases-irritation of air -passages. and pressure on lungs or on their neryes. DRA1YIKG OF FACE TO ONE SIDE I Are evi~QUINTING dence of FIXED COKDITION OF PUPILS (dilated) Paralys~s, ,-from dISIRREGULARITY IN THE SIZE OF (ease orinPUPILS jury of the TWITCHING OF THE MUSCLES ON nervous OXE SIDE OF DODY J system. ~TAGGERING GAIT indicates disease or injury of the brain or spinal cord j or intoxication.

IXTOXICATION.-Cause: Excess in drink. Symptoms. Odour of liquor in breath. Insensibility usually not complete. Patient call. usually be roused. No stertorous breathing. Pupils of equal size and usu'l:l~y dilated (large). C;rnea senSItlve to touch. Temperature of body 2° to 3° below normal. Pulse soft and frequent. No difference between sides of body, both being equally helpless. Treatment. Emetics j cold water applied to head j. warmth to surface of body and extremities. .APOPLEXY.-Cause : Effusion of blood producin o• pressure on the brain. 0 Symptoms . Patient becomes suddenly insensible. Face fi ushed or very pale. Pulse full. Breathing stertorous. Convuh;ions. Paralysis. T1'eatment . Place body in lying-down position, with the head raised. Undo clothin o• around neck. Apply iced or cold water to head. Act on the bowels. EPILEPSY.-Cause: Disease or disorder of brain Symptoms. Convulsions. . Foaming at mouth. Biting tongue. Partial insensibility. Breathing and pulse normal. Treatment. Prevent. patient injuring himself.

CHAPTER II. IMPORTANT DISEASES AND INJURIES OF TIlE HEAD. The following conditions are of such frequent occurrence that their symptoms and treatment should be clearly understood and remembered.

34:

13LOOD POISONli~G from kidney disease. Symptoms. Convulsions-insensibility.

Twitching of muscles. Delirium. Breath has a urinous odour. Signs of dropsy. T?'eatment . Hot air or vapour bath. Acti ve pUTgatives. Ice to head. <OPIUM OR MORPHIA POISONING. . Symptoms . Stupor;. con~r~c:ted pupIls;. progreso sive lllsenslbIhty, whICh IS seldolll complete till convulsions 01' death occurs. T1'eatment . Emetics-cold douche to head and chest--walking exercise- strong coffee. -artificial respiration. SHOCK OR COLLAPSE. Cause InjUTies to nervous syst~m b:f bl~ws operations, fright, grIef, hghtmng. Death may be instantaneous; recoverJ may be slow or rapid. Symptoms. Face pale anc.~ pinched, .eyes dull. Pulse almost ImperceptIble. BreathinO' very feeble; the functions 01 respiration and circulation are reo duced to a minimum. T '}'wtm,ent . Place patient ~ horizontal p?sit~oJl restore circulatIOn and respIratIOll. r emove tight-fitting clothing froll neck, apply warmth to surface of bod) and extremities; stimulants may given cautiously in small quantities,

35 CONCUSSION OF BRAIN.- Causes: Blows or falls on head. Symptoms. External bruises, &c. Confusion of ideas. Sickness. Fainting; patient lics pale and shivering. Stupor and partial insensibility. Treatment. Place patient on his back, with head slightly raised, in a dark, quiet roomapply warmth to sUTface of body and extremities. COMPRESSION OF BRAIN. Causes . . Pieces of bone or hremorrhage pressing on substance of the brain. Symptoms . Those of apoplexy, following some injury to head, such as fracture of the skull. Treatment. The same as in apoplexy.

CHAPTER III. TREATMENT OF CASES OF DROWNING, HANGING, SUFFOCATION BY GASES, 8UNSTROKE.* I.-DROWNING.-Send immediately for medical assistance, blankets, and dry clothing, but proceed to t reat the patient INSTANTLY, securing as much fresh air as p ossible. '" The above ciirectiollB are chiefl~ Dr U. H. ;) JLV ]"STER'S method of r estoring the Apparently D end or Drowned, and ha.ve been approved by the Royal Medical aDd Chirurgical Society.

o 2

36 The points to be aimed at are-first, and immediately, the RESTOHATION OF BREATHING; and secondly, after breathing is restored, the rnmIOTION OF WARMTH AND (;IHCULATION.

The efforts to restore life must be persevered in until the arrival of medical assistance, or until the pulse and breathing have ceased for at least an hour. TREAT:\IE~T TO RESTORE NATURAL BREATHING.

Rule l.-To maintain a Free Entmncc of Ai?· 'into the TVindpipe.-Cleanse the mouth and nostrils; open the mouth; draw forward the patient's tongue, and keep it forward: an elastic band over the tongue and under the chin will answer this purpose. Remove all tight clothing from about the neck and chest. Hule 2.-To a(/just the Patient's Posilion.-Place the lJatient on his back on a fiat surface, inclined a little from the feet upwards; raise and support the head and shoulders on a small firm cushion or folded article of dress placed under the shoulu.er-blades. Rule 3.-To imitate the llIovelllcl1ts of Brcathinq.-Grasp the pati ent's arms just above the elbow, and draw the arms gently and steadily upwards, until they m eet above the head (this is for the purpose of drawing air into the lungs); and keep the arms in that position for two seconds. Then turn down the patient's arms, and press them gently and firmly fOJ' two seconds against the sides of the chest (this is with the object of pressing air out of the lungs, Pressure on the breast-bone will aid this) . Repeat these measures alternately, deliberately, and

perseveringly, :fifteen times in a minute, until a spontaneous effort to respire is perceived ill di,ately: upon which cease to imitate the move~ent~~f bI eathmg, and proceed to INDUCE cmCULATION AND WAR)ITH.

Should a .wa:rm bath be procurable, the body may be placed m It up to the neck, continuino' to imitate th movemen~s of br~at?ing. Raise the body for twent e sec~nds m a slttmg position, dash cold wate~ :gamst the chest an.d face, and pass ammonia under "he nose. The patIent should not be kept' th warm bath longer than five or six minutes. m e Rule 4.-To excite InspiJ·ation.-During the emplo ent of th~ above method excite the nostrils with sn;:: or smellmg-salts, or tickle the throat with a f th ' Rub the chest and face briskly, and dash cold a~l~ he~t '!Yater alternately on them. TREAnIEXT AFTER NATURAL BREATHIN"G HAS BEEN RESTORED.

Rule .5.-'['0 1'nduce Circulation and Wannth _ W tl l~atlent m dry blankets and commence ~ubbi~~ Ie lImbs upwards, firmly and enero'etically Th f \=> ~he l1lU~t. be continued under the biankets ~r e tThlctdl~n clothmg. over e 1y .Promote the warmth of the bod b 1 '. ho.t flannels, bottles or bladdeJs o~ t~t apPth~ayon of brlcks, &c., to the pit of the stomach Wtt el, lea~ed ~tween the. thighs, and to the soles' of et~~m¥~!~, atTm dclothmg may generally be obtained fl'om' b ys an ers.

38 On the restoration of life, when the power of swallowing has returned, a t easpoonful of warm water, small quantities of wine, warm brandy and water, or coffee should be given. The patient should be kept in bed, and a disposition to sleep encouraged. During reaction large mustard plasters to the chest and below the shoulders will greatly relieve the distressed breathing. II.-HANGING.-Remove all constrictions from neck . and chest, and employ artificial respiration as for drowning. IH.-SUFFOCATION BY GASES.-Remove the patient into fresh air, undo clothing, and employ artificial respiration, as in drowning. IV.-SUNSTROKE.-Cold should be applied to the head, which should be kept well raised. Tight clothing should be r emoved from the neck and chest. Stimulants should be avoided.

CHAPTER IV. HlEMORRHAGE. Hremorrhage, or bleeding, is the r esult of the opening of a blood-vessel by a wound or otherwise. It may be external or internal. Hremorrhage is divided into-l, A1'te1'ial, where the blood flows in jets in great force, and is of a bright

39 red colour. 2, VenollS, where it flows slowly-wells out--and is of a dark purple hue. 3, Capillary, where there is a general oozing from the smface. GENERAL TREATUENT OF IL£lIIORRIIAGE.-Pressure is -the most powerful means of arresting external hremorrhage; and to use it effectively, it is important that the pressure should be directed against some bone as a point of resistance. In all portions of the body where special treatment is not specified, direct pressure to the wounded part will be sufficient to arrest hremorrhage till fmth er assistance can be procured. ARTERIAL IILE~10RRIIAGE is the most important and the most dangerous form of bleeding, and not a moment ought to be lost in giving help.

Treatment. 1. Expose and examine wound. 2. "Wash with cold water. 3. Elevate the bleeding part, but place body in the lying-do\\TJ1 position. 4. Apply pressure with the fingers directly over the mouths of the bleeding vessels till you can get furth er help. 5. Apply pressure to the main artery Oll the heart side, with the fingers or with a pad and bandage (tourniquet). 6. Apply a pad and bandage over wound as an additiona.l safeguard.

VENOUS HlEMORRHAGE may occur along ·with arterial, or by itself. A superficial wound is more 3ITUATION OF THE }'IAIN ARTERIES IN TIlE DIFFERENT REGIONS OF THE BODY, A1VD likely to divide veins than arteries. Dangerous venous THEIR TREATJ.1 IENT WHEN WOUNDED .* bleeding often takes place where the patient has varicose veins and ulcers on the lower limbs. TREAT~IENT. SITUATION OF VESSELS. REGIONS. (The direction of the flow of bl~od--:-towards ~he H EAD. Temporal, in front of ear. Compress over heart-just the reverse of what obtams m the arterIes, the wound, and P. Auriculm', back of ear. is a fact which b ears on the treatment.) bandage. Occipital, back of head. T"eatment . 1. Expose and examine wound. 2. 'Vash NECK. Carotid A1·te1-ies ascend in Digital compreswell in cold water. 3. Elevate limb, sion in line of a line from inner ends keeping body in lying-down position. vessels above of collar-bones to angles 4. Apply a pad and bandage on both and below the of jaw. sides of wound. 5. Remove any pressure wound, or dior restriction to the circulation 0 )] rectly into the heart side, such as tight clothing wound on the (this cannot be done where arterial mouths of the bleeding has also to be treated). bleeding vessels. CAPILLARY HlElVIORRIIAGE is easily controlled. ARl\IPIT. Axillm'y Artery lies across Compress subT1'eatment . 1. Direct pressure to the bleeding clavian artery hollow space of armpit. 2. Application of ice, surface. behind middle or of styptics) such as alum, steel of collar-bone, drops, caustics, &c., &c. or digital pressure into the INTERNAL HlElVIORRHAGE is seldom so rapid, except wound. in cases of bursting of an aneurism, as not to give UPPER Brachial A1·te1·Y lies on Compress artery time for skilled aid. ARM. inner side of arm, in a bya tourniquet line with seam on coat Treatment . 1. Place patient in an easy recumbent above wound. sleeve-from inner fold position, 2, Apply ice to, or as near of armpit to middle of as possible to, t.he part affected. bend of elbow. 3. Sucking ice is useful in bleeding about mouth, throat, or air-passages. * Wounded veiDs should be treated according to rules laid down under .. , Venous Hremorrhage."

42 REGIONS.

SITUATION OF YESSELS.

FORE-ARM. Radial Clnd Ulna1' A,'te"ies begin a little below the middle of bend of elbow and descend one on each side of the front of the arm to tho wrist.

J:> ALM OF RacHcd and Ulnct?' A,"teries HARD. gi ve anum bel' of branches, which spread out and supply the palm.

THIGH.

HAl\l.

F em01'Cll A,'le1'y, from middle of fold of groin runs down the inside of thi o,h in its upper two-third~. Popliteal A1'teJ'Y lies along middle of ham.

TREATMENT.

Comp!'ess Brachial artery in the upper arm by a tourniquet, 01' place a pad in hollow of elbow and bend fore-arm against arm. Apply two small firm pads to arteries at wrist, orforciblyclose and fix hand over a piece of stick or hard subst.:'lnce, and bandage. Presstue at middle of fold of groin, with the fingers or by tourniq uet above wound. Compress popliteal artery above wound, or compress femoral artery in front of thigh by tourniquet.

REGIONS.

SITUATION OF VESSELS.

TREATMENT.

BACK OF Post. Tibial and P el'oneal Compress at ham or in front of Al'teries descend the back LEG. thigh or double and outside of leg from leg on thigh below ham, passing bewith a pad in hind ankle-bones. the ham, FRONT OF Ante}', Tibial A,'leJ'y de- Compress artery above wound. scends along middle of LEG AND front of l eg and instep. INSTEP, SOLE OF Post, Tibial and Pel'on eal Compress by n. pad behind descend behind ankle:FOOT. inner anklebones; the former supbone j if this plies branches, which fails,placepads spread out on sole of behind outer foot. ankle-bone and on middle of front of ankle. CHAPTER V. FRACTURES. Fractures, or broken bonos, may be divided into four .classes : 1. Simple Fracture ; a simple break. 2. Compound Fracture j a flesh woun.d communicating with the broken ends of the bone. 3, Complicated Fracture j injuries to soH parts, blood-vessels, nerves, or internal organs. 4. Comminuted Fracture; smashing of bone into pieces.

44 A fractme may take place transversely, obliquelYr or longitudinally. Fractmes are caused by violence. SYMPTOMS OF FRACTURE. The symptoms of fracture are1. Alteration in shape and general appearance. 2. Unusual mobility at seat of fractme. 3. Crepitus or crackling on placing one hand over the. broken part, and creating motion with the other. 4. Shortening of limb. 5. Some inequality felt on running the fingers along the surface of the injured bone. FractU1'es a?'e dist'ingui8hecl i1'om dislocations as follows: FRACTURES.

Crepitus. Unnaturally movable. Easily replaced. Limb often shortened. Seat of injury in the shaft or body of the bone.

DISLOCATIONS,

No crepitus. lUore or less fixed. Replaced with difficulty. Limb may be shortened or' lengthened. Seat of injury at a joint.

TREATMENT OF FRACTURES. 1. Reduce the fractured ends or portions to their'

natural position. 2. Retain them immovably in their proper places till nature has effected a permanent cure. There is no mgency abont treating a broken limbprovided no attempt is made to move the person, but if it is imperative that the patient be moved in the absence of'

" absolute neccssity to secure the safety a slU'geon, It IS an < • g 't 'n splints before removal. of the limb by. puthtm \ 1 safe means of conveyance for A stretcher IS t e on y cases of fracture. . either serious mischief or Unskilful han.dh~g::Yd~~u~~s are pressing ~he sbarp even loss of life, h bl d~ essels nerves, or mto some ends through the fles, 00 v , internal organ, such as the lungs. SPECIAL FRACTURES. FRACTURE OF THE SKULL. Blows or falls. I Causes l' not always present. n Symptoms. Externa sIglflSthe base there may be fracture 0 < . , hremorrhage from ear, mouth, ~)l no~e , red atcbes of blood under conJunctlv:re p of eyes; an d oozin bo' of watery flUId from tbe ears. b • 0' tbese . there maytoms e Accompanymb symptoms o~ conCUSSIOn, or symp of compressIOn. , , t in a dark and qmet room Treatment. Place :patbien 'tb bead sliO'htly raised. on biS ack ,WI < b t' on A 1 cold to bead as soon as reac 1 pp ~ "Ild patient 9.'ets hot and sets In co v feverisb. FRACTURE OF ~O'VER Js~'~~llS on cbin. Causes . DIrect bl~w , ' the line of the teeth and Symptoms. Irregularlll m f tbe lower margin of tbe out me 0 , bone' inability to m?ve Jaw. o' . lower ' .Jaw to u1)per Jaw by a bandabc. Treatment. FIX 1:

4G FRACTURE of COLLAR-BONE Causes

Blows on h . hand. s oulder j falls on elbow or

Symptoms. Shou~der drops.

Arm IS helpless. Irregularity on d . slU'face of bo rawlllg finger alono' Treatment . Place a pad in . 0:> just above ~lbo~t, bmdd ar~ to side arm. ' an slrng fore-

a~~'

FRACTURE OF RIBS BI ows, .falls weig'ht . or back. ' passmg over chest Symptoms. Pain <and d'ffi 1 CU1t . b the usual si y 111 r ea thing, and T1'eatment . Appl b gns of fracture. b y a road roll round chest er andage firmly , so as to prevent 11 ment i or stra) th . ' . a. moveadhesive plast:r. e rnJured sIde with Causes

l!'RACTURE 0 F THE nUMERUS C

a uses . Direct bl s . Symptoms . Mobilit °a: , falls on elbow.

Crepitu~.

seat of fracture.

ShOltening, usuall ' tUl'e is obI' y Pl esent when fracTreatment . Apply a 1'0lllque. er band f elbow, abduct arm age rom hand to four splints from ~nd ladPply three or Support arm in a sISmg. . ou er to elbow.

FRACTURE OF THE FORE-ARM.

Causes Direct violent blows, falls. Ic,'ymptoms . Crepitns.

Mobility. Alteration in shape of arm. Treatment. Semiflex fore-arm with thumb pointing upwards. Apply two splints, one in fr ont from bend of elbow to the tips of the fingers, and one behind from elboy;, to ';vrist. The splints should be well paddec1. Place arm in sling.

FRACTURES ABOUT 'VRIST A}.T}) HAND. Causes . Blows or other injm'ies. Symptoms . Pain, swelling. Irregularity in the outline of the bones~ Crepitus. Treatment. Bandage to a flat board or splint, and support by sling.

FRACTURE OF FEMUR OR TlIIGH-BO:XE. Causes Blows, falls. Symptoms. Pain and loss of power. Crepitus. Shortening. Broken ends may be felt. Foot turned out. T1'ecltment . E xtend the limb, apply a long splint on outside along the whole side, from the armpit to the outside of the heel, and another on the inside of the thigh, from top of the inside of the thigh. to the knee.

FRACTURE OF PATELLA OR KNEE-CAP. Causes . Blows, or excessive muscular action. Symptoms. Inability to stand Upon leg. Fragments can be felt. T1'eatment. Raise limb to a position at right angles to body, and apply a figure-of-eight bandage around the knee, including the fragments. FRACTURE OF BONES OF THE LEG. Causes . Blows, falls, crushing weight, such as wheels, passing over the limb. Symptoms . Pain and loss of power. Alteration in shape. Crepitus. Broken ends may be felt. Treatment. Apply two splints, one inside and one outside the limb. Elevate limb. FRACTURES ABOUT FOOT AND ANKLE. Causes . Blows or other injuries. Symptoms . Pain, swelling. Alteration in outline of bones. Crepitus. Treatment. Elevate foot; apply cold water. N.B.-It must be remembered that the treatment for fractlU'es here given is only temporary, to enable the patient to be moved without further injuries, which might result in the loss of the limb or even life, till a surgeon can be sent for. The treatment for dislocations is purposely omitted, as being dangerous, except in the hands of a surgeon.

49 CHAPTER VI. WOUNDS. INCISED WOUl\TD~ash the part carefully with water. Treatment . ~. Arrest the hremorrhag~ . a natural 3: Adjust the edges and x III position.. 'n an easy position, so the parts. In 4 Place patlent I . , . as to avoid stram:~d_bags are good wounds of thro~t, head and neck. supports for fix~g dressinD' or strips 5 Apply cold wa er n' . of adhesive plaster. USION OF 'VOUNDS, 'VITHRGPr~lR INCISED INTERNAL 0 f 11y and return, d and V h the parts care u '., T1'eatment . "\ as1 they are much IllJhure te of un ess . t' a thoroug s ta place patien ill r est. f e it is very important . . d woundsded about t~e acWI'th as little delay as IllClse portIOns to In r eplace the wonn 'bl e. are AND LACERATE D 'VOUNDS h 1 besides CONTUSED and troublesome to ea, more dangerous , elas gangrene, &c. being liable to erysip , t VVash. T1'eatmen . Arrest natural Replace parts 1U td ssings or poultiCes. Apply cold water re

POSSI

hremorr~ag~eir

posi~ion.

Lacerated and contused wounds about the head are very liable to erysipelas. Cold water dressings, when carefully attended to, and not allowed to dry, are very suitable where there is bleeding. If there is no tendency to bleeding, poultices are probably the safer r emedy, as they do not allow the wound to become dry and inflamed. FO.R EIGN BODIES IN TIrE EYE,-If the foreign body is under the upper eye-lid, seat the patient in a chair, and standing behind, place a pencil over the lid; lay hold of the eye-lashes, and evert the lid. Then, having exposed the substance, brush it off with the corner of a handkerchief or a camel's hair brush. If it is under the lower eye -lid, simply depress this, and proceed as above with handkerchief or brush. FOREIGN BODIES ll\T TIlE EAR.-The canal l eading to the inside of the ear is about an inch and a quarter in l ength, and at the inner end of this canal is placed the drum of the ear, a very thin delicate membrane, resembling a piece of tissue paper. A blow on the ear with the open hand, or the concussion from the discharge of firearms, is quite sufficient to rupture and destroy this membrane. No interference, therefore, with tho ear, beyond using a syringe, should be attempted, except by a surgeon. Such substances as accumulations of wax, pieces of slate pencil, insects, &c., may be removed by syringing with tepid water. It will be well, however, to r emember that peas and porous substances would be rendered more difIicult of removal after the use of the syringe.

51 burn is caused by concenNS AND SCALDS.-A l' d to surface, or BURl. t d heat fire a Pp and the tissues tra e , ' t destroymg t e h s 1 chemlCal agen s, , underneath. hot or boiling liquids tOl:ch:l A scald is prod~lCed?y f kin is raised and destroy , , the cutIcle or scar s d th\ skin redden,ed and 'scalds are apt to an~esides their local actIO~, bur~estion of internal organs. mixture of oil and 'oduce danO'erous effects y cono pr of oil, castor oil, or hme-wa, er, d llodion' and wrap up castor 011 an co 1 ,~ool or flannel. the partin cotton woo trono'ly alkaline T?'eatment of Scal~s.-Apply '~h Sthe ~arbonate of solution made Wl 'a' and enclose l' or magnesl , 1 soda, nne, ,t in cotton woo, exthe limb, ,or par , ossible. eluding al~' as far aSc~Llsino' deformity,

direc~ly

s:~~ ~rue

T)'eat~u!nt

l~'n

in~a:~

~~mls'tAPP;tv~

N.B'nTro~~e~~~ei~orst~~~;~~~rr~:~~\~::;;~~:~!~~ 0:v

often fo , natu~al position, an aVOl patient he 111 a 'h l' bs or doubling up t e 1m , -'t of eXI)oslU'e to r esl.:u FROST _BITE,-Frost- b,I't e, 1's the f the l)art is reduced t 0 a 0 severe co Id " The Vltahty 't natural colour, an d becomes very low pomt, loses 1 s blu'e or purple, b t reaction gradually by Treatment , Brin('l' , b, a ouPlace the pat'lent 1'n a room R b fnctIOn, < d avoid heat. u without a fire, an , or other cold t with snow d . the par, d administer bran y m all quantities. applicatIOn, an ,' water carefully 111 sm C

BED SORES are the result of pressure from lying in one' position. They may be jJ1'evenled by hardening the skin by rubbing it with brandy, salt and ,Yater, &c., applying adhesive plaster spread on leather, or the use of air- or water-cushions.

STRETCHERS.~A stre~c . it is composed of a frame~

BITES OF RABID ANIMALS. T,'eatment. If possible immediately apply a ligatlU'e on the side nearest the heart i suck the wound j bathe it with warm water,. so as to encourage bleeding j scarify around the wound to the depth of a quarter of an inch j use caustics, such as nitrate of silver or carbolic acid. The internal use of brandy and ammonia is advisable.

CHAPTER VII. MATERIAL AJ.\I"D APPLIAN CES FOR THE RELIEF OF THE SICK AND INJURED. THE ORDER OF ST. JOHN LITTER is a combined stretcher and wheeled ambulance. It obtained the medal of the Sanitary Institute of Great Britain, as well as the prize medal at the Brussels Exhibition. It is the best of its kind, and is a most useful conveyance for sick and wounded in the field, for colliery districts, railways, or for street accidents. The Metropolitan Police have recently adopted this litter as their r egulation ambulance, and have placed it at their stations for the use of the public.

her is simply a light portable

bed for carryIllg the. sIck, . ce of canvas stretched work of poles, wIth a pIe between them as a n:attrass~ost improved and best The" Beaufort" IS the Ar regulation stretcher myserVlcea . bl c, oWl'ng to pattern of st·1 et cher 'nd Our the l east is about the worst ~ d O"reat weight. its faulty constrU?tI?n ~~l ~nswer as substitutes for ~ A variety of thmgs ~ . indow shutters, ladders, or stretcher, such as doOls, w

WITII TIIREE BEARERS. hurdles. A STRETCIIER . . ed To PLACE A MAN ON . f . g the feet of the IllJur 1 The three men fall III a~noff from the right. . . man, and are munb~~et her at the man's head, III Put the foot of the s .le c . b d 2. a line continuous wIth .h~S o. K~ locking hands 1 and 2, one at elt er SI 'hi s raise the 3. N:derneath the sholfllders stretcher; . him orwar't patient j carlY. and then lower hIm onh!o i~ :med portion (li~nb or 4. No. 3 takesdchtar~~e~lt ~ith ihand on either SIde of head), an seam the wound. h take their places at ~eackan~ 5 Nos. 1 and 2 t en t. t nd carry off, wlnle 0 . .:> . foot of stretch.er, t~e str~tcher as a safeguar.d relief to No.1 or 2 If walks at the SIde 0 to the patient, and as a

da~~er .£h~

STRETCIIER. necessary. RULES FOR C~RRYIN~ A . suspend it by straps C IT stretcher m han s, or 1. ~vZr the bearers' shoulhde~s'to be placed on the 2. Never allow the stretc er shoulders.

3. Bearers to march . ~. Avoid all Joltin o. I~ bl:oken step, and not in ti D. Pace to b 5' CIOssmg fences d't h me. G I ~ a b out 20 inches , 1 C es, &c. . n ascendmg, patient's h'l . descendino. behind eae to be ill front and' SPLL.'fT . 5,. ' ill S.-SplInts are a) r t~~~s? fo~' supporti~i p t1a:c~~ used. in tre~ting fracp TJlOn tIll a: cure is effected nes m theIr natmal wood1e "matenaJs ch'Ie fl y used . for k' . wire 't~I on, pasteboard, leather mat illg splmts are f ,m, and bark E t ' gu ta percha f It with umbreilas, dier:,e w~~wp~~:pesrs'hPoli~emen ~5t~~~~C!:~0~Isgar bdoxes, PAD ' uc as rIfles d ,an solS.-Splints should b ' Swor s, or bayonets wool, tow, flannel orel:vetll padded with wool cottO BAND A ;~ ,m . ' on are usually f rom unbleached cali B flann~fSl' d ,men, webbino·made & an ages are used- 5' rc. co, 1. As supports to th . ~. #s means of apPl;i~~ffe:ent parts of the body . or fixino' splint ' d 5 ~I essure. . 4. T? allay ~uscul~~ rte~smgs, &c. c ac IOn. Th e chIef k' d th e t· s of bandag'es are the roller ba I nangular III banda' . A combination of sg)1·. l1C age and tmg ordinar b ~ I mt and bandao'e i d starch and ~ anaagcs with plaster of pS ~a e by satura5um, chalk and ans, glue star h po t as h (gLass slJlint) gum, or silicates of 'd c, The .b 1 • so a and to . se ~ndage-splints, beino' of ~I~~:~I~~t ~hey are kept in pl~~~~oonn ~lOist, and allowed of the parts lo and well. ey are applied. sur ace

f~r:eld

~~TIr12o:ise~l spl~ts m~y \~

~~~~~le,

ad~p~;J ~~et~~vantfage

ROLLER BANDAGES have certain convenient sizes, according to the part of the body for which they are required, as follows : For the fingers, ~ jnch wide and 1 yard long. " arm, 2t inches wide and 3 to 6 yards long. " leg, 3 inches wide and 6 to 8 yards long. " chest, 4 to 5 inches wide and 8 to 12 yards long, " head, 2t inches wide and 4 to G yards long. In applying a roller balldage: 1. Begin from below and work upwards. 2. Insure that the pressure is uniformly and evenly applied. 3. Avoid wrinkles. 4. Bandage from within outwards. 5. He,erse on the fleshy side of the limb, and not over the sharp edges of a bone. G. 'Where the limb is of uniform thickness u se the simple spi?'ol; where the limb thickens use the 1'eveTse spi1'Cd; and at joints use the figw'e-of-eight. The application of bandages is best learnt by a practical lesson. ESMARCII'S TRIANGULAR B.A NDAGE is a triangular piece of cloth i the lower border measures 4 feet, and the two side borders :2 feet 10 inches each.* It can be applied in thirty-two different ways; it answers every purpose for temporary dressings or fie1<1. work; and the means of making one are always at hand, namely, a pocket-handkerchief cut diagonally in two. Its application is so easy, that a look at the diagram will enable anyone to use it in the manner indicated. MATERIALS USED IN DRESSlL~G ",VOUNDS are adhesive plasters, oiled silk, gutta-percha tissue, lint, charpie, oakum, tow, cotton wool, &c., &c.

* A triangular baud age, with figures illustratiug its use, can be obtained from the Order of St. John.

Adhesive plaste?'s are used for keeping the edges of wounds in position, and for :fixing dressings in lieu of bandages. Oiled silk and gutta-pe1'cha tissue are used over other dressings to retain moisture, to prevent the escape of liquid applications, and to protect the part from any external impurities.

CHAPTER VIII.

STIMULANTS. The stimulants in ordinary use are: intemally, tea, beef tea, brandy, and coffee. Extemally, friction, smellingsalts to nostrils, mustard to extremities, cold affusion, and slapping the face with a wet towel. POULTICES. The use of pOUltices is to apply and retain heat and moisture, clean foul wounds, allay pain, draw the ch'culation of the blood towards the surface from internal organs, and to encourage suppuration in abscesses. They may be made from bread, linseed, or other meals: charcoal, mustard, carrots, onions, &c., &c. LEECHES. In applying leeches, observe the following rules :_ 1. Thoroughly clean the part. 2. Use an inverted wine-glass; or, if to the inside of the mouth, use the leech-glass made for that purpose. 3. If it is necessary, bleeding may be further encouraged by using a poultice afterwards. 4. Take care that bleeding does not become too abundant, an event which may happen with children. If it does, the hremorrhage may be arrested by exposing the part to the air, and applying cold or pressure.

DISINFECTION. . d Ita 'ous (catching) applied to The terms illfeclWIl~ a:n c~~nicable from the sick to It disease signify that It IS co the healthy. . . 1 infectious diseases :The following are the prmClpa 11- )OX and scarlet fever. Eruptive fevers-measles, sm\ Ihoid relapsing and Continued fevers D' t11~~~ia ~.ysip~las, whoopingyellow fevers. Ip , cough and cholera. f ' . 1 used for the purpose 0 DISINFECTANTS. are mat:n~osil &c., by removing or purifying the all', w~tc, .ou~ substances j they may rendering i~ert COl·tam noXl be divided mtoVolatile or gaseous. ~: Solid or liquid.

VOLATILE OR GASEOUS.

Chlor~ne.

Bromme. Iodine. Sulphurou~ acid. Nitrous aCld. Fresh air. Oxygen. Ozone. \ Camphor. 'L Extreme heat or cold.

Chlorides of ~ metals, alkalies. Sulphates do. do. Nitrates. SOLID OR LIQUID. Carbolic acid and carbolates. Tar acids. Charcoal. I Salt. LDried earth. The most common patent disinfectants are :_ Condy's fluid. Burnett's fluid. Ledoyen's fluid . Dougall's powders. Sirel's compounds. RlTLES FOR DISINFECTING AN UNOCCUPIED ROO)f. . 1. Close ?very: door and window, and stop up every opcn1llg or creVIce WIth old rags or tow. 2. Fumigate by any of the following methods :_ (1.) By CIILORINE.-Place a few saucers in different parts of the room, containing a mixture of one part of common salt, one part of black oxide of manganese, and two parts of oil of vitriol. (2.) By IODINE.-Place two drachms of iodine in a metal cup or vessel, and place a lamp or burnino' 0 candle underneath it till it evaporates. (3.) By SULPlIURUS ACID.-Burn sulphur in saucers. (4:.) .By NITROUS ACID .FU~IEs.-Place several cups 1llto saucers or basins containino' hot water and inside the cups put two ounc~s of nit,rate of potash and one Olllce of sulphuric acid. (5.) By CARBOLIC ACID.-Place some pure carbolic acid in shallow vessels around the r oom.

3. Furniture and floors to be well washed or scrubbed with a solution of chloride of lime i the latter may be sprinkled with the powdered chloride of lime or Dougall's powder. 4. Papers to b e str~pped from the walls, and the walls and ceilinO"s to be whIte-washed. 5. All ~lothing to be disinfected by washing:. boiling, bakin o' in an oven or exposure to the sun or before a fire, jf a disinfecting e~tablishment is not available. 6. Curtains and carpets are best disinfected by exposure to a heat of from 200 deg. to 400 deg. 7. In extreme cases, destroy by fire all clothing, bedding, carpets, &ic.

RULES FOR DISINFECTmG AN OCCUPIED ROO)I. 1. :1Uaintain a proper state of ventilation by doors, windows, and outer openings. 2. Keep up a good fire in the room. 3. Use Condy's fiuid, Burnett's .fiu~d, or solutions of chloride of lime for utensIls III room, closets, &c. 4. Disinfect all cl thing, linen, &c., before it lea:ves the room, as laid down (in rule 8 for prevent1llg spread of diseases). . . 5. Fumigate room cautiously wi?h eIther ~hlo~Illated lime or carbolic acid, placed III saucers III different parts of the room. B e careful not to use gases or vapours too fr.eely, as ~he.y ar e liable to cause inconvenience to the patIent, by 11'1'1tation of his lungs or air-passages.

60 RULES FOR THE PREVENTION OF THE SpnEAD OF INFE CTIOUS DISEASES.

1. Decide as to sending the patient to a hospital or treating the cases in the house. 2. If a case for the hospital, apply to the Vestry for a special conveyance, and do not under any circumstances employ a public carriage. 3. After the removal of the infected person, fumigate and disinfect rooms occupied (vide instructions for disinfecting unoccupied rooms). 4. If a case for treatment at home, clear the house as far as possible of all inmates except the attendants on the sick, and secure the services of a trained nurse. 5. Remove carpets, curtains and all superfluous furniture. 6. If small-pox, vaccinate everyone in any way exposed to infection. 7. Allow as much fr esh air as possible without creating draughts, and keep a good fire burnin o' day and night in the room. 0 8. Use disinfectant solutions in all utensils and slop pails. Place soiled clothes and linen in a disinfectant solution, or boil with soda for several hours before they are taken from the room. 9. Open doors or windows are to be curtained with sheets kept moist with carbolic acid and water. 10. Drains, sinks, and closets to be flushed at least once a day with disinfectants. 11. Every room that has been occupied by an infected person should be thoroughly purified before it is reoccupied.

12. During convalescence patients should have tepid or warm baths medicated with some suitable disinfectant, such as Condy's fluid. This is very useful in cases of scarlet fever.

CHAPTER IX. BATHS. The following are the principal kinds of baths : Bath.

The Cold ... Cool ... Temperate Tepid Warm Hot ...

Air.

Water. Degrees.

Vapour. Degrees.

Degrees.

to 65 to 75 to 85 to 92 to 98 98 to 112

90 to 100 100 to 115 115 to 140

go to 106 106 to 120 120 to 180

33 65 75 85 92

The COLD BATH chills the surface, contracts the blood-vessels forces the circulation from the surface to the internal ~'egions, and checks perspiration; when not too prolonged, and the individual is in robust health, th~se effects are followed by a reaction, and a pleasant feelmg of warmth. Its oO'enora1 effect on the system is bracing and tonic. The dangers are congestions of internal organs. .SHOWER BATH is similar to the cold bath in its effects; probably somewhat more bracing.

62 COLD AFFUSION is the application of a stream of cold water from a height; it produces a sudden and violent stimulating effect, and is useful for rousing persons from states of insensibility, suffocation, drunkenness, hysteria, and poisoning. It is some times useful for producing sleep in delirium tremens. or drunken mania. THE ,VET COMPRESS acts as a local bath, and gives a combination of effects; it first acts as a cold bath, and secondarilya.s a prolonged warm bath; its effects are very soothing. ICE AND ICED ,VATER applied locally produce contraction of the blood-vessels, and drive the blood away from the part. They are useful for r educingswelling and inflammation, and arresting hcemorrhage. TilE TEPID, WARM, AND HOT BATHS act as stimulants ; they increase the circulation in the surface of the body, relieve congest ed internal organs, and promote secretion and excretion. The repeated Ol~ prolonged use of hot baths has a very weakening effect on the body; they relax the tissues and weaken the nervous system.

nOT FOMENTATIONS are simply local hot baths, and act in a similar way i they are useful for relieving pain. ACID BATHS are useful in liver and malarious diseases. Add three ounces of nitro-hydrochloric acid to thirty gallons of water, using a wooden tub. DISINFECTANT BATHS should always be used during convalescence from infectious diseases, and for several days before the invalid is allowed to join his family. Add eight ounces of Condy's fluid to 16 to 30 gallons of water (tepid or warm).

63 ALKALINE BATHS are useful in cases of gou~ anddr:e~~ Add a .rl)Olllld of carbonate 0 so · mat Ism. 30 gallons of. w~t~~. t 11 ealth who cannot bear a cold N.B.-Persons m e lC~O\ '0' ettin o· into warm or tepid bath may manage tOd dOll lo\v~rino. °the temperature; by water, and then gra h\l~. yg Of the "'surface is avoided, and l this plan a sudden c b . llld h t and cold bath are obtained the benefits of a com me 0, with safety. CHAPTER X. POISONS. ble of destroying life. Poisons are sul:)3tances capa d' o. to their action They are divided mto classes, accor lllo -on the body.. 1. 17Tdants

It'

the tissues , and prodnce nervons shock. . 'b'lity by their action 2. l"Tarcotics produce m senSl 1 on the brain. . the action of 3. NClrcot ico -ir1'ita1~ts. combme < narco~ics and Ir~~t~:~~. view in poisoning a~'e: T7·ecttment. -The pomt~ tio bfe t~e l)oison by encouraglDg 1. To get rIC 0 vomiting. ffects of the poisons by 2. To c.ountcract. t~ewi~l mechanically or chemih I antIdotes, w IC cally render theffPol' sonro~:Ce~ss~nd obviate ' edy the e ect s p , t' 3 . T 0 rem t I th by stimulants, ar 1the tend~ncy: 0 ( Cda 't' 0' the excretory ficial r espIratIon, an eXCl mo organs. C es roy

64: EMETICS.-Emetics are remedies used for the purpose of causing vomiting. The safest and readiest are~ irritating back of throat with the finger or a feather; large draughts of tepid water combined with a tablespoonful of salt or mustard; one or two tablespoonfuls of ipecacuanha wine in water; and twenty grains of sulphate of zinc in water.

65 ANTIDOTES.

POISONS.

Emetics; milk; peroxide of ARSENIC . iron; raw eggs; castor or salad oil. ANTThIONY (Butte1'oj n - Encourage vomiting. :Thlilk; tea; tannic acid. timony and Tartar emet~c).

ACIDS AND ALKALIES form antidotes to each other. The acids suitable for the purpose are vinegar, lime juice, and orange juice, mixed with water. The alkalies are soda, potash, lime, and magnesia diluted with water.

MINERAL ACIDS (Oil.o/ EncoUl'age vomiting. Alkalies-solutions of soda; Vitriol, Aquajortis, SPl1'lt potash; lime; magnesia; oj Salt). whiting; wall plaster. OXALIC ACID.

ALBUMEN AND OILS will protect the gullet and walls of the stomach in poisoning by irritants. White of egg, milk, flour and water, salad oil, and castor oil may be used.

CARBOLIC ACID.

The STOMACH PUMP cannot be used except by a surgeon but a very good substitute can be found in a pieoe of gutta-percha tubing, provided the patient is not in an insensible condition. Take three yards of elastic gutta percha tubing, about half-an-inch in diameter, make the patient swallow a.bout 20 to 25 inches of it; ra,ise the free end above his head, and pour down a pint of water, or as much as the stomach will receive. Then lower the free end, and it will empty itself; repeat the filling and emptying as often as you think necessary. This remedy is perfectly safe and effectual; it has been used by German physicians for disorders of the stomach with considerable success. The swallowing of the tube can be done with the greatest facility, without assistance and without danger.

ALKALIES (Caustic Potash, SoeZa or Lime). PHOSPHOl~US -

(Rat

Poison).

~IER(J DRY SALTS (Co 1'-

1'osive Sublimate, Calomel).

SALTS OF LEAD (SugQ1' oj lead, paint).

Acids-vinegar and wa.te.r ; lime juice; or~nge JUlce in water; emetics ; salad oils. Encourage vomiting by large draughts of water. . . Large doses of magnesIa m water. Avoid oils. Encourage vomiting; white of eggs; flour and water; milk. Emetics and Epsom salts.

NITRATE OF SILVER- Common salt aud water. CAU TIC.

Go POISOKS.

IHRITAl\,T GASES (eMor(J/onn).

PllUSSIC ACID.

STRYCHNIA .

NARCOTICS (Opium, }.{orphia).

ALCOHOL.

67 Al-iTlDOTES.

Fr~sh .air ; loo.sen.dress; Rrtificial respIratIOn; dash cold ,rater about face and neck. Cold douche; 8111elliuO' salts to . no~trils; artifici;l 1'eSpIr~tIOn ; brandy and ammonIa. E~etics; chloroform to 1'0l~eve spasms; cold affuSIon; artificial respiration· brandy and ammonin. ' Emetic~ ; strong coffee; cold aiIusIOll j forced walkillu about. I::> Emetics j cold affusion' warmth Lo sul'face of body; a dessel'tspoonful of vinegar in ,rater.

CHAPTER XI. MODES OF DE}1.'l'II.

1!eath . max Occur in three differ ent ways as t b egms III the heart, lungs, or heacl.

' accordiug

~. f!eart--b y aSlh~nia, as ill hce7J101Tlwge. •

Ullgs

.and

drotcnmg.

an'-passages - by Wl1)liyxi l

3. Head-hy co III ((, as in ap(Jjilc,c!/.

SIGNS OF DEATH. The uost obvious signs of death areCessation of breathing-no movement of chest-no moist breath t o dim a looking-glass placed before mouth. Cessation of heart's action-no impulse against side or pulse b eating in arteri~s. Eyelids half closed, eyes dIm and glassy, pupils dilated. ;; aws clenched. '-,-'ongue appearing between teeth. Frothy mucus about nose and mouth. ringers half closed. Eurface of body pale and cold. Body rigid after fiJ time.

CAUSES OF ,UDDEN DEATH. The chief oauses of sudden death areApoplexy. Aneurism. Heart disease. Suffocation. Shock. Injuries to the nervous system. Sunstroke. Struck by lightning. Poisoning.

Directions for Restoring the Apparently Drowned. TilE leading principles of the following Directions for the Restoration of the Apparently Dead from Drowning are founded on those of the late Dn. )UARSIIALL HALL, and are the result of extensive inquiries ,yhich were made by the Royal National Lifeboat Institution in 1863-4 amongDt Medical Men, Medical Bodies, and Coroners throughout the United Kingdom. These Directions have been extensively circulated by the INSTITUTION throughout the Gnited King'dom and in the Colonies. They aTe also in use in HeT Majesty's Fleet, in the Coastguard Service, and at all the Stations of the British Army at home and abroad.. I.

SEND immediately for med.ical assistance, blanketB. and dry clothing, but proceed to treat the Patient il/st((lItly on the spot, in the open air, with the face clo\Yl1\vard, whcther on shore or afloat i expo ing the face, neck, and chest to toe wind, except in Scyere wcather, and removing all tight clothing from the neck and chest, especially the bracer,;. The points to be a.lmed at arc-:tirst and immediate/?}, the RESTORATION OF BllEATIlI~G i and secondly, after breathing is restored, the PlW;,lOTWN OF \VAlUITlI A};D CIHCL'LATHU';. The efforts to 1'c:;torc Bre((thillfj must be conunenceu immediately and energetically, and persevered. in for onc or two hours, or until a medicaJ man ha . pronounced that life is extinct. Bfforts to promote H'u1'Inth and Circul((tioll, beyond removing thc wct clothes and drying the skin, mnst not be made until the fil'stappearant:e of natural breathing i for if circulation of the blood be induced before breathing has recommenced, the restoration to life will be endangercd. n.-TO RESTORE BREATHING.

To CLEAR THE TllltOA'l'.-Place the patient Oll the Hoor or ground with the face clownwar(ls, and one of the ,U'JW:\ under the foreheacl, in 'whlch position all tiul(ls will mon' l'cauily eseape by Lbe mouth, nlld the tongue it::;clf will fnll

fot·\\ anI, lea\'iug the eutl't1ll(;e into the Willupipe free. A::;::;i::;t this operation by wiping and cleansing the mouth. 1£ satisfactory breathing commences, use the treatment described below to promote 'Varmth. If there be only slight breathing-ol' no breathing-or if the breathing fail, thenTo EXCITE BHEATllLNG-Tmn the patient well and instantly on the side, Suppol'ting the head, and excite the nostrils with snuff, hal'tshorn, and smelling salts, or tickle the throat with a feather, &c., if they are at hand. Rub the chest and face war Ill, and dash cold water, or cold and hot water alternately, on them. If there be no success, lose not a moment, but instantlyTo LmTATE BHEATllING-H.eplace the patient on the face, l'aising and supporting the chest well on a folded coat 01' other article of dl'ess, Turn the body very gen tly on the side and a little beyond, and then briskly on the face, back again, repeating these me~tsures cautiously, efficiently, and per::;everingly, about fifteen times in the minute, 01' once every foul' 01' five ::;ccon<1s, occasionally varying the side, (B!J placing the P(/tir'llt 01/ the chest, the ~l'(· ight of the bOlly f01'ces the ail' out; lcltcn turned 01/ the siue, this jJl'e8S1.lTe 1'S ?'elJloved, ((l1d ai?' elilt?·s the chest.) On each occasion that the body is replaced on the face, make uniform but e1licient pressure with brisk movement, on the back beLweell and below the ::;houlUer-blade::; or bones on each si(10, removing the pl'essure illlUleclia.tely before turning the body on the side. During the whole of the operatiolls let 011e pel'son attellcl solely to the movements of the hea.d and of the arm placed under it. (The P'l'st meWim'e iI/creases the e.rpiration-the second COII/ mences illspimtion.) The Hesult is Respimtion or Natural lj/,('uthillg; and if not too late, Life. W hiJst the above operations arc being pl'oceeded 'with, dry the hands and feet, and as soon as dl'Y clothing or blankets can be pl'ocmcd, strip the body, and covel' 01' gntt1ually reclothe it, but taking e:al'<.; Hot to interfere: with tlll' effol'tl) Lo l'l'slore In·calhillg.

INDEX. --0-AOID BATHS, 62 " carbolic, antidotes, to, G5 " oxalic, antidotes to, G5 " prussic, antidotes to, 6G Acids, mineral, antidotes to, 65 AcidE and alkalies, 64 Adhesive plasters, 56 Affusion, cold, 62 Air, water, soil, &c., materials for purifying, 57 Albumen and oils, 64 Alco 'lOl, antidotes to, 66 Alim 3n tary canal, 25 Alkalies, antidotes to, 65 Alka lies and acids, 64 Alka line baths, G3 Anatomical and Physiological Outlines, 4 Animals, bi tes of rabid, 52 Ankle and foot, fractures about,48 An tidotes to poisons, 65 Antimony, antidotes to, 65 Apoplexy, 33 Arm (fore), fracture of, 47 Arsenic, antidotes to, 65 Arterial bremorrhage, 39 Arteries, 16 " situation of, and treatment when wounded, 41 Arteries and veins, difference between, 17

BANDAGE Bhd SPLINT. combina' tion of, 54 Bandages, 54: " sizes of, 55 Baths, acid, 62 " alkaline, 63 cold, 61 disinfectan t, 62 shower, 61 tepid, warm, and hot, G2 " temperatures of, 61 Bearers, bow to place a man on a stretcher with three, 53 Bed sores, 52 Bites of rabid animal~, 52 Blood, composition of, 14 Blood and organs of circulation, 13 Blood poisoning from kidney disease, 34 Body, the human, 3 Bones, broken, 43 " of leg, fracture of, 48 Brain, 9 compression of, 35 " cOllcmsion of, 35 Breathing, difficulty in; a symptom of, 32 Breathing, stertorous, 32 Broken bones, 43 Burns ana Ecalds, 51

70 CANAL, alimentary, 25 Capacity, vital, 25 Capillary bremorrhage, 40 Carbolic acid, antidotes to, 65 Caustic, antidotes to, 65 Chill, how to avoid in use of bath, 63 Chloroform, antidotes to, 66 Circulation, organs of, 13 " tabular view of, 15 Cold affusion, 62 " bath, 61 Collapse, 34 Collar-bone, fracture of, 46 Comminuted fracture, 43 Complicated fracture, 43 Compound fracture, 43 Compress, wet, G2 Compression of brain, 35 Concussion of brain, 35 Congestion of internal organs apt to follow burns and scalds. 51 Con tused fwd lacerated wounds, 49 Conveyance, stretcher only safe means in cases of fracture, 45 Convulsions, 31 Cough, a symptom of, 32 DEATH, cases of Budden, 66 " causes of sudden, 67 " signs of, G7 Difficulty in breathing, a symptom of, 32 Digestion, organs of, 25

Diseases, infectious, 57 " ., rules fo r preventing smead of, 60 Diseases and inj uries of the head,32 Disinfectant blths, 62 Disinfectants, 57 Disinfecting ! n occupiec· room, rules for, 59 Disinfecting Rl 1 unoccupie lroom, rules for, 58 Disinfection, r 7 Dislor.ations c.is tinguisbe-l from fractures, 44 Dislocations, treatment nf, dang erous except in h l.llc1s of surgeon, ·18 Dressings for wounds, 55 Drowning, 35 Drunkenness, insensibility liable to be mistaken for, ~9 EAR, danger of interfel'en::e with, 50 " foreign bodies in, 50 Emetics, 6:1: Epilepsy, 33 Erysipelas, wounds about head, liable tel, 50 Esmarch's triangular bandage, 55 Excretion, organs of, 28 Eye, foreign bodies in, 50 EyeS, pupils of: indications flom,

[31 FACE, flushed, 31 Femur, fracture of, 47

Flushed f!lce, 31 Fits, shiverillg, 31 " violent, 31 Fomentat ions, hor, G2 Foot !lnd ankle, fractures about, 48 Fore-arm. fracture of, 47 Foreign bodies in the ear, ':;0 " " "eye, 50 Fracture, commiuuted, 43 complicated,43 compound, 43 simple, 43 " stretcher ouly safe means of conveyance in cases of, 45 Fracture, symplol11s of, 4{ of collar-b one, 4G of bon es of leg, 48 " of femur or tbigh. bone,

4:7

of fore-arm, 4: 7 of humerus, {U of lower jaw, 4[) of patella or knee-cilp, 48 of ribs, 4G " " of skull, 45 Fractures 43 Fraclures'abont foot and ankle, 48 " about wrist and band, 47 " distinguished from disl ocations, 44 l!'lactur~ s, treatment of, 44 Frost-blte,51

GASES, irritant, antidotes to, G6

suffocation by, 38

Giddiness, a symptom of, :n Gutta-percba tissue, 56 HAND &WRIST, fractures about, 4: 7 Han~ling, unskilful: danger of, 10 cases of fract ure, 45 Hanging, 38 Hremorrhage, arterial, 39 capillary, 40 from ear, moutb, nose, or eyes : indications of, 31 Hremorrhage, general treatment of, 38 Hremorrhage, internal, 40 " venous, 40 Head, diseases and injuries of, 32 lieart, 14 Hot bath, ()2 0' fomentations, G2 Human body, 3 Humerus, fracture of, 4G ICE and ICED WA'l'ER, 62 Incised wounds, 49 " " with protrusion of internal organs, 49 Infectious diseases, 57 " "rules for preventing spread of, GO Inj uries au d diseases of the head, 32 Insensibilily, 29 causes of, 2:> " examination of 0. pcr~on found insensible, 00

72 Insemibilily: importan~ symptoms and theiriodications, 31 Insen sibihty liable to be mistaken for drunkenness, 29 Internal bremorrhage, 40 " organs, diagram of, 23 Iutoxication, 33 Irritant gases, antidotes to, 66 JAW, lower: fracture of, 45 KIDNEY DISEASE, blood poisoning from, 34: Kidneys, 28 Knee-cap, fracture of, 4.8 LACERATED and contused wounds, 49 Lead, salts of, antidotes to, G5 Leeches, 56 Leg, fracture of bones of, !8 Litter, Order of St. John, 02 Liver, functions of, 27 Lungs, 24, 28 MATERIAL and appliances for the relief of the sick and in jured, 52 Medical and Surgical Outlines, 29 Men:u ry salts, antidot es to, G5 Mineral acid s, antidotes to, 65 Morphia, an till.otes t o! 66. " or 0illum pOlsolllng, 34: Muscular system, 8 NARCOTICS, antidotes to, 66 Nervous system, 9 Nitrale of silver, antidotes to, 65

73 OILED SILK, 56 Oils, 64: Opium, antidote to, 66 " or morpl itt poisoniLg, 34Ord. r of St. Jol.n litter, 52 Organs, int ernal, diagram of, 23 " of circuhtion, 13 of digestion, 25 of excretion, 28 of secretion, 26 " of sp ecial sense, 11 [22 of voice and respir~tion, Ox~iic acid, antidotes to, 65 PADS, 54 Paralysis, indications of, 3:3 Patella, fracture of, 48 Phosphorus. anlidotes to, 65 Plasters, adhesive, 56 Poisoning, blood, from kidney disease, 34: Poisoning, opium or morphia, 34 " treatment of, 63 Poisons, classification of, 63 " and an tidotes, 65 P oultices, 56 Prussic acid, antidotes to, GG Pulse, indications of, 31 Pump, stomach, substitute for,6 -b Pu pils of eye s, i ndicnt ious from, 31 PurifyiLlg ail', wat er, soil, &c., materials for, 57 RABID ANIMALS, bites of, 52 Rat poison (phosphQrus), antidotes to, 65 Respiration, organs of, 22

Ribs, fracture of, 46 Roller bandages, 54, 55 Room, rules for disinfecting an occupied,58 Room, rules for disinfecting an unoccupied, 58 SALTS OF LEAD, antidotes to, 65 Scalds and burns, 51 Scars, causing deformity, often follow burns, 51 Secretion, organs of, 26 Sense; organs of special, 11 Shivering fits, 31 Shock or colJapse, 34 Shower bath, 61 Silk, oiled, 56 Sil vel', nitrate of: antidotes to, G5 Simple fracture, 43 Skeleton, descliption of, 4: " diagram of, 2 Skin, the, 28 Skull, fracture of, 45 Sores, b ed, 52 Special sense, organs of, 11 Splint and bandage, combination of,5± Splints, 54 " extemporised, 54 [32 Staggering gait, iudications from, Stertorous breathing, 32 Stimulant~, 56 Stomach,26 Stomach pump, substitute for, 64 Stretcher, how to place a man on with three bearers, 53

Stretcher only safe means of conveyance in cases of fracture, 45 " rules for carrying, 53 Stretchers, 53 Strychnia, an tidotes to, GG Sudden death, cases of, 6G " " causes of, G7 Suffocation by gases, 38 Sunstrok e, 38 System, the muscular, S the nervous, 9 TEPID BATHS, G2 Thigh-bone, fracture of, 47 Triangular bandage, 54-, 5:3 UNSKILFUL HA~i'DLrNG, danger of,

in cases of fractLlre, -1,j VEINS, 17, 20 Veins an d arteries, difference bebetween, 17 Venous hremorrhage, 40 Vitai capacity, 25 Vo ice and respira tion, organs of:22 \V ARM BATHS, 62 Water. iced, 62 Wet compress, 62 Wounds,49 [4:!:> " contused and lacerated, incised, 49 " "with protrusion of in ternal organs, 49 Wounds, materials used in dressing,55 [4:7 Wrist and hand, fractures about, E

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